Orem Doctor Shapes U.S. Testosterone Debate

A doctor in Orem, Utah, is helping steer a national fight over how easy it should be for men to get testosterone online. (businessinsider.com) Business Insider’s April 22, 2026 report centers on Dr. Landon Trost, a former Mayo Clinic male infertility specialist whose clinic says it focuses exclusively on male infertility and Peyronie’s disease in Utah County. Trost is also listed as a panel member on the American Urological Association’s testosterone deficiency guideline. (businessinsider.com) (malefertilityandpeyroniesclinic.com) (auanet.org) Testosterone therapy is meant for men with clinically low testosterone and related symptoms, not simply for men chasing more muscle, energy, or libido. The American Urological Association says care should start with accurate testing, symptom review, and follow-up monitoring after treatment begins. (auanet.org) That standard is colliding with telehealth’s fast growth. A 2021 review in the *International Journal of Impotence Research* said telemedicine can expand access to guideline-based testosterone care, but it also limits physical exams and raises legal and safety concerns. (pmc.ncbi.nlm.nih.gov) The online market has already shown how loose some screening can be. A JAMA Internal Medicine study found 85.7% of direct-to-consumer platforms offered testosterone to a secret shopper with normal hormone levels who said he wanted future fertility. (jamanetwork.com) (news.feinberg.northwestern.edu) Business Insider reported a similar result in 2026: a 34-year-old reporter posing as a patient obtained testosterone replacement therapy from six of seven telehealth clinics despite normal testosterone levels and limited cardiovascular screening. The piece says the easy access is feeding higher-dose use among younger men. (businessinsider.com) (cashwalklabs.io) Federal regulators are now weighing how much access to preserve. The Drug Enforcement Administration announced new telemedicine rules on January 16, 2025, including a special registration framework for clinicians prescribing Schedule III-V controlled substances without an in-person exam. (dea.gov) The Food and Drug Administration opened a separate front on December 11, 2025, when it asked the public for information to help shape its thinking on testosterone replacement therapy for men. Comments were due February 9, 2026. (federalregister.gov) The medical risks are specific, not abstract. The Food and Drug Administration said on February 28, 2025 that all testosterone products should carry updated labeling about increased blood pressure, and a 2025 systematic review found erythrocytosis — an abnormal rise in red blood cells — in up to 66.7% of testosterone users in some studied groups, with thromboembolic events reported in up to 2.7%. (fda.gov) (ashpublications.org) Fertility is another fault line. The American Urological Association guideline specifically flags men who want to preserve fertility as a group needing special management, because testosterone can suppress sperm production even as it raises hormone levels. (auanet.org) (jamanetwork.com) Demand keeps rising while the rules are still being written. A 2024 cross-sectional analysis found the number of people filling testosterone prescriptions increased 27% from 2018 to 2022, with a 58% increase among ages 35 to 44. (pmc.ncbi.nlm.nih.gov) That leaves doctors like Trost in the middle of a widening split: one side argues telehealth reaches men who would never get evaluated in person, and the other points to normal-lab patients getting a controlled drug with thin screening and uneven follow-up. (pmc.ncbi.nlm.nih.gov) (jamanetwork.com) (businessinsider.com)