Are the testosterone clinics and telehealth TRT services that have proliferated actually safe?

Telehealth TRT services that prescribe testosterone after a single online questionnaire and a home testosterone test, without cardiovascular risk assessment, ECG, or in-person evaluation, are not practicing evidence-based medicine, the TRAVERSE trial data on atrial fibrillation and PE risk makes cardiovascular pre-screening a clinical imperative, and the hematocrit monitoring that all testosterone guidelines mandate requires ongoing laboratory supervision that many telehealth models do not adequately provide (Mulhall et al., J Sex Med, 2018).

The proliferation of testosterone clinics is driven by genuine patient demand (men with hypogonadal symptoms who are underserved by primary care), but the clinical corner-cutting creates real risk. The men most likely to be harmed are those with undiagnosed sleep apnea (which both causes low testosterone AND creates polycythemia risk on TRT), those with undiagnosed atrial fibrillation vulnerability, and those with prior undiagnosed DVT or PE. These are all conditions that a proper cardiovascular pre-screening would identify.

Honesty Scale: Solid (1) for the inadequacy of telehealth TRT without cardiovascular evaluation as a standard of care concern.

What to do: If you are pursuing TRT, the minimum evaluation before starting should include: two morning testosterone measurements, LH and FSH (to establish whether hypogonadism is primary or secondary), CBC with hematocrit, blood pressure measurement, ECG for AF screening, and a physician visit (in-person or complete video with full history review). Do not proceed with any TRT service that does not include all of these.

For the full picture, read The Testosterone/TRT Deep Dive