The latest report by the men’s health charity Movember shows just how deeply men are disengaged from health care in Canada.
Two-thirds reportedly delayed seeking care for more than six days, and almost half said they felt treated unfairly by doctors because they are men.
This echoes earlier findings, including a 2014 study showing 80 per cent of Canadian men avoided seeing a physician unless prompted by a partner, and an April survey showing two-thirds of Canadian men never seek out professional mental health services.
The consequences are stark: 75,000 Canadian men died prematurely last year of causes such as cancer, overdose and suicide.
The reluctance to seek care from traditional health-care providers has created fertile ground for online men’s health clinics to take off.
Marketed as convenient, stigma-free alternatives to health-care professionals, these platforms promise quick fixes for everything from erectile dysfunction to hair loss.
But experts say many of these clinics are selling modern-day snake oil — peddling misinformation, handing out drugs outside guidelines and cutting corners on medical oversight.
“[Online clinics] focus on masculinity,” said Dr. Gerald Brock, a urologist and professor at Western University. “They focus on [saying] you’re not as strong or as muscular as you used to be.”
Quick and easy
Direct-to-consumer online men’s health clinics began emerging in the mid-2010s to meet growing demand for quick, easy results and anonymity.
Clinics such as Rocky Health and Enhanced Men’s Clinic commonly offer testosterone therapy, finasteride for hair loss, Ozempic for weight loss, and PDE5 inhibitors such as Viagra and Cialis for erectile dysfunction.
Brock says these clinics frequently exploit men’s insecurities to push products.
“I think that they’re very smart marketers, and they know exactly which buttons to push for men to put down their credit card … it really is a cash grab.”
Dr. Ryan Flannigan, a reproductive microsurgeon at the University of British Columbia, says virtual care providers are a positive development insofar as they can be more effective at engaging men than traditional providers.
“Some of the anonymity that virtual care and online platforms offer seems to be something that more men are engaging in,” he said.
But Flannigan cautions that online men’s health clinics often fall short of clinical best practices.
“Part of providing good clinical care is being able to discriminate scenarios and, you know, really assess to the best of your clinical judgment … providing the appropriate evaluation, and then management strategies,” said Flannigan.
“[U]sing cultural reference points [such as masculinity] to shape that [care] is not in the spirit of how medicine should be practiced.”
A 2023 review of more than 200 American D2C men’s health clinics found wide variation in the services they provide and frequent misinformation.
Provider credentials were inconsistent, nonphysicians were sometimes listed as primary providers, and urologists were present in only about 10 per cent of clinics.
A 2022 study of seven D2C testosterone platforms found most prescribed treatments to men who would not qualify for such treatment under clinical guidelines.
Specifically, the study found testosterone was provided even when men faced fertility issues, cardiovascular risks or other health issues. Many clinics failed to discuss side effects or properly monitor patients.
Brock, who was formerly president of the Canadian Urological Association, says testosterone can be highly beneficial for the right patient — but comes with serious risks.
In his 35 years of practice, he has treated men who used D2C clinics, including a patient on injectable testosterone who developed dangerously high red blood cell levels.
“I saw one guy whose hemoglobin should be up to 175 in most labs, but it was over 200,” he said. “In that scenario, that man is putting his health at risk [when] … he [just] wanted to feel more energetic.”
There are no studies specifically on Canadian D2C men’s health clinics, which were estimated to number around 40 in 2022.
At Rocky Health — which has partnered with the Toronto Argonauts, Maple Leafs and Blue Jays — patients complete only a brief online questionnaire to qualify for medications, sometimes without seeing a Canadian-licensed physician.
At Enhanced Men’s Clinic, Australian doctors serve Canadian patients. The clinic offers bloodwork, follow-ups and monitoring, according to their website. The website does not mention in-person exams, complete lab assessments or evaluations of fertility and cardiovascular risk.
Rocky Health and Enhanced Men’s Clinic did not respond to multiple requests for comment.
“There’s always risks and benefits to all forms of treatment,” said Brock. “[This underscores] the importance of somebody who has a deeper understanding of those risks and benefits that can provide patients with that information.
“You can’t get that sort of information for a particular individual if all you do is access a website and are never seen by a physician, never deeply questioned by somebody who has expertise in health care.”
Lack of regulation
D2C clinics operate across borders, sometimes using doctors licensed in other countries or other provinces. This can put them outside the scope of Canadian regulators.
The federal government oversees the safety and sale of medications, while provincial professional regulators set prescribing standards.
Where provincial rules do not apply, these clinics are operating in a regulatory “wild west,” Brock says.
“Health Canada has taken enforcement action against online health clinics found to be non-compliant with federal regulatory requirements,” said Karine LeBlanc, a Health Canada spokesperson, in an email to Canadian Affairs.
But she noted the department does not regulate how clinicians prescribe medications. “Healthcare professionals are responsible for ensuring that the health products they buy, use, or sell are authorized for sale in Canada and purchased through Health Canada licensed, registered, or authorized sources,” said LeBlanc.
Health Canada encourages anyone with information about the advertising or sale of unauthorized health products in Canada to report it through their online complaint form.
The College of Physicians and Surgeons of Ontario, which regulates doctors in the province, says Ontario physicians providing virtual care must meet the same standards as in-person care.
“Before prescribing a drug, physicians must — among other requirements — undertake an appropriate clinical assessment of the patient, obtain informed consent, and prescribe a drug only if they have the knowledge, skill, and judgment to do so safely and effectively,” Mickey Cirak, a spokesperson for the college, told Canadian Affairs in an email.
Cirak says physicians from other jurisdictions who provide virtual care to Ontario patients are also expected to comply with the college’s virtual care and licensing requirements.
But because the college can only oversee Ontario-licensed doctors, clinics such as Enhanced Men’s Clinic — which advertises initial consultations with Australian doctors — operate in what Brock refers to as a regulatory “wild west.”
‘Digital age’
Flannigan says he has seen some online health clinics offer excellent care while still meeting best clinical practices.
He praised the Men’s Health Clinic Manitoba, which combines virtual and in-person services.
“They’re fighting the good fight,” he said. “They'[re] an example of specialists creating a team that are trying to utilize technology and … evidence-based care.”
Brock advises men to ask online clinics a few key questions before starting treatment with them.
These include questions about a provider’s background, training and expertise in men’s health; the potential risks and costs of treatment; the evidence to support a proposed treatment; and how potential complications would be handled.
“If you can … get answers that you can believe and that you think are fair, then you’re probably at a good place,” said Brock.
“If that individual says, ‘you’re asking too many questions and you’re not the right person for this’, well then you have probably saved yourself being exposed to something you should never have been exposed to.”
If men feel they are treated unfairly by MDs, and women definitely feel they are treated unfairly by MDs, it leaves me wondering who do MDs treat “fairly”? Now I know there are individual exceptions, but doesn’t this reflect badly on how MDs are trained or not trained to listen to their patients.
I call BS on half of men feeling they are treated unfairly “because they are men”. But, if that many men do report that they feel that way it’s likely a reflection of in-group bias and we shouldn’t lay that at the feet of the doctors. Manage patient expectations first.