The Hollow Men of Hims

> If you want safe and really high quality medical care you should absolutely have a personal physician you have a personal relationship with, who understands your lifestyle, your risk factors for side effects, and your medical needs deeply. How many Americans have that? Maybe a few dozen?

A bit of a tangent: I have this here in the US, through a model called Direct Primary Care. I pay $50/mo for a single provider, unlimited visits / communication, and highly discounted labs. She makes house calls on occasion. This doctor is working solely in my interest, and has little concern of insurance, except to help me navigate that system should I need a specialist, prior authorization, etc.

I do worry that it's sustainable, but I think there must by a way to scale up this practice of the general practitioner working in the interest of the patient.

My previous doctor was part of a large health system, who also happens to be directly associated with the large regional insurance provider whom my employer supplied to me without another choice. Every 8 minute visit centered around insurance and billing, with my health seeming to be a distant second. It seemed every visit had to end in some kind of prescription or referral, arrived at quickly and without much discussion. It quickly became clear they were not working in my interest, and I sought other options, eventually landing on the Direct Primary Care model. Now I have full 1 hour visits, and someone who seeks to understand what is happening for me completely, not through the lens of a payer.

It’s possible for both you and the article to be right.

The system sucks, but Hims are also terrible, and medical care should not be like Amazon prime.

I helped setup vaccination sites during the pandemic. One thing that struck me was how the providers who were working and the patients were all like “this is so much easier than normal medical care”.

Hims is like that.

Literally the only reason I would use them is price. Cannot get anything for the prices they offer at a normal place or through insurance

But access to medical treatment, particularly drugs, should be "paternalistic", so I strongly agree.

Really? I wanted to try Cialis, primarily for my enlarged prostrate but also for the erection effects. I asked my primary care doctor, that was a $20 copayment, I fill it my local pharmacy and it costs about a $5 copayment for a month’s supply. It’s a big practice where I might have to wait a long time if I want to see the head doctor but if I don’t care who I see I can usually get in pretty quick and they do a good job of keeping notes so care is well coordinated.

Some of it is that there’s a general breakdown in trust that makes a lot of people think that somebody who shot a healthcare executive is a hero, or that there is little outrage that a lunatic like RFK jr is in charge of HHS. I mean, there are legitimate reasons to think institutions are illegitimate but I think there’s something self-perpetuating about distrust, people find meaning in it. It reminds me of the 1980s and 1990s when there were all the stories right out of Rambo that there were still POW in Vietnam and you’d see those black flags everywhere because it wasn’t patriotic enough to fly an American flag.

Yup, this is what happens when you deregulate (or under-regulate) an industry and "let the market speak."

Isn't the point of regulation to set the bar you must prove you meet, rather than a bar you must prove others haven't met?

The problem with your position is simple: where does it come from?

The legit path for compounded semaglutide is buying up Rybelsus, impacting the supply for diabetics. Compounding pharmacies are notoriously shady, and are likely using grey market materials from questionable sources.

Agreed. The number of times the article specifically calls out "shady Chinese knockoffs" is honestly, actually, racism. If there's evidence that Hims' drugs are harmful: Present it. The article doesn't. I know tons of people who have used Hims and companies like it, for a variety of things. I'm aware of no specific or general problems anyone has had with their medication.

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When it comes to Men's health, doctor's really don't give much of a fuck. Their primary concern is are you actually sick, they don't care about how you feel, or your self-image, or your sense of masculinity.

Hair loss is sucky, sure, but in the grand scheme of medicine it's nothing. Erectile dysfunction sucks, but are you old? That's just the name of the game.

I lost my testicles to cancer (yippee) and you would be shocked how difficult it is to just... get testosterone. My fundamental bodily functions no longer exist, but I'm technically fine so... I guess that's okay? Like I'm not dying, and quality of life is in the eye of the beholder or something. Never mind I'm literally castrated, like physically. And they'll talk your ear off about side effects.

Side effects? What about primary effects? Man, I have no balls! Everything sucks and I wake up feeling like I've been run over by a truck!

I think it's both. Hims doesn't really even do the telemedicine bit all that well, and Hims customers know what they're there for. This is isn't a "by the way" conversation at the end of an annual physical, nor is it a dedicated full-cost office visit to discuss ED, Weight Loss, or Hair Loss. It's a quick website visit, and then maybe 5 minutes zooming with a doctor in another state you will never see again and who will never remember you among the thousands of patients they "see".

There's a lot of shame in society around all of these issues, and it's really appealing to a lot of Men to be able to spend an extra $100-200 to not have to have a conversation that embarrasses them with a Doctor who may know their wife, friends, or otherwise may be part of the community. That's the value proposition of Hims; a $200 fee to maintain the illusion of their inherent virility and masculinity. A lot of Men will happily pay that, and have the disposable income to do so.

Diet and exercise!

Don't forget that 3 month out appointment is probably 15 minutes long with a 30 min office wait which you'll then inevitably fight insurance over (Hims doesn't bill insurance either)

It's a little of column A, little of column B, but in a mixed way. A lot of doctor visits for basic health issues are ones that can be dealt with over a phone or video call. Routine stuff like updating your medicines, changing dosages, showing a bruise or dealing with a mild fever don't require you to be physically present at the doctor's office. Having to deal with insurance, scheduling, waiting times, driving to the doctor's office in the middle of the workday are unnecessary for a large proportion of the sorts of day-to-day issues people deal with.

Telemedicine isn't a panacea, but in a system with major constraints on doctor bandwidth and where in-person visits are very expensive, it's extremely helpful. And yeah, a lot of that is because so often the solution is as you said -- get more sleep, eat better, maybe work out a little, reduce your stress. I'd much rather have a quick 15 minute call to be told that, instead of having to take several hours off work to go visit the doctor in person.

My Kaiser doctor recommended Hims for finasteride.

Every human is just one "are you drinking enough water? how much water are you drinking" interaction with their doctor away from instant radicalization against the traditional healthcare system. You can really tell the author of this article hasn't yet actually had to use the non-emergent American healthcare system for anything significant.

Tretinoin is easily prescribed by seeing a dermatologist. What do you mean it’s a nightmare to get even with a prescription? I think a tube of cream cost like $10 at Costco. You don’t even need to use your own insurance to buy things from the pharmacy as long as you have a prescription. I never once had a problem filling it before I switched to Accutane.

I'm confused. An insurance company cannot reject a prescription. They can only reject paying for it.

So if you're paying for it with Hims why wouldn't you be willing to pay for the medication the doctor prescribes to you if the insurance company is refusing to pay for it?

I agree. I enjoy off the wall and humorous writing usually. This article is pretty bad. Somehow it made me want to like the subject they were trying to eviscerate. I wouldn't want to be too harsh though; at least they did write something! Perhaps I'll read another article by this same person in the future and find they've improved their tone.

I had the opposite take, actually. I had to think about it for a sec and suddenly, “oh, right. Novo nordisk == Danish == Scandinavian design” cute.

This style of writing is a welcome change from all the AI slop or self promoting blogs out there.

It’s a personal touch without making it all about the author. Long form articles with some humor used to be all I wanted to read on the web.

Im all-in for using technicalities to get what I want out of the healthcare system instead of having them all weaponized against me.

I see a lot of complaints about "the healthcare bureaucracy in America".

And I don't doubt that it exists. But I will say the limited number of times I've needed to interact with the system it was surprisingly cheap and downright pleasant.

The only negative experiences I've had is interacting with government run health systems (the VA).

Up until the part where people couldn’t cancel their subscriptions or got charged out of the blue