AUTHOR REPLY.

We appreciate the supportive editorial comment on our study. The controversy surrounding direct-to-consumer (DTC) internet prescription platforms comes at a time when the COVID-19 pandemic has shifted the paradigm of how patients receive care. In the months preceding the pandemic, DTC internet companies were achieving billion-dollar valuations, in large part due to their collective focus on catering to a younger generation portrayed as unwilling to engage with an increasingly byzantine health care system in an era of smartphone conveniences. Since the pandemic, however, it is clear that telemedicine has become an essential component of health care delivery and is here to stay.

In this paradigm, the value-added is therefore the physician, not the platform. It is incumbent on urologists and their primary care referral base to recognize that young men with erectile dysfunction (ED) may have comorbid conditions worth addressing, either with further evaluation or targeted counseling – elements that are absent from DTC internet prescribing platforms, which rely solely on yes/no questionnaires. The American Urological Association Guideline on ED serves an important foundation for providing comprehensive, evidence-based care and can be adapted for telemedicine by individual practices. Though the nature of the “office” visit may change, the doctoring does not.