Algorithmic Prescriptions
Taking a trip to the Doctor's office (Instagram)
Pharmaceuticals on Feed
My Instagram algorithm is cooked. Not my feed, where I see the ins-and-outs of the lives of my beloved 811 mutuals. Not even my explore page, which is a wholesome mix of improbable golf trick shots and increasingly esoteric dogs from Japan and Korea. Compared to the explore pages of some other late 20s straight men1, mine is positively puritan. Even the famously cursed TikTok Algorithm is pretty palatable. Right now I have a healthy mix of kettlebell workouts, tarot readings, motivational slideshows, sad slideshows, break-up coaching,2 and dogs that can stand. But Instagram ads (mostly in my Stories) are another thing entirely. For most of the last year, my ads have been innocuous; primarily expensive knitwear and the occasional Headspace or Calm ad. But recently, there has been a vibe shift. Here are just a few advertisements I’ve been served:
Minoxidil (hair growth)
Finasteride (hair growth)
Ozempic
Antidepressants like Lexapro
Nootropics
Viagra/Cialis3
Therapeutic ketamine (Mindbloom/Joyous)
Invisalign alternatives
Something called “Hostage Tape”
You might say, Caleb, you realize that your own internet activity4 drives what ads you see, didn’t you google “alopecia in sideburn’s” five times last week? To which I would say, Yes! That’s absolutely something I’m insecure about, but how and why am I being targeted for hormone-altering treatments on social? Don’t I have to go see a doctor?
Now, I am famously not against making life-altering purchases off Instagram. I bought my bed frame off Instagram and my mattress off Instagram. I even take probiotics that are advertised incessantly on all platforms. The only thing I categorically refuse to buy is clothing. Copping off the feed is pathetic!
This genre of advertising is troubling, but there are some positives; the number one being accessibility. I used to drive two goddamn hours each way to therapy5 to get diagnosed with absolute nonsense and eventually, prescribed Lexapro, a devious little drug that saved and ruined my life in equal measure. Point being, there are helpful medications out there that people either aren’t aware of, aren’t able to get on their own,6 or in the case of many meds, are too ashamed or embarrassed to seek help non-digitally. Someone struggling with depression, balding, erectile dysfunction, or just some really beat teeth might not know where to start.
It’s true that these tele-health services just make shit way easier. I was able to get sleep apnea treatment from home without having to jump through the hoops of referrals and in-person visits I’d need otherwise. After several months and a lot of money, I had my own mouthguard!7
But for some of these issues, should making shit easier really be the goal?
Side Effects
Some of the medications on the list above are advertised appropriately. Oh, you are struggling with hair-loss? Topical minoxidil or oral finasteride may help.8 These medications are specifically designed to combat hair loss, and the side effects (while sometimes gnarly) are well documented. At the very least, if I go down the path of taking one or both of these pills, I know I am taking a hair-loss drug that was designed to combat hair-loss and is advertised as such.
However, there are other cases where the medical solution is much murkier to the consumer. The condition here will be familiar to my beloved 21 subscribers: premature ejaculation. The obsession with “lasting longer” is a ubiquitous part of growing up for most dudes. Companies like Hims and Roman run frequent and costly social media campaigns that play directly on these insecurities. Many male-led podcasts in the 2020s have advertised products such as Roman Swipes, a product that literally numbs genitalia in exchange for a few more minutes of sex.9 And alongside treatments for ED and hair loss, the silver bullet of “lasting longer” is also promised.
A few major red flags from the page above. For one, the use of “off-label” raises my hackles. But let’s take a closer look at what these medications actually do.
Sildenafil: Generic for Viagra. Some side effects including increased risk of heart failure. But at least it is a drug designed for sex.
Sertraline: Generic for Zoloft. An SSRI10 traditionally used to treat depression, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), social anxiety disorder, and panic disorder. A very intense drug with intense side effects like: nausea, weight gain, dizziness, dry mouth, etc.
Paroxetine: Generic for Paxil. An SSRI used to treat depression, panic attacks, obsessive-compulsive disorder (OCD), anxiety disorders, premenstrual dysphoric disorder (PMDD), and post-traumatic stress disorder (PTSD). Another intense drug with intense side effects.
After clicking on an ad and briefly conversing with a chatbot,11 all of these treatments can be yours! The cute little screenshot above lays out a few options, and the framing here is important. Take Viagra (🥱) and potentially delay ejaculation, take Sertraline and increase time to climax by 400% (😍), or take Paroxetine and last 9-12x longer12 (😳).
Does this screen mention any details about these medications outside of the fine print? Of course not. From the look of the ad, Setraline and Paroxetine are simply more potent methods of tackling the problem. Outside of fine print, is there any definition of what an SSRI is? Of course not, just some sexy copy that “being ready to go at any time” is “hot”.
Essentially, these “treatments” promise to cure PE by back-dooring antidepressant side effects. SSRIs are notorious for delaying or restricting climax entirely, and sometimes at high doses, even killing sex drive completely. Is there appropriate due diligence on the cause of concern for the patient and suggestions for intermediate treatments before getting on SSRIs? Of course not, in the Hims Hospital the chatbot residents are just there to make quota. You might gain weight, be permanently fatigued, and actually lose the sex drive you are trying to desperately to sustain; but hey, at least you lasted 15 minutes! Ultimately, working on anxieties and finding sexual partners who like you and make you feel comfortable is a far more sustainable remedy than these meds.13 But honestly that sounds way more difficult than answering a couple questions and taking a pill everyday (shipped discreetly of course).
Anxiety and the Power of Suggestibility
In the same way Cialis ads took the 50-65 male demo of the Golf Channel by storm in the early 2000s, Instagram is doing the same for the anxious over-medicated 20 and 30-somethings of today. Multi-billion dollar companies like Hims and Roman are positioned as one-stop shops for male insecurities. Hell, you might not even have any of these issues; but after seeing another ad on hair loss you might notice a bit of recession at the temples and click a link, after seeing a Tend dental ad you might notice the cross-bite your dentist used to trip about, or after seeing an ad for ED/PE, you might think back to old should’ve/would’ve/could’ve feelings of sexual inadequacy. So many things to worry about! So many modern solutions!
The ads reinforce the insecurities and the insecurities reinforce the ads. The internal monologue of someone subject to this boner-pill barrage is quite depressing!14 Am I balding, should I be getting rock hard and lasting 45 minutes, do I need to take ketamine once a week and do guided meditations15 to keep the demons at bay?16
These concepts are pernicious and present far outside the realm of Instagram ads and prescription meds. Every day, influencers, brands, and regular folks push all kinds of supplements, treatments, and holistic cures for a massive range of issues. How many ladies get native advertisements17 for face sculpting massages, botox, filler, boob jobs, and other procedures?18
Social media has always caused harm by creating an environment of inadequacy driven by watching highly edited people live highly curated lives. But now, the steps to resolving those inadequacies are advertised in the very same feed. Oh that girl who was mean to you in high school has an insane body now, don’t fret, here’s an Ozempic ad so you can get snatched too!
The future is here: the algorithm knows what’s going wrong, and it knows how to fix it. In a vacuum this is great! Medicine is great when it solves problems. But as the telemedicine-pharma complex grows, so will the systemic desire to stoke insecurity and push the newest and easiest medication to treat that symptom and create ten more symptoms on the back-end.
I’d be shocked if there weren’t some big law suits around these companies in the next 10 years around these misleading advertisements and blasé prescription processes.19 Telehealth can be revolutionary and accessibility to affordable medication can be life-saving. The anti-depressants discussed above have undoubtedly helped countless people, maybe even saved lives. But they are anti-depressants, not a quick fix for sexual deficiencies. The bar to get a package shipped to your door that may alter your body and brain forever is shockingly low.
Editor’s note: All research for this piece was done in the pursuit of journalism, and had nothing to do with any of the author’s numerous anxieties, deficiencies, and insecurities
Turns out OnlyFans is a really good business
Many suggested starting a trimonthly culture substack
The old Cialis commercials with the couple in bathtubs was my sexual education
I saw one Hims ad for Cialis that I found hilarious and sent it to several people, I think that was the beginning of my downfall
“OMG you are in therapy 😍😍😍” (I’m actually taking a break right now ladies thank you though mental health is SO important)
Maybe they aren’t able to afford to even see a therapist or anyone who might prescribe Lexapro
I still snore
Hims actually sells a combo of these medications in a chewable, in case you are a child experiencing male-pattern-baldness
The implementation of this product has always fascinated me: how do you excuse yourself to go to the bathroom and use the wipe? Does it leave a smell? Taste? Wouldn’t it also numb your partner’s sensations? Why would anyone use this?
Mayo Clinic definition:
“SSRIs treat depression by increasing levels of serotonin in the brain. Serotonin is one of the chemical messengers (neurotransmitters) that carry signals between brain nerve cells (neurons).
SSRIs block the reabsorption (reuptake) of serotonin into neurons. This makes more serotonin available to improve transmission of messages between neurons. SSRIs are called selective because they mainly affect serotonin, not other neurotransmitters.
SSRIs may also be used to treat conditions other than depression, such as anxiety disorders.”
I know that technically there are doctors involved, but it gives a very “went to medical school out of country vibe”
This seems like too long
This advice is very “cure your depression by drinking water, exercising, and meditating”-core, but true human connections solves a lot of these issues!
Not me obviously, I purposefully bombed my algorithm to educate my readers
Guided meditations are just mediations but a white dude is whispering during it
I might need to be doing all these things tbh
“Native” defined in this case as an influencer getting one of these treatments comped in return for a video
Ladies? Ladies?????
The BetterHelp lawsuit is a good example of this concept in action: https://www.ftc.gov/business-guidance/blog/2023/03/ftc-says-online-counseling-service-betterhelp-pushed-people-handing-over-health-information-broke