A wave of online telehealth clinics has built entire business models around testosterone prescriptions, often gated behind nothing more than a short questionnaire and a single lab test. Some are staffed by genuine medical professionals practicing responsibly. Others are functionally prescription mills, optimized to convert a borderline or even normal lab result into a paying, recurring customer.
The business model itself is worth understanding plainly: a telehealth company that prescribes testosterone therapy typically earns recurring monthly revenue for as long as the patient continues treatment. That's not inherently sinister — plenty of legitimate medicine works on a subscription model — but it creates a structural incentive that a responsible clinic actively resists and an irresponsible one actively exploits.
What a real workup actually looks like
A responsible evaluation typically involves at least two separate blood draws on different days, usually in the morning when testosterone is naturally at its highest. It should include more than total testosterone alone — ideally free testosterone, LH, FSH, SHBG, and estradiol together, along with a review of symptoms and general health history.
If a clinic offers you a diagnosis and a prescription off a single test with no repeat draw and no real conversation about your history, that's a meaningful red flag about the rigor of that particular provider.
Compare that to what a five-minute online questionnaire actually screens for. A quiz that awards points for common, nonspecific complaints — tiredness, reduced motivation, difficulty concentrating — will flag a large share of any population as "likely low testosterone," regardless of actual hormone levels, simply because those symptoms are so common in modern life for entirely unrelated reasons.
Why insurers are starting to push back
Health insurers have taken increasing interest in this space precisely because of concerns about over-diagnosis. Some insurers now require documented, repeat lab-confirmed low testosterone before approving coverage for treatment — a real-world check that happens to align with exactly the rigorous-workup standard a careful doctor would use anyway.
A clinic or provider that bypasses this kind of documentation isn't just skipping a bureaucratic hurdle. They're skipping the same evidentiary standard that a careful insurer independently arrived at, for the same reasons a careful doctor would.
What to actually ask before you start anything
- "Based on these numbers, do I actually meet the clinical criteria for low testosterone, or am I in a normal range for my age?"
- "What else could explain these symptoms besides my hormone levels?"
- "What does ongoing monitoring look like if treatment is appropriate?"
These questions signal to a doctor — telehealth or in-person — that you want a real evaluation, not just a prescription. A good doctor will welcome them. One who brushes past them is telling you something too.