Editor’s Note: This editorial from author Helen Donahue was originally published on Playboy.com in May 2019.

Hers describes itself as a “one-stop shop for women’s health and personal care providing medical grade solutions for skin care, birth control, and sexual health.” Best known for their deliciously corny advertisements, the offshoot of Hims is a nice thought. It’s meant to eliminate trips to the pharmacy by delivering products to your door with an easy “online medical assessment.” And seeing as Hims—which specifically offers masculine-identifying people products and medication for common issues like hair loss and erectile dysfunction—is reportedly worth $1 billion, why wouldn’t the makers do the same in the women’s wellness space?

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There are a few things that are problematic about the brand launched in late 2018—one being the gendered messaging that alienates those who identify as non-binary. Still, nothing is quite as problematic as what they’re actually selling. In March, Hers began marketing Propanolol—a beta-blocker used to treat heart conditions and, off-label, anxiety—via Facebook and Instagram to consumers with copy that reads as harmless as a CBD ad: “Nervous about your big date? Propranolol can help stop your shaky voice, sweating and racing heartbeat,” with no mention of serious side effects (extreme fatigue, dizziness, etc).

I thought to myself, “Who said okayed this? Was it posted without review? How are they getting away with this? And without listing side effects? Is that even legal?”Instagram users agreed with me too. Followers responded with comments like, “What the fuck is wrong with you?!” alongside an abundance of “shame on you!” followed by statements like, “You’re treating a serious medication as if it’s candy,” and “ANXIETY ISSUES SHOULD BE TREATED BY REAL DOCTORS NOT A FUCKING INSTAGRAM PAGE.” Sure, us millennials spend too much time staring at screens. Sure, there are a few of us who tend to respond with too much passion to benign or completely irrelevant matters, but this outrage, to me, is warranted.

Psychiatrist Sarah Oreck, MD, who specializes in women’s mental wellness, tells me direct-to-consumer drug advertising is, in fact, legal in the United States and regulated by the FDA, though “it’s noteworthy that most developed countries, including most European countries, have much stricter guidelines and outright bans on these practices.”

“The doctor-patient relationship is one that is forged over time. [I’m] concerned about the inherent conflict interest when the company marketing the medication also employs the physicians prescribing it.”

Hers isn’t breaking any laws, but they are skipping into a grey area that surrounds advertising medication on any social media platform. “There are guidelines for more traditional forms of advertising including those in TV and magazines that do require the listing of known side effects,” Oreck explains. “Hers advertising on social media without the mention of any side effects illustrates the difficulty our government and regulatory agencies have keeping up with new tech,” Oreck says.

Still, legality aside, consumers have a right to be angry. How can a company essentially suggest women medicate themselves before a first date to avoid harmless jitters that accompany feeling nervous about spending time with a new person? A new dependence on dating apps means women have to be more alert than ever since they may have no connection to their date other than a selfie. But if a beta-blocker is dulling your senses, you’re not thinking as clearly.

Beta-blockers work by impacting the body’s epinephrine hormone (or adrenaline) and suppressing some of the more overwhelming physiological symptoms of anxiety, like sweaty palms and a racing heart. But it’s natural to feel like you might throw up on a first date, and anxiety can be useful to make decisions based on how you’re genuinely feeling in a situation, especially if you’ve been drinking. Drinking on Propranolol, while technically safe, can make one shot of whiskey feel like five shots. Propranolol also weakens the all too familiar “flight or fight” response we feel when we’re nervous.

Through direct-to-consumer prescription Propranolol, Hers appears to be gambling with a pretty precarious approach to mental health: Even if taking a beta-blocker before a date is safe for one person, it doesn’t mean it will work for all, and without hazard. What happens if someone suffers adverse side effects? Does Hers take the blame or is it on the consumer for not reading the fine print (which specifies you should call the Poison Help line in case of overdose, though Hers allegedly has 24/7 support to answer “any questions or address concerns” about medication).

After enduring their first Instagram embarrassment, Hers issued a pretty audacious non-apology, meaning “sorry” did not make it into the statement, alongside a carousel of photos urging angry onlookers to believe that Hers doesn’t take prescription medication lightly. The company offered a live questionnaire session (also known as “ask me anything” or AMA) with a Hers physician through Instagram Stories (which is difficult for newcomers to their product to find as it’s under a Story Highlight bizarrely titled “aha! Telemed.”). Unfortunately, the discourse was text-only and didn’t have any actual live discourse with a physician. Consumers weren’t buying Hers’ explanation or the AMA, subsequently accusing the brand of having cherry-picking questions and ignoring arguably the most important ones—like those surrounding the ethicality and legality of their advertisement on its own or if, at the very least, it broke Facebook and Instagram’s hard guidelines.

The company is oblivious. Yes, suggesting women take off-label anxiety medication before first dates is wrong, that’s a given, but how is it okay to market a prescription drug in a millennial-branded, pocket-sized pouch? They list Propranolol under their “Well-Being” tab, right next to a bottle of cute, teddy-bear-shaped gummy Biotin vitamins that allegedly can “help strengthen your hair, nails, and skin.” The difference between the two medications is noticeable: one is a vitamin, and the other is potentially dangerous if consumption is unmonitored, but both are being sold like any other wellness product.

Packaging anxiety and depression as “wellness” seems like smart business…if you can ignore morality. Who wouldn’t want to do whatever they can to cash in on the wellness industry; an industry that,according to a 2018 study by the Global Wellness Institute, has grown from $3.7 trillion in 2015 to $4.2 trillion in 2017. Millennials, after all, have been dubbed the “anxious generation.” We’re the first generation raised with the internet, flanked by student loans, burned out at higher rates, likely impacted by the 2008 recession and the ever-intensifying doom that comes with political climate and a nonstop news cycle. We’re scared. We make jokes about anxiety, depression and suicide on social media and thousands share under the guise of relatability.

In 2018, Blue Cross Blue Shield found that depression is up 47 percent among American millennials, anxiety disorders are the most commonly diagnosed mental illness, and suicide rates are up 33 percent since 1999. The generation immediately after millennials, gen Z, isn’t far either; they’re the first generation that’s grown up with social media have their own uniquely stressful experiences, like the collective anxiety surrounding mass shootings in the United States. A whopping 91 percent of gen Z are stressed, according to the American Psychological Association, and their fear is manifesting itself in anxiety and depression. Why wouldn’t we see brands cropping up attempting to capitalize on our mental health?

“If it’s normal anxiety, you don’t need medication for it. “

But anxiety is also an inherent part of the human condition, and we shouldn’t be turning to medication for every minutely anxiety-inducing matter we endure. “I think we have to be careful about medicating parts of our normal human experience and personalities,” Oreck tells me. She’s not wrong, and that’s why it’s so disconcerting that Hers—while they did finally remove the controversial first date ads—is still running promos for Propranolol for “job interviews” and other performance-based anxieties (Hers, in their AMA, communicate that “performance anxiety strikes all kinds of people, including athletes, students, and public speakers”). The product is still for sale on their website; Hers has not indicated they’ll be removing it any time soon.

Hers has also considerably hiked the price of Propranolol. Five pills for $25. Every psychiatrist I spoke to for this story asserts consumers could go to a physician, receive a prescription (if it truly suits their needs), and pay considerably less than $25 for a 30-day-supply at an approved pharmacy—a supply that could last them a year. Oreck tells me, “Propranolol is an old and cheap medication,” and claims she “found a coupon from a drug store in LA that charges $3.00 for 60 pills” with a prescription. “Do these consumers even get a prescription they could take to a physician?” psychiatrist Aruna Kodali, MD asks, “or do they have to keep purchasing it through Hers at a higher cost?” Hers’ AMA claims patients can only receive “a maximum of 5 Propranolol 20mg pills in a single month,” which suggests the packages are indeed subscription-based.

Patients can obtain the Propranolol through an online consultation with a Hers-staffed physician alone, though it’s unclear what the digital meeting entails. Oreck asserts, “from the low cost, it is likely a limited amount of time,” adding that physician fees are typically much more costly than $25. Though Telemedicine can be an excellent tool, it’s usually only practiced by doctors who have established relationships with their patients, especially in the mental health space. “The doctor-patient relationship is one that is forged over time,” Oreck asserts. “[I’m] concerned about the inherent conflict interest when the company marketing the medication also employs the physicians prescribing it.” According to Hers’ AMA, their patients are required to fill out a “comprehensive health history questionnaire” that is ultimately rerouted to an MD in the patient’s state.

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Not only are online physicians unable to complete routine screenings to check if the patient’s blood pressure and heart rate are normal (remember, beta-blockers are FDA-approved for heart conditions), but physicians ordinarily prefer to observe the patient in the flesh to suitably evaluate their needs. Doctors speak at length with subjects to assess their needs and develop treatment plans depending on if the patient is on other medications or undergoing additional anxiety treatments like Cognitive Behavioral Therapy. Doctors also want to be able to judge that nothing else is wrong with the patient, and if something is, refer them to a specialist that can actually help them. Before prescribing anxiety medication, most specialists require proper medical diagnosis, especially before prescribing an off-label drug. After all, as Kodali points out, “Propranolol is, first and foremost, a cardiac medication.”

On top of it all, a psychiatrist (who wishes to remain anonymous) warns me Propranolol could exacerbate depression and doctors should be extremely cautious of prescribing the beta-blocker to someone who uses drugs recreationally or may have bipolar disorder or other mental disorders. Kodali says before prescribing Propranolol, which no doubt can tentatively relieve anxiety symptoms as what she calls a “band-aid” medication, she needs to know: “Is the patient having generalized anxiety? Panic anxiety? Is something more severe going on other than situational or performance anxiety?” While Hers’ AMA insists their doctors are able to tell the difference, it seems difficult to assess someone’s physiological anxiety symptoms over video chat. “Anxiety is totally normal,” Kodali tells me. “If it’s normal anxiety, you don’t need medication for it. Propranolol can be useful for real disorders, but you can only discover that through a thorough evaluation.”

Oreck echoes Kodali’s sentiment, and adds that “anxiety can also sometimes be a manifestation of thyroid dysfunction,” but there’s no way of being made aware of an underlying cause without in-person visits. Hers makes it seem like Propranolol is a beneficial pill anyone should be able to easily secure, but it’s a drug, not a vitamin. It’s not for everyone. The company claims the “highly qualified” physician can perform “comprehensive evaluations” and “have the experience and training to distinguish forms of anxiety.” At the same time, the company admits it “relies on patients to provide accurate information” during the process. Hers’ website also suggests they do offer online follow-ups for $5, which hardly seems like an amount that could allow enough time to truly assess a patient’s experience with a medication, or hear them speak about the very thing they’ve come to Hers for: their anxiety.

Propranolol isn’t the only drug Hers is vending on their website. They’re also selling birth control (which, okay) and Addyi (Flibanserin), a drug used to treat “hypoactive sexual desire disorder.” Interestingly, Addyi is meant to treat low libido in women, a symptom that Propranolol can cause and exacerbate. And the thing about Addyi is that it barely passed FDA inspection, after previously failing it twice, and remains a controversial treatment choice. So, while it’s approved, it’s not exactly an ideal remedy for low libido. Even if it’s touted as “the female Viagra,” the drug isn’t like Viagra at all: Unlike Addyi, Viagra does nothing for psychological stimulation. Viagra can also be taken as needed, while Addyi is a daily medication that impacts dopamine and serotonin, not unlike antidepressants. Taking Addyi is a daily commitment—one that, among other treatment methods, should be considered with a general practitioner, not a doctor you just met through your computer camera.

And as far as Hers’ dainty, minimalist marketing goes, it’s unknown if its condom-sized, baby blue pouch offers any medical information on the back (the front details merely what’s inside, unlike a prescription pill bottle). Another packaging problem is that these pouches are not childproof, something adults without kids take for granted with those orange, annoying-to-open bottle. “If it’s as easy to open as it appears, this could pose a significant risk to children,” Oreck affirms. Their scanty packaging for so few pills could be a way to save money as larger plastic bottles—like the ones Hers sells their Addyi in—are more costly than thin plastic throwaways.

It’s also unknown where Hers’ Propranolol comes from at all. Unlike Addyi, which on Hers’ website implies but does not unreservedly state comes from an “exclusive Addyi partner,” there’s no such implication for Propranolol. “If you’re ordering medication on the internet, you don’t necessarily know what you’re getting if it’s not approved by the FDA or from an approved pharmacist,” adding, “that’s kind of the point” of picking up prescriptions from a pharmacy: that you’re fully aware of the contents of your medication.

Despite the controversy, Hers (and similar direct-to-consumer medication vendors) is unlikely to fade anytime soon. Their advertisements have been plastered all over New York City and the NYC Subway since late 2018, photos of which they proudly share on their Instagram page alongside their exquisite marketing and branded campaigns (they teamed up with Planned Parenthood in February to expound on safe sex).

I have failed to find anyone who consumes Propanolol through Hers, but that doesn’t necessarily means they don’t exist—mental illness is still highly stigmatized and admitting you take medication, or believe you need it, can be uncomfortable. I assume these particular customers hope to skip the dreaded doctor’s office waiting room out of shame and desire to carry their pills in a discreet package. And who better to market a fun-sized medication pouch to than women who feel humiliated if a tampon falls out of their bag?

Hers feels like a symptom of a dilemma much more significant than occasional performance anxiety—rather a lack of resources to promote affordable and effective treatment for mental health issues and the lack of true stigmatization. The truth is that whether or not we cloak our depression and anxiety in shareable memes, having frank conversations about mental health—especially women and marginalized group’s mental health—just isn’t happening on the scale it needs to be to create change. We’re living in an increasingly isolated world where brands play on our addiction to instant gratification: we can order take-out or groceries for immediate delivery, have our laundry picked up and returned to us, arrange for a car to take us from point A to point B, pay for a person to build our Ikea furniture and so on.

The dependency we have on the screens in front of us is increasing, but not everything that can be should be redirected to our smartphones. Prescription medication is one of those things.

When Playboy reached out for comment, Hers responded with the following statement:

*Only a licensed physician is in the position to know the risks and benefits of a certain medication and whether it’s the best option for a patient. We created the platform to help make that conversation possible without judgement or stigmatization and to ensure that everyone has the ability to access safe, clinically proven and affordable treatments if determined by their doctor to be medically appropriate.

While there are restrictions imposed by the FDA on drug manufacturers and certain distributors with respect to promotion, hims and hers are neither drug manufacturers or distributors. We believe that, when a physician deems it appropriate, patients should have access to treatments that have demonstrated to be safe and effective.*