The Dark Side of Low-T Clinics with Dr. Justin Dubin - EP 155
Guest Bio
Dr. Justin Dubin is a fellowship-trained urologist and andrologist at Memorial Healthcare System in South Florida. He specializes in male fertility, low testosterone, Peyronie’s disease, sexual function, and testicular pain—addressing every aspect of men’s sexual and reproductive health.
Dr. Dubin is also the host of Man Up: A Doctor’s Guide to Men’s Health, a podcast dedicated to demystifying and destigmatizing men’s health topics. He’s a nationally recognized voice on the rise of direct-to-consumer testosterone clinics and has led groundbreaking research—including a secret shopper study published in peer-reviewed journals—exposing the risks and inconsistencies in this growing industry.
Through both clinical care and public education, Dr. Dubin is committed to helping men make informed, evidence-based decisions about testosterone replacement therapy, fertility, and sexual health.
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Show Notes
Episode Summary:
In this revealing episode, Dr. Geo sits down with Dr. Justin Dubin to examine the fast-growing world of direct-to-consumer (DTC) testosterone clinics. Based on personal undercover research and clinical expertise, Dr. Dubin shares what these clinics are getting wrong, what patients should be asking before starting TRT (testosterone replacement therapy), and why the buzzword “optimization” can be misleading. The conversation also highlights the importance of patient education, fertility implications, and the need for comprehensive care in men's health.
Key Takeaways:
✅ The Rise of DTC Clinics
✅ The Rise of DTC Clinics
COVID-era telemedicine expansion enabled DTC TRT clinics to flourish.
Many offer treatment with minimal oversight and insufficient patient education.
✅ Undercover Research Findings
Dr. Dubin posed as a healthy 34-year-old man with normal testosterone levels (675 ng/dL) and a desire to have children.
6 out of 7 clinics offered TRT despite clear contraindications (normal T, fertility goals).
Only 50% disclosed the infertility risks of TRT.
✅ Why "More T" Isn't Always Better
Supraphysiological T levels (above 1000 ng/dL) can lead to priapism, psychiatric effects, infertility, and heart risks.
The goal of TRT is replacement—not enhancement or “optimization.”
✅ The Buzzword “Optimization”
Used widely in social media and marketing, but medically vague and misleading.
“Optimized” hormone levels are subjective and not evidence-based.
✅ Fertility Risk with TRT
TRT shuts down LH/FSH production, which can halt sperm production in as little as 4 months.
Alternatives like Clomid or HCG can support endogenous testosterone and fertility preservation.
✅ Social Media & Misinformation
Studies found most online men’s health content is inaccurate and unregulated.
Many non-experts promote TRT or SARMs without scientific basis.
✅ The Privacy Factor in Men’s Health
Surveys show privacy is the top reason men prefer DTC clinics—even over cost or convenience.
Embarrassment and stigma around ED and low T prevent men from seeking traditional care.
✅ Clinical vs. DTC Care
DTC clinics rarely offer a full picture—often skipping evaluations for sleep apnea, mental health, or cardiometabolic issues.
Only a trained specialist can accurately diagnose and treat the root cause of symptoms.
✅ How to Be a Smarter Patient
Dr. Dubin’s top 5 questions to ask before starting TRT:
What is my goal—am I seeking labs, treatment, or answers?
Who am I talking to—what’s their background and experience?
What are the risks and long-term consequences of TRT?
Do I truly need TRT—or are there other causes (e.g., mental health, sleep)?
Can I get a second opinion from a urologist or endocrinologist?
Curated Transcripts
[00:00:00]
Dr. Geo: Welcome to the Dr. Geo Prostate Podcast. Today’s guest is Dr. Justin Dubin, a fellowship-trained urologist and andrologist at Memorial Healthcare System. He specializes in male fertility, low testosterone, Peyronie’s disease, sexual function, and testicular pain—everything related to men’s sexual and reproductive health.
Dr. Dubin is also the host of Man Up: A Doctor’s Guide to Men’s Health. Today we’ll explore the rise of direct-to-consumer testosterone clinics—what they get right, where they fall short, and why “optimization” isn’t always best. You’ll hear what every man should ask before starting TRT and how to make informed decisions about hormonal health.
[00:01:00]
Disclaimer: All content is separate from my faculty position at NYU Langone Health. Sponsors are curated independently to support providing free, high-quality information on prostate health, testosterone, erectile function, and aging well.
[00:02:00]
Dr. Geo: This is Justin’s second time on the show—episode 77 was on male porn and ED. That was a hit. Thanks for coming back.
Dr. Dubin: Always great to be here. I appreciate your curiosity in the urology and wellness space—it’s contagious.
The Rise of Direct-to-Consumer Testosterone Clinics
[00:03:00]
Dr. Geo: I saw an article in Scientific American about a man diagnosed with low testosterone at a men’s clinic—who actually didn’t need TRT—and you were quoted. What’s happening out there?
Dr. Dubin: Since COVID, telemedicine rules have loosened, making it easier for controlled substances like testosterone to be prescribed remotely. This opened the door for direct-to-consumer TRT.
In South Florida, men’s health “brick-and-mortar” clinics have been common for years—offering testosterone and penile injections. Without proper education, complications like priapism can occur.
Not Against Direct-to-Consumer Care—But…
[00:08:00]
Dr. Dubin: I’m not against direct-to-consumer care. It offers privacy, convenience, and access—especially for men uncomfortable discussing sexual health in person. But it comes with risks.
I began seeing many young men (<35) on TRT for infertility issues—unaware that TRT can cause sterility by shutting down sperm production. After ~4 months on TRT, 65% of men have no sperm in their ejaculate.
The Secret Shopper Study
[00:11:00]
Dr. Dubin: We investigated by posing as a 34-year-old man with “low T” symptoms, a normal testosterone level (675 ng/dL), and a desire to have children.
Results:
6 of 7 companies offered TRT despite normal labs.
Only 50% mentioned infertility risks.
Some had no defined treatment goals; others aimed for testosterone >1,000 ng/dL or “until you feel better.”
Why “Optimization” is a Problem Word
[00:21:00]
Dr. Dubin: “Optimization” sounds sexy but is vague. What’s optimal for you might not be for me. It’s often used as marketing rather than medical guidance. True optimization should start with lifestyle: sleep, exercise, diet, and targeted supplements—not unnecessary TRT.
Symptoms Without Low T
[00:28:00]
Normal testosterone with ED or low libido? Often it’s:
Sleep issues (including sleep apnea)
Mental health (stress, anxiety, depression)
Medications (e.g., SSRIs like Lexapro)
Testosterone isn’t always the answer.
Guidelines vs. Real-World Practice
[00:32:00]
Guidelines require symptoms + low T for diagnosis. But medicine isn’t black-and-white—sometimes men with borderline levels (350–400 ng/dL) benefit from therapy. This requires careful, individualized discussion.
Alternatives to TRT
[00:33:00]
For men concerned about permanence or fertility loss:
Clomid or HCG stimulate natural testosterone production.
These are reversible and preserve fertility.
Why Men Choose Direct-to-Consumer Clinics
[00:38:00]
Two surveys of men under 40 revealed:
Privacy was the #1 factor for choosing care (more than cost or convenience).
~32% of ED patients and ~25% of TRT users had used direct-to-consumer platforms.
Many also used unsafe SARMs purchased online.
The Role of Privacy
[00:43:00]
Even though HIPAA protects privacy, men avoid in-person visits to escape perceived stigma—such as being recognized in a waiting room.
Coexistence and Patient Education
[00:45:00]
Dr. Dubin: Direct-to-consumer care isn’t going away. We must:
Educate patients on risks/benefits.
Encourage informed questions.
Use telemedicine where appropriate.
Offer in-person exams for complete evaluation.
Top Questions to Ask Any TRT Provider
[00:54:00]
What’s my treatment goal?
Who will be treating me? What’s their medical background?
What are the risks and benefits?
How will this affect my fertility?
What are my non-TRT options?
[00:56:00]
How to find Dr. Dubin:
Urologist, Memorial Healthcare System (Broward, FL)
Podcast: The Man Up Podcast
Social: @JustinDubinMD on Instagram & X
Resources
Scientific Articles & Journals
Scientific American – An article discussing the misuse of testosterone clinics, in which Dr. Dubin is quoted.
Published Study by Dr. Dubin (Secret Shopper Study) – Dr. Dubin pretended to be a 34-year-old man with normal testosterone to investigate seven direct-to-consumer TRT clinics. The findings are published and include his full lab panel in the supplemental materials.
UCLA Study – Found that ~20% of erectile dysfunction (ED) cases in men could be diagnosed only through in-person exams, highlighting the limits of telemedicine/direct-to-consumer models.
Books & Authors
Robert Sapolsky – Stanford evolutionary biologist cited for his findings that testosterone amplifies existing personality traits rather than turning people into “a-holes.” His research draws on observations in animals and primates.
Medical Treatments & Drugs Mentioned
Kyzatrex – A prescription oral testosterone replacement therapy (TRT). The episode includes a sponsored segment explaining its benefits, risks, and side effects.
Aromatase Inhibitors – Mentioned in critique (Dr. Geo is not a fan of these for TRT).
Clomid – A SERM (Selective Estrogen Receptor Modulator), used off-label to stimulate natural testosterone production, especially for fertility-preserving therapy.
hCG (Human Chorionic Gonadotropin) – Another treatment to stimulate endogenous testosterone production.
SARMs (Selective Androgen Receptor Modulators) – Such as Ostarine, discussed as concerning due to unregulated use and being sold as experimental compounds.
Lexapro (Escitalopram) – Mentioned as a medication that can negatively affect libido and erections.
Trimix – Injectable ED medication often given by men's health clinics, potentially leading to priapism.
Viagra and Cialis – Referenced for ED treatment.
Gas Station Pills – Mentioned as dangerous unregulated ED enhancers with super-high doses of active ingredients.
Health Metrics & Tools
SHBG, LH, FSH, Free T, Bioavailable T – Hormonal values and markers Dr. Dubin used in his study and clinical discussion.
IIEF/SHIM Questionnaires – Validated tools used in the ED study to assess erectile function in men under 40.
Lab Panels – Dr. Dubin used full hormone panels in his research, including testosterone, free T, estradiol, and others.
Podcasts
Man Up: A Doctor’s Guide to Men’s Health – Dr. Dubin’s podcast, also featuring Dr. Geo as a guest.
Websites and Contact
www.kyzatrex.com – Website mentioned for ordering a TRT test kit.
DrGeo.com – For Dr. Geo’s newsletter and integrative urology resources.
Justin Dubin, MD – Can be found on Twitter/X and Instagram at @JustinDubinMD, and practices at Memorial Healthcare System in South Florida.
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