“You can dress up greed, but you can’t stop the stench.”
Predatory medical hucksters have always been with us.
During the Roaring Twenties and the depression, John Romulus Brinkley became famous and rich performing procedures in which, for $750 (about $11,000 in current value) he grafted goat testicles into men’s bodies, purportedly to cure sexual dysfunction, impotence, and infertility.
Brinkley’s self-promotion was legendary. He commissioned a biography about himself, The Life of a Man, and there was even a 2016 documentary made about him, Nuts!, based on the biography.
Predictably, the book said that for Brinkley “…money is not an aim, or an end in itself, but a means of enlarging the central idea of his life-work.”
Investigators eventually discovered that Brinkley had no formal medical training and his medical credentials were meaningless documents from a “diploma mill”. The legitimate medical community also thoroughly discredited his work.
Medical hucksterism lives on
But Brinkley’s success as a medical huckster promoting sexual vitality lives on. Too many men persist in seeking rejuvenation through miracle devices, creams, pills and serums and hustlers with chutzpah stand ready to exploit them.
Today, the Internet is crowded with advertisements for products that claim they will maintain or restore youth and sexual performance.
One controversial anti-aging idea currently being promoted is transfusions of blood plasma from young people (so-called “young blood”). The treatment is gaining wider acceptance even while the Food and Drug Administration (FDA) is issuing warnings that not only is its value unproven, but its use could be harmful.
On Feb. 19, 2009, the FDA issued a statement cautioning consumers and providers about businesses transfusing blood plasma from young donors into older patients.
“The FDA has recently become aware of reports of establishments in several states that are offering infusions of plasma from young donors to purportedly treat the effects of a variety of conditions,” the statement said. “There is no proven clinical benefit of infusion of plasma from young donors to cure, mitigate, treat, or prevent these conditions, and there are risks associated with the use of any plasma product…the reported uses of these products should not be assumed to be safe or effective.”
The most widely hawked anti-aging youth restoration product today, however, is testosterone, a steroid hormone often associated with masculinity.
Dr. Steven Woloshin, co-director of the Center for Medicine and Media at The Dartmouth Institute for Health Policy and Clinical Practice, has called low testosterone, often promoted as “low T “, treatment “the mother of all disease mongering.”
The hormone is involved in the development of male sex organs before birth and the development of secondary sex characteristics at puberty. It also plays a role in sex drive, sperm production and maintenance of muscle strength, according to the Mayo Clinic. Testosterone levels peak during adolescence and early adulthood and then gradually decline with age.
Testosterone replacement therapy is approved by the FDA to treat low testosterone, but it is too often prescribed unnecessarily and may do more harm than good.
Men unwilling to embrace successful aging all too often take what the Harvard Medical School calls “a medicinal shortcut” and become willing targets of testosterone promoters.
Michael J. Dimitrion, a doctor in Honolulu, HI, is one person who years ago likely saw the opportunity in marketing testosterone treatments. Over the past eight years he has been relentless in aggressively exploiting testosterone’s appeal, raking in money by peddling misinformation to susceptible and insecure men.
Dimitrion’s license on file with the Oregon Medical Board says he graduated in 1973 from Far Eastern University – Nicanor Reyes Medical Foundation in Quezon City, the Philippines.
Specializing in internal medicine, Dimitrion has reported that he completed an internship at St. Francis Medical Center in Honolulu, HI in 1975 and his residency at University of Hawaii School of Medicine, also in Honolulu, in 1977. He entered private practice as an Internal Medicine Specialist in Honolulu in 1977.
In 2011, he opened the privately-owned Hawaii Male Medical Clinic, focusing on treating men for conditions such as low testosterone and erectile dysfunction, even though he had not specialized in urology or endocrinology.
.“Little was known about andropause, the male equivalent to menopause in women, and few understood the dangers of low testosterone,” Dimitrion said in 2013. “Even fewer believed there were proven erectile dysfunction treatments beyond the little blue pills. Realizing there was a need to address this issue and bring it to the forefront of medical care, and because of new men’s health care developments, I started (the) Clinic with an emphasis on good, evidence-based medical care.”
In 2012, the Clinic’s Director, Terry Harmon, said in an interview for a Hawaiian blog on healthy living that testosterone treatment is appropriate now because people are living longer.
Two-hundred years ago people lived to be only 40 or 45, he said, so it didn’t matter much that somebody had low testosterone at that point because they were approaching death. Now, however, men have years to live at 45, but have low testosterone a.
“Testosterone replacement therapy is putting back in what nature, unfortunately, took out,” Harmon said.
In 2013, Dimitrion expanded his operations to the mainland, opening a clinic at the Swedish Medical Center in Seattle and changing the name of his business to Universal Men’s Clinic.
Like an aggressive disease spreading across the landscape, Universal Men’s Clinics have since opened in Portland, OR and eight more U.S. cities (Oklahoma City, OK; Tulsa, OK; Tucson, AZ; Murray, UT; Austin, TX; San Antonio, TX; Sacramento, CA; Las Vegas, NV).
You may have seen the clinic’s ads on local television evangelizing for testosterone treatments for men with an appetite for chemical rejuvenation.
Such ads “smack of profitmaking opportunism,” wrote Lisa Schwartz, M.D., and Steven Woloshin, M.D., co-directors of the Dartmouth College Center for Medicine and the Media.
“Whether the campaign is motivated by a sincere desire to help men or simply by greed, we should recognize it for what it is: a mass, uncontrolled experiment that invites men to expose themselves to the harms of a treatment unlikely to fix problems that may be wholly unrelated to testosterone levels,” they wrote in a JAMA Internal Medicine editorial.
Also of concern, some the online “patient” testimonials are by people affiliated with the clinic.
Frank Grigg, a Mixed martial arts fighter, who endorses the clinic on its websites and has appeared at promotional events, says on his resume he has done “commercial” work for the clinic. Similarly, Tom Harmon, who’s testimonial is on clinic websites, failed to mention that he was a clinic employee.
But testosterone marketing by Universal Men’s Clinic and other promoters and pharmaceutical companies appears to be working. Gross U.S. sales of testosterone in 2018 were projected to reach $3.8 billion, up from $2.4 billion in 2013.
The “sell” at the clinic
After doing research and reviewing online patient reviews* of Universal Men’s Clinic, which are overwhelmingly negative, I decided to take a closer look.
I had my first appointment at the Portland Universal Men’s Clinic on the 6th floor of the Portland Medical Center building at 511 S.W. 10th Avenue on March 13, 2019.
Entering a cramped waiting room, I was handed a sheaf of papers to fill out.
An extensive questionnaire asked for identification information, my medical and surgery history, history of injuries, recreational activities, family history and allergies.
One page asked 10 questions associated with what it said was “Androgen deficiency in the Aging Male,” such as:
- Have you had a decrease in sex drive?
- Falling asleep after dinner?
- Have you noticed problems sleeping?
- Have you had a lack of energy?
I figured I should say something, so I said I was having problems sleeping and identified my “Main Complaint(s) Today” as “Just less zip”.
Included in the paperwork was an Informed Consent form that said at the top:
“You will be attended to by a state licensed physician who will examine you, check your general medical condition, ask about any medications you are presently taking, and discuss with you the specific problem for which you have come to the medical clinic. PLEASE BE AS SPECIFIC AS POSSIBLE IN YOUR RESPONSES. OUR PHYSICIANS NEED ACCURATE INFORMATION IN ORDER TO ENSURE SAFE RECOMMENDATIONS IN YOUR MEDICATIONS” (Emphasis in original)
After a short period, clinic staff directed me to an examination room.
From that point forward, contrary to the assertion in the Consent Form that I would be attended to by a state licensed physician, I was not.
My first encounter was with Walt Coxeff, a “Patient Coordinator” who said he wasn’t a physician, but “the middle person between patients and the doctors.”
Coxeff , who said the Portland clinic sees about 50 clients a day, told me right off that I had to agree to pay $199 for the consultation. He added that private insurance and Medicare typically don’t cover the clinic’s treatments.
Then Ronald King came in.
Like some others at the Portland clinic, King is identified as a Certified Physician Assistant (PA-C), not a physician, on the clinic’s website.
Despite the fact that I had left substantial portions of the paperwork blank, and did not sign the Consent Form, neither Coxeff nor King asked that I fill out the missing information or add my signature.
King did suggest, however, that even though some men have no symptoms of low-T, he’ll endorse testosterone treatments for them to make their energy, moods, etc. even better.
King said medical schools don’t teach about testosterone. Instead, they teach about anti-depressants, sleep aids, Viagra, losing weight, quitting smoking, or going to the gym, he said.
King also assured me that testosterone is safe and doesn’t cause heart attacks, strokes or cancer.
According to the FDA, “Testosterone products are FDA-approved only for use in men who lack or have low testosterone levels in conjunction with an associated medical condition. Examples of these conditions include failure of the testicles to produce testosterone because of reasons such as genetic problems or chemotherapy.”
Ryan C. Petering, M.D. and Nathan A. Brooks, MD, MPH, Oregon Health & Science University, wrote in Testosterone Therapy: Review of Clinical Applications, “Physicians should not measure testosterone levels unless a patient has signs and symptoms of hypogonadism, such as loss of body hair, sexual dysfunction, hot flashes, or gynecomastia.”
Although I had no clear medical condition associated with low testosterone and no signs or symptoms of hypogonadism, and was not examined for them, the clinic gave me a blood test to measure my testosterone levels. King said the blood test results would likely be available within a day,
Back at the clinic again
When the test results didn’t show up, I went back to the clinic six days later on March 19, 2019.
At that visit, I was handed one page of blood test results and again ushered into an examination room, this time by an employee who identified himself as Mark, an employee in training.
Mark said the blood test showed my testosterone level was “a little bit on the low end,” with the clinic considering 800-1000 nanograms per deciliter (ng/dl) as “optimum.”
That meant I was a good candidate for testosterone replacement therapy, he said.
This conclusion came despite the clinic having given me just one blood test, contrary to medical recommendations that testosterone therapy should be initiated only after two morning total serum testosterone measurements show decreased levels.
The conclusion was also contrary to guidance from the Endocrine Society, which focuses on advancing hormone research and clinical practice. “In the absence of symptoms in men ages 65 and older, low testosterone levels alone shouldn’t routinely lead to prescribing testosterone therapy,” the Society says.
The clinic gives men an opportunity to increase their testosterone levels so they can feel more energetic and stronger, Mark said.
The clinic’s “medical provider” recommended, he said, that I start with a 200-milligram injection of testosterone or daily application of a 300-milligram cream.
I began to feel passed around like a rumor when Mark then shifted me to Thomas Pierce for information on the treatment cost. An employee identified Pierce as the clinic’s Area Director; on Linkedin he’s described as Regional Operations Manager.
As with the other people I met with at the clinic, Pierce is not a physician. His Linkedin account says he attended Kaplan College-San Diego during 2009-2010 (the college shut down in Dec. 2018), where he obtained a Technical Certification as a Medical/Clinical Assistant.
Pierce said the testosterone treatment plan at Universal Men’s Clinic is 18 months long and costs $3402, or $189 per month, with a minimum down-payment of $378. The cost is fully inclusive, he said, covering medications, consultations and other items. “It’s kind of a concierge medicine model,” he said.
The treatment goal, Pierce said, would be to raise my testosterone to the 800-1000 level and the clinic has a 90 percent success rate, Pierce said.
Would the treatment end if I reached the goal? “No,” Pierce said. Treatment would continue indefinitely to maintain the right testosterone level.
In other words, once you start the testosterone treatment, Universal Men’s Clinic stands to have a permanent paying customer.
What the evidence shows
There is evidence that testosterone replacement therapy can have merit in certain circumstances. However, treating symptoms of aging with testosterone can also lead men to avoid pursuing preferred alternatives that can enhance a man’s well-being with less risk, such as leading a healthier lifestyle, losing excessive weight or drinking less.
“You’re better off exercising than putting some silly compound in your armpit,” says Nortin Hadler, M.D., now Emeritus Professor of Medicine and Microbiology/Immunology at the University of North Carolina in Chapel Hill and the author of Rethinking Aging.
Or, as Dr. Robert Alan Clare put it, “I’m not surprised that men with lots of health problems have low testosterone levels, but it’s a big stretch to think that supplementing this hormone will cure any of them. There is good evidence that the real culprit for low testosterone is inactivity.”
And, according to American Family Physician, a journal of the American Academy of Family Physicians, “No consistent relationship has been proven between testosterone levels and symptoms purportedly associated with Low T. Testosterone may increase libido, but testosterone levels do not correlate with sexual function.”
Testosterone also does not reverse or postpone age. “FDA has become aware that testosterone is being used extensively in attempts to relieve symptoms in men who have low testosterone for no apparent reason other than aging.,” the FDA has cautioned. “The benefits and safety of this use have not been established.”
The fact is, low testosterone is real for only a slim percentage of men. A male aging study in the British Medical Journal (BMJ), found that only 0.1 percent of men in their forties, 0.6 percent in their fifties, 3.2 percent in their sixties, and 5.1 percent of men in their seventies would meet the criteria for the diagnosis.
Then there are the warnings that testosterone treatments can be fraught with danger.
The FDA requires that manufacturers include information on testosterone labeling about a possible increased risk of heart attacks and strokes in patients taking testosterone. Unnecessary testosterone therapy can also increase the risk of mood swings and aggression.
FDA-approved testosterone formulations include a transdermal patch, buccal system (applied to upper gum or inner cheek), injection and a topical gel. Each has its own potential concerns.
If the gel rubs off on a child, for example, the child may develop signs of early puberty; if it smears onto a woman’s skin, it can interrupt menstruation, make her anxious and irritable and she could experience changes in body hair or acne.
The gel can even harm pets if it rubs off on them, causing such affects as lethargy, fever, bleeding, pale gums and hair loss.
What to do?
Medical hucksters aren’t going to go away. The testosterone pushers will continue to exploit men who fear getting old, losing their sexual vitality and having a less thrilling life.
But men can best avoid the hucksters by refusing to be a mark or willing target. Consult with primary care doctors first, not operations focused just on pedaling testosterone treatments.
Government regulators can also be more aggressive and tighten up on the rules on testosterone treatments by unscrupulous profiteers. Research on the safety, efficacy and effects of testosterone treatments can also be accelerated.
Promotional materials by pharmaceutical companies and testosterone providers can be more closely monitored to prevent the spread of misleading and unsubstantiated claims.
And men have a choice. They don’t have to fall for “low T” hucksters run amok. They don’t have to treat getting older as a disease that miracle drugs can cure.
As Maggie Kuhn, Founder of the Gray Panthers, said, “Old age is not a disease—it’s a triumph.”
*A sampling of online reviews of Universal Men’s Clinics
“Very terrible company, avoid like the plague. – Overpriced. Medication/non-effective – Rude employees – They don’t spend the proper time to understand the patient’s needs and concerns – Completely sales driven, they try to lock you into high monthly payments.” Review of Honolulu, HI clinic.
“This place is a total scam. When you go for your initial consultation they charge you $199.00 then try to sell you a testosterone replacement therapy for $3,000.00 or a ED program for $2,000.00. But they won’t tell you that until your consultation. What a bunch of BS. If you are smart you will just run away and save your money!” Review of Honolulu, HI clinic.
“Everything was good at first until we started feeling like we were (at) a used cars sales lot. The patient counselor kept hounding us to pay over $3,000 upfront for all of the medication and then they put us in a contract that we cannot get out of unless my husband has medical issues… I would not recommend this to my worst enemy. Don’t get caught up in their scam.” Review of Murray, Utah clinic.
“Go see your primary care provider and don’t waste your money. They only want to get you on a monthly payment program. They don’t care about your past medical history, family history, or current medical history.” Review of Oklahoma City, OK clinic.
“There are other, much better, much cheaper options for LowT in the Tulsa area. Do your research – Don’t go to UMC in Tulsa.” Review of Tulsa, OK clinic
“Stay away from this clinic. Everything they offer has drastic effects to your body. Save your liver and stay away from this place. You’ll have better luck in Mexico with your health.” Review of Tucson, AZ clinic.
“Stay away it’s a scam. They don’t do your blood work before guessing a prescription and putting you on a payment plan. When there done guessing and got you bank info. They then send someone in to draw blood, but you will never hear back about the blood work. They are prescribing medication that could do you long term harm if they don’t check your blood first to see if you need it and won’t die/harm you permanently. Go to a real doctor to get checked out if you feel you need this kind of help save your money and you health.” Review of Tucson, AZ clinic.
“BEWARE – this clinic engages in lies and manipulation to get you to sign up for an expensive long-term contract.” Review of Tucson, AZ clinic.
“This clinic is a scam to get ppl in the door and rob them of their money. They lie about test results and get u to go with their service with overpriced meds. They even gave me a shot b4 my blood results came in saying I needed it.” Review of Sacramento, CA clinic.
“If you are looking for natural men’s health strategies or a real doctor, keep looking. This is a drug pushing factory. I found better advice searching on line. Getting better sleep, working out, reducing stress and healthier eating are better places to start.” Review of Sacramento, CA clinic.
“Deceptive high pressure up selling. They lure you in with a big promise. For only $199 they say blood work, consultation, and follow ups are included…Treatment plan was $200 per month for 18 months.” Review of Austin, TX clinic.
“A prime example of junk science run amuck in the marketplace. Do not waste your time and money with scams like these. Do the research.” Review of Austin, TX clinic.
“Unethical business practices…Hard pressure sales, lies, inconsistent medication, micromanaged, no medical background management.” Former clinic employee on Glassdoor.com
“They say you are a Patient Care Coordinator but you are nothing but a sleazy salesman. This company is so micromanaged and all they care about is getting people to sign up for overpriced “treatment.” Former clinic employee on Glassdoor.com
“What a ripoff… When I went in for my appointment, they first send a gentleman in to get you started on the paperwork. Then the Doctor came in and immediately diagnosed me with low T, (before they even drew any blood to test) and E.D. (erectile dysfunction).” Review of Tucson, AZ clinic.
“They charge $200 for your initial consult fee. THEN they want you to agree to the $2988.00 fee for the 18 month treatment. My husband felt scammed and said the pressure was the same as when the car dealers want you to get the undercoat on your new car. Extremely shady!” Review of Seattle, WA clinic.