--:-- Ryan Knudsen: Welcome to The Journal, our show about money, business, and power. I'm Ryan Knudsen.
--:-- Ryan Knudsen: It's Wednesday, September 11th. Coming up on the show, the testosterone treatment business is booming. What's the catch?
--:-- Ryan Knudsen: I'm so excited to embark on this adventure with all of you. May the best I do win! On brand with Jimmy Fallon. Series premiere Tuesday on NBC.
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--:-- Ryan Knudsen: Testosterone is a steroid, a hormone that people produce in their bodies. And as men age, their levels of testosterone naturally decrease.
--:-- Ryan Knudsen: When a man's testosterone falls below normal levels, it's a condition called hypogonadism. It brings down libido, strength, and energy.
--:-- Ryan Knudsen: And the solution for that has been to inject testosterone as a synthetic drug. That's why pharmaceutical companies started making it.
--:-- Ryan Knudsen: But about a decade ago, one pharmaceutical company called AbbVie launched an ad campaign to broaden the appeal of testosterone therapy.
--:-- Ryan Knudsen: Lost your appetite for romance? And your mood is on its way down? You might not just be getting older. You might have a treatable condition called low testosterone or low T.
--:-- Ryan Knudsen: Millions of men 45 or older may have low T. So talk to your doctor about low T.
--:-- Ryan Knudsen: The website was called isitlowtea And to entice people about the product the company included a quiz on the site It sort of this intake questionnaire that asks questions like are you feeling sad or grumpy lately?
--:-- Ryan Knudsen: Do you feel like your energy is falling? One of my favorite questions, are you falling asleep after dinner? Which I think describes everybody.
--:-- Ryan Knudsen: and kind of standard pharmaceutical playbook where they're driving people to a webpage to get them to ask their doctor about this treatment.
--:-- Ryan Knudsen: And they tried to promote off-label prescribing, not just for hypogonadism, but for all of these other things, low energy, low libido.
--:-- Ryan Knudsen: We have a solution for you. The campaign kicked off a rise in interest around testosterone treatment, But prescriptions for testosterone didn't really take off until the last few years, when men's health clinics and telehealth providers got involved.
--:-- Ryan Knudsen: Companies like these are popping up everywhere. This is a business that ranges from single doctors running a man clinic, and they're bringing people in, all the way up to national telehealth operations.
--:-- Ryan Knudsen: But one big part of the cottage industry is testosterone clinics, med spas. they're doing the weight loss drugs, they're doing hormone replacement therapy, and many of them target men specifically.
--:-- Ryan Knudsen: And when they target these men, these clinics have a big advantage. They don't face the same kind of advertising regulations that pharmaceutical companies do.
--:-- Ryan Knudsen: And they don't need to have all of the risk information that you see in kind of, you know, drug ads that show up on the evening news from pharma companies.
--:-- Ryan Knudsen: Some of them do put a little fine print at the bottom. But really, it's just some guy telling you about how amazing this drug is, and you should come to us for it.
--:-- Ryan Knudsen: Why? Why aren't they subject to these regulations? Why don't they have to put these disclaimers?
--:-- Ryan Knudsen: Oh, well, they operate in a gray area where the regulations, the FDA rules about advertising drugs really apply to pharmaceutical makers of drugs, and they don't make the drugs.
--:-- Ryan Knudsen: Once someone goes to one of these clinics, how do these companies actually talk with them about this treatment?
--:-- Ryan Knudsen: They talk about the benefits, right? As we've described, better libido, more energy, better results in the gym.
--:-- Ryan Knudsen: But they also talk about the difference between normal levels of testosterone and, quote, optimal levels.
--:-- Ryan Knudsen: Traditional doctors, you might go in and say, Doc, I don't know. I don't know if my testosterone is low.
--:-- Ryan Knudsen: They'll get you tested and they'll say, you know, it's not high, but it's not out of the range of normal. So I don't think you're a good candidate for this.
--:-- Ryan Knudsen: But a clinic might say, yeah, you're normal, but do you want to feel optimal? Sure, doesn't everybody want to feel optimal?
--:-- Ryan Knudsen: One man who was enticed by that question was David Pivavarov. He's 40 years old and lives in Miami.
--:-- Ryan Knudsen: And he's always been in great shape. My entire life, I've never had any illnesses. I've never taken any medication.
--:-- Ryan Knudsen: I've always enjoyed being physically active, whether that's in the gym or playing tennis or swimming or running or whatever it is.
--:-- Ryan Knudsen: But as David got into his late 30s, he noticed he wasn't feeling as energized as he used to, even though he maintained all his good habits.
--:-- Ryan Knudsen: I've never been a drinker. I've never been a partier. I've always got a good amount of sleep.
--:-- Ryan Knudsen: I maintained my habits, but the results just weren't there. I kept finding myself more and more fatigued.
--:-- Ryan Knudsen: I would need, you know, a nap to get through the day. I would find my joints aching. I would be sore. I'd be limping, you know, throughout the week.
--:-- Ryan Knudsen: About two years ago, a trainer at David's gym gave him some advice. He said, hey, why don't you go see Mr. T?
--:-- Ryan Knudsen: And I'm like, Mr. T, what are you talking about? He's like, you know, testosterone therapy.
--:-- Ryan Knudsen: So David decided to give it a try He came across a clinic called the Biostation Which has nine locations in Florida And hormone replacement therapy For both men and women Is its best-selling service
--:-- Ryan Knudsen: I wanted something reliable And the Biostation provided that Like you walk in, it looks like any other doctor's office You meet someone in the lab coat And, you know, they have waiting rooms
--:-- Ryan Knudsen: When a nurse practitioner at the clinic Looked at David's initial blood work he said his testosterone levels were fine.
--:-- Ryan Knudsen: According to David, the nurse told him he wasn't a typical candidate for the treatment.
--:-- Ryan Knudsen: And, you know, to be perfectly forthright, I knew I needed it I wanted it I wanted to you know go into my 40s at my maximum potential I didn't want to be tired I didn't want to be low energy
--:-- Ryan Knudsen: And I told the doctor my symptoms I said look I'm getting more and more tired sore, like these types of things. I don't want to feel this way anymore.
--:-- Ryan Knudsen: I want to be at my optimal potential. And he said, okay, look, we'll get you started.
--:-- Ryan Knudsen: So even though the nurse practitioner said, you're not actually a good candidate for this because your testosterone levels were normal, You said, I think I want to do it anyway.
--:-- Ryan Knudsen: And he said yes? Correct. Yeah. Yeah.
--:-- Ryan Knudsen: The bio station said it wouldn't comment on David's care because of confidentiality rules and that it prescribes testosterone only in cases where it's appropriate.
--:-- Ryan Knudsen: So how did it go once you started taking the treatment?
--:-- Ryan Knudsen: So for the first month or so, mentally I felt great, physically I felt great.
--:-- Ryan Knudsen: Within 72 hours, my strength improved in the gym. I was sleeping like I've never slept before.
--:-- Ryan Knudsen: And then after three or four weeks, just things kind of went sideways. I looked amazing, but I felt like trash.
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--:-- Ryan Knudsen: Some men swear by testosterone therapy and say it's changed their lives for the better.
--:-- Ryan Knudsen: But others have had to deal with side effects. Our colleague Rolf says one of the more common side effects is infertility.
--:-- Ryan Knudsen: Testosterone is male birth control. If you're injecting that hormone, your body stops producing it naturally.
--:-- Ryan Knudsen: Your body stops sending a signal to your testicles to produce sperm. So your sperm count can go to zero.
--:-- Ryan Knudsen: and this was a fascinating part of the reporting because I started to call reproductive urologists infertility doctors and they all said I talked to 15 of them they're like oh yeah 15-20 years ago maybe it was one guy a year a couple guys a year who were on testosterone and you know that was the reason why he and his wife couldn't conceive a kid they were struggling with fertility now it's several times a week several times a month it's a standard question we have to ask now because it's so common is what they all said
--:-- Ryan Knudsen: There are other side effects, too. So acne, blood clots, cardiovascular events over time are a risk.
--:-- Ryan Knudsen: Sleep apnea, male breast enlargement, and obviously mood swings, right? Roid rage. You can feel pretty amped and be quick to anger.
--:-- Ryan Knudsen: That can happen to people. For David Pivavarov, the problems began about a month after he started the testosterone prescribed by the biostation.
--:-- Ryan Knudsen: I started just feeling emotionally flat. My libido, like, disappeared. And my blood pressure went up.
--:-- Ryan Knudsen: And I brought this up to the nurse practitioner. And they looked at me as if this was the first time they've ever heard these side effects before.
--:-- Ryan Knudsen: Had you talked to anybody at the clinic about these side effects before you started taking this treatment?
--:-- Ryan Knudsen: I did not. They were not brought up to me. I wasn't told about the side effects.
--:-- Ryan Knudsen: I did some cursory research. You know, when you do your research, it kind of sounds like it's very low risk. It happens to very few men.
--:-- Ryan Knudsen: And I didn't think that I was going to get all of them at the same time.
--:-- Ryan Knudsen: The senior doctor at the biostation said that he discusses side effects with patients and prescribes medications to manage them.
--:-- Ryan Knudsen: Prescribing testosterone, he said, is a quote, art, not purely a science.
--:-- Ryan Knudsen: David said he wished he known more about the risks before he started the therapy
--:-- Ryan Knudsen: How did the side effects start affecting your life
--:-- Ryan Knudsen: It was an added stress that I never had before I couldn't get more than four and a half, maybe five hours of sleep.
--:-- Ryan Knudsen: Anxiety, acne. Acne where I would wake up in the morning and there were spots of blood on my sheets. Like, it was painful.
--:-- Ryan Knudsen: All of this combined, just, you know, it was extremely stressful. It's all I would think about all day long.
--:-- Ryan Knudsen: David asked his doctor at the clinic for help. They offered him other hormonal replacements to try and balance out how he was feeling on the testosterone.
--:-- Ryan Knudsen: But at a couple hundred dollars, it started getting expensive. And any time that I would try some kind of additional medication, I would feel great for a couple of weeks, and then everything would fade away and go back to the way it was.
--:-- Ryan Knudsen: And the thing about testosterone therapy is that you can't just stop taking it and go back to normal.
--:-- Ryan Knudsen: Here's Rolf again. If you start taking it, your body stops producing natural testosterone.
--:-- Ryan Knudsen: So in theory, it's a treatment you're on for the rest of your life.
--:-- Ryan Knudsen: So if you start this in your 30s because you want to stay jacked and look like Sylvester Stallone, going into your 40s, are you going to be on this the rest of your life?
--:-- Ryan Knudsen: you can go off it and what happens is your testosterone level will crash to zero very quickly
--:-- Ryan Knudsen: doctors who take people off it they'll give you other things to naturally boost your testosterone while you're getting off the synthetic stuff but it may not feel great it can take a few months to recharge six months to a year maybe and you may not fully recharge ever some doctors said
--:-- Ryan Knudsen: They're not sure if you get back everything you had before.
--:-- Ryan Knudsen: Earlier this year, David decided to stop taking testosterone.
--:-- Ryan Knudsen: Within weeks, his blood pressure was back to normal, he was sleeping more at night, and his anxiety subsided.
--:-- Ryan Knudsen: But libido and acne never recovered. And it was a strange, you know, feeling to be able to have sex and not feel a thing.
--:-- Ryan Knudsen: I mean, this is very personal to even share. But that's the reality of it.
--:-- Ryan Knudsen: Did you ever feel like, oh my God, what have I done?
--:-- Ryan Knudsen: Yeah, yeah. It definitely crossed my mind. You know, if I could step into a time machine and never pick up that first needle, I wish I would have done that.
--:-- Ryan Knudsen: But unfortunately, it's like a game of chess. after you make a wrong move, you're playing a brand new game. You can't undo that.
--:-- Ryan Knudsen: Today, David's on a prescription for a different steroid that helps with testosterone's lingering symptoms.
--:-- Ryan Knudsen: It comes with some extra risks to his heart, and he'll probably need to stay on it for the rest of his life.
--:-- Ryan Knudsen: What would you say to other men who are thinking about taking testosterone?
--:-- Ryan Knudsen: I would say consider the risks very seriously. Don't take them lightly.
--:-- Ryan Knudsen: I had nephews asking me, Uncle David you look like Captain America I want to get on TRT this is guys in their mid-twenties and when I told them the side effects that I had and the trouble and the cost and the mental anguish
--:-- Ryan Knudsen: I think I did a good job of scaring the bejesus out of them just be aware that there are side effects there that if you're perfectly healthy already, you might end up with a worse quality of life than before you started.
--:-- Ryan Knudsen: Despite problems like these, Rolf says the testosterone therapy industry doesn't seem to be slowing down.
--:-- Ryan Knudsen: Everybody views this as a growth business and, you know, the baby boom isn't getting younger.
--:-- Ryan Knudsen: That's a very large potential market, growing market for testosterone therapy.
--:-- Ryan Knudsen: We're talking probably thousands of these kinds of clinics nationwide, thousands of doctors prescribing this nationwide.
--:-- Ryan Knudsen: And there's a lot of money to be made here.
--:-- Ryan Knudsen: That's all for today. Wednesday, September 11th. The Journal is a co-production of Spotify and The Wall Street Journal.
--:-- Ryan Knudsen: If you like our show, follow us on Spotify or wherever you get your podcasts. We're out every weekday afternoon.
--:-- Ryan Knudsen: Thanks for listening. See you tomorrow.
