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Physician-directed versus direct-to-consumer

The difference is not the website. It is whether the process contains a step that is allowed to end in no therapy. Three questions, and what the research says about why they matter.

Medically reviewed by the Kesbury Health Clinical Team · Last updated 2026-09-02

Quick answer

The difference between a physician-directed practice and a direct-to-consumer prescription pipeline is not the website, the branding or the word telehealth. It is whether the process contains a step that is allowed to end in no therapy. In a physician-directed model, a licensed clinician evaluates your specific case, orders what is needed to decide, can decline, sets an individualized protocol, and stays involved while it is adjusted. In a pipeline model, a questionnaire routes to a prescription and the clinical layer exists to authorise rather than to decide. Published research on direct-to-consumer telemedicine has documented the pressures that produce the second model: satisfaction scores that rise when a prescription is written [2], and frequently undisclosed clinician identity and licensure [3]. Neither finding is an accusation against telehealth. Both are reasons to ask specific questions.

What the research actually found

Three studies are worth knowing about, because they describe the model rather than any particular company.

  • 2016, JAMA Dermatology. Researchers submitted 62 clinical encounters to 16 direct-to-consumer telemedicine websites and apps between 4 February and 11 March 2016. Prescription medications were ordered in 31 of 48 diagnosed cases, or 65%, and the study reported problems with disclosure of clinician identity, licensure and credentials, and with coordination of care [3].
  • 2018, JAMA Internal Medicine. An analysis of direct-to-consumer telemedicine encounters for respiratory tract infections found that patient satisfaction scores were higher when an antibiotic was prescribed [2]. That is a structural incentive, and it operates whether or not anyone intends it.
  • 2020, JAMA Network Open. A comparison of direct-to-consumer telemedicine visits with primary care visits examined how the two differ in practice [1].

Read together, the message is not that telehealth is unsafe. It is that a model paid per prescription and rated by patient satisfaction has a gradient, and that a practice which wants to resist it has to build something specific into its process.

The three questions that separate the models

1. Can this process end with no therapy?

Ask it directly, before you pay. If the answer is a real one, it will describe a step: a lab result, a history finding, a contraindication. If the answer is reassurance, you have learned something. At Kesbury Health the $179 Sermorelin Baseline Panel is a prerequisite for sermorelin therapy, and a result that argues against therapy means therapy is not prescribed.

2. Who is the clinician, and where are they licensed?

Undisclosed clinician identity and licensure was one of the specific findings in the 2016 study [3]. You should be able to establish that a licensed physician is responsible for your care and that they are licensed where you live. Kesbury Health is licensed in ten states, and eligibility is confirmed during the assessment rather than after payment.

3. What is measured, before and after?

Individualized therapy requires something to individualize against. Endocrine Society guidance for growth hormone therapy describes titration against clinical response and IGF-1 rather than a fixed schedule [4], and IGF-1 assays differ enough between laboratories that a 2011 consensus statement was written about standardizing them [5]. A protocol with no baseline and no follow-up measurement is a fixed dose with a personalised label on it.

What individualized dosing means in practice

It means the number is derived rather than selected. Physiology varies: a 1991 study of healthy men reported that each decade of increasing age attenuated the growth hormone production rate by 14% and the half-life of circulating growth hormone by 6%, with relative adiposity an independent negative factor [6]. Two people of the same age start from different places, so the same dose does different things. That is the argument for measuring first, and it is the reason this practice publishes no dosing chart.

Where a compounded medication fits

Compounded medications are prepared by a licensed pharmacy for an individual patient against a prescription. They are not FDA-approved finished drug products, and any provider implying otherwise is misdescribing the category. A physician-directed practice states that distinction plainly, because the patient is entitled to know which category their medication is in.

How physician-directed care works at Kesbury Health

  1. Complete a short online assessment about your goals, symptoms and health history. It takes about 60 seconds to begin.
  2. A licensed Kesbury Health physician reviews what you submitted and decides whether therapy is a reasonable fit for you, or whether something else should be looked at first.
  3. Baseline labs where they apply. The $179 Sermorelin Baseline Panel is a prerequisite for sermorelin therapy, and the results can end the conversation rather than continue it.
  4. If therapy is appropriate, the medication is compounded by a licensed U.S. pharmacy and shipped to your door, with dosing set to you rather than to a chart.
  5. Ongoing physician oversight adjusts the protocol over time, with a 90-day re-evaluation built into the sermorelin program.

Care is delivered by telehealth to residents of the ten states where your Kesbury Health physician is licensed: Alabama, District of Columbia, Delaware, Florida, Maryland, Michigan, New Jersey, Ohio, Pennsylvania and Texas. Eligibility is confirmed during the assessment.

Frequently asked questions

What does physician-directed actually mean?

That a licensed physician evaluates your specific case, decides whether therapy is appropriate, sets the protocol, and stays involved as it is adjusted. The test is whether the process contains a point at which the physician can decline. A questionnaire that routes to a prescription regardless of the answers is not that, whatever it is called.

Is direct-to-consumer telehealth bad?

No, and the research does not say that. It says the model has measurable failure modes worth knowing about. A 2020 JAMA Network Open study compared direct-to-consumer telemedicine visits with primary care visits [1]; a 2018 JAMA Internal Medicine analysis found patient satisfaction in direct-to-consumer telemedicine was higher when an antibiotic was prescribed [2]; and a 2016 JAMA Dermatology study of 62 encounters across 16 sites found clinician identity and licensure were frequently undisclosed [3]. Those are structural pressures, not accusations.

How can I tell which one I am looking at?

Ask three questions before paying. Can this process end with no therapy? Who is the clinician and where are they licensed? What is measured before the prescription and after it? Clear answers to all three describe one model; vague answers describe the other.

Does a lab requirement prove a clinic is careful?

It is evidence, not proof. What matters is whether the result can change the outcome. A panel whose only possible consequence is to confirm a sale that has already been made is a formality. Ask what happens if the result argues against therapy.

Why does Kesbury Health not name its physicians publicly?

Because the practice presents care as the responsibility of its clinical team rather than as one person's brand, and its articles carry a team byline. Licensure and identity are confirmed to patients through the intake and consent process, which is where it matters.

Ask us the three questions

Take the free 60-second Kesbury Health assessment. A licensed physician reviews your case, the required baseline panel comes before any sermorelin prescription, and the process is built so the answer can be no.

Start your free 60-second assessment →

Kesbury Health is a LegitScript-certified (#51875982) telehealth longevity practice licensed in ten states. Sermorelin and NAD+ are compounded medications prescribed by a licensed physician after review. Compounded medications are not FDA-approved. This page is educational and is not individualized medical advice. Statements on this page have not been evaluated by the FDA. Individual results vary.

References (primary sources)

Every reference below was checked against its PubMed record on 2026-09-02. Links open the abstract.

  1. Jain T, Mehrotra A. Comparison of direct-to-consumer telemedicine visits with primary care visits. JAMA Network Open. 2020;3(12):e2028392. doi:10.1001/jamanetworkopen.2020.28392. PMID 33289842.
  2. Martinez KA, Rood M, Jhangiani N, Kou L, et al. Association between antibiotic prescribing for respiratory tract infections and patient satisfaction in direct-to-consumer telemedicine. JAMA Internal Medicine. 2018;178(11):1558-1560. doi:10.1001/jamainternmed.2018.4318. PMID 30285050.
  3. Resneck JS Jr, Abrouk M, Steuer M, Tam A, et al. Choice, transparency, coordination, and quality among direct-to-consumer telemedicine websites and apps treating skin disease. JAMA Dermatology. 2016;152(7):768-775. doi:10.1001/jamadermatol.2016.1774. PMID 27180232.
  4. Molitch ME, Clemmons DR, Malozowski S, Merriam GR, Vance ML. Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism. 2011;96(6):1587-1609. doi:10.1210/jc.2011-0179. PMID 21602453.
  5. Clemmons DR. Consensus statement on the standardization and evaluation of growth hormone and insulin-like growth factor assays. Clinical Chemistry. 2011;57(4):555-559. doi:10.1373/clinchem.2010.150631. PMID 21285256.
  6. Iranmanesh A, Lizarralde G, Veldhuis JD. Age and relative adiposity are specific negative determinants of the frequency and amplitude of growth hormone (GH) secretory bursts and the half-life of endogenous GH in healthy men. Journal of Clinical Endocrinology and Metabolism. 1991;73(5):1081-1088. doi:10.1210/jcem-73-5-1081. PMID 1939523.

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