Robert H Shahinyan1, Arash Amighi1, Alson N Carey1, Dar A Yoffe1, Devyn C Hodge1, Matthew E Pollard2, Justin J Nork3, Jesse N Mills1, Sriram V Eleswarapu4. 1. Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA. 2. Scott Department of Urology, Baylor College of Medicine, Houston, TX. 3. United States Naval Hospital, Guam. 4. Division of Andrology, Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA. Electronic address: SEleswarapu@mednet.ucla.edu.
Abstract
OBJECTIVE: To determine comorbidities in young men with erectile dysfunction (ED) who are increasingly targeted by direct-to-consumer (DTC) internet platforms that sell phosphodiesterase-5 (PDE-5) inhibitors without comprehensive clinical evaluation; and, further, to characterize the portrayal of DTC platforms by popular news media. METHODS: We retrospectively reviewed all men age ≤40 evaluated for ED at an andrology clinic during January 2016-March 2019 to obtain demographics, exam and lab findings, and treatments. Five news sources were analyzed during the study period to characterize whether articles about DTC platforms were positive, critical, or balanced/neutral. RESULTS: We identified 388 patients, with age 29.5 ± 5.0 years, 15% rate of obesity, 20% prediabetes or diabetes, 54% dyslipidemia, and 20% hypogonadism. Serum lab findings associated with subfertility were found in 11%. Semen analysis was conducted in 64 men, of whom 40% were abnormal. Varicoceles were found in 35%. PDE-5 inhibitor was prescribed to 328 men (88%). Off-label empiric therapies included clomiphene (32.9%) or aromatase inhibitor (12.1%). Testosterone replacement was initiated in 9.7%. Analysis of news coverage revealed 18 articles, of which 61% portrayed DTC platforms exclusively in a positive light. CONCLUSION: Office consultation identified young men with significant comorbidities that would be missed by DTC platforms, which employ only questionnaires for health screening. DTC platforms present themselves as medical authorities without following AUA Guidelines, yet garner mostly positive press coverage. Patients engaging these platforms may falsely believe they are receiving adequate medical assessment. Urologists may do well to incorporate telemedicine to enfranchise young men with evidence-based evaluation.
OBJECTIVE: To determine comorbidities in young men with erectile dysfunction (ED) who are increasingly targeted by direct-to-consumer (DTC) internet platforms that sell phosphodiesterase-5 (PDE-5) inhibitors without comprehensive clinical evaluation; and, further, to characterize the portrayal of DTC platforms by popular news media. METHODS: We retrospectively reviewed all men age ≤40 evaluated for ED at an andrology clinic during January 2016-March 2019 to obtain demographics, exam and lab findings, and treatments. Five news sources were analyzed during the study period to characterize whether articles about DTC platforms were positive, critical, or balanced/neutral. RESULTS: We identified 388 patients, with age 29.5 ± 5.0 years, 15% rate of obesity, 20% prediabetes or diabetes, 54% dyslipidemia, and 20% hypogonadism. Serum lab findings associated with subfertility were found in 11%. Semen analysis was conducted in 64 men, of whom 40% were abnormal. Varicoceles were found in 35%. PDE-5 inhibitor was prescribed to 328 men (88%). Off-label empiric therapies included clomiphene (32.9%) or aromatase inhibitor (12.1%). Testosterone replacement was initiated in 9.7%. Analysis of news coverage revealed 18 articles, of which 61% portrayed DTC platforms exclusively in a positive light. CONCLUSION: Office consultation identified young men with significant comorbidities that would be missed by DTC platforms, which employ only questionnaires for health screening. DTC platforms present themselves as medical authorities without following AUA Guidelines, yet garner mostly positive press coverage. Patients engaging these platforms may falsely believe they are receiving adequate medical assessment. Urologists may do well to incorporate telemedicine to enfranchise young men with evidence-based evaluation.
Authors: Isabelle V Carter; Michael J Callegari; Tarun K Jella; Amr Mahran; Thomas B Cwalina; Wade Muncey; Aram Loeb; Nannan Thirumavalavan Journal: Int J Impot Res Date: 2022-01-07 Impact factor: 2.896
Authors: Gary K Shahinyan; James M Weinberger; Robert H Shahinyan; Shangyang C Yang; Jesse N Mills; Sriram V Eleswarapu Journal: JAMA Netw Open Date: 2022-05-02
Authors: Joel J Wackerbarth; Richard J Fantus; Annie Darves-Bornoz; Marah C Hehemann; Brian T Helfand; Mary Kate Keeter; Robert E Brannigan; Nelson E Bennett; Joshua A Halpern Journal: Sex Med Date: 2021-01-08 Impact factor: 2.491
Authors: Douglas Schneider; Charles A Loeb; Andrew Brevik; Farouk El-Khatib; Lawrence C Jenkins; Faysal A Yafi Journal: Int J Impot Res Date: 2022-04-09 Impact factor: 2.896