Semaglutide, Testosterone and Sildenafil advertising on social media: The Normalisation of lifestyle enhancement drugs

Recently, there has been a sharp increase in advertising for the ‘prescription-only’ medicines semaglutide and testosterone on social media platforms in the UK, along with the ‘pharmacy medicine’ sexual enhancer Sildenafil. These promoted adverts appear to come from both legitimate clinics in the case of testosterone replacement therapy (TRT) and Sildenafil, and illicitly operating suppliers with the attempted appearance of legitimacy in the case of semaglutide. This commentary explores the extent to which the prevalent advertising of these lifestyle medicines on social media is normalising their use, and the potential harms associated with each. For testosterone / TRT, we consider the over-medicalisation of men's general wellbeing concerns and potential harms relating to dependency if use is promoted and encouraged beyond medical need, paralleling prior observations for the sexual enhancer sildenafil. This is followed by an exploration of harms relating to black market semaglutide supply on social media to individuals who are often unaware they are not accessing legitimate pharmaceutical product, including the dangers of product contamination and substitution, as well as uninformed use linked to a lack of information on safe dosages provided by suppliers. Following these discussions, this commentary examines the potential harm reduction impacts that direct to consumer (DTC) supply of prescription medicines could have, and considers how policy could encourage these beneficial effects without further normalising or encouraging drug use in otherwise healthy individuals. However, we also note the importance of tackling prevailing cultural pressures towards lifestyle drug use and the need to address these through education and similar policies.