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Authors Oberlin DT, Masson P, Brannigan RE
Review Date April 2015
Citation Urology 2015; 85: 814-818
Testosterone use has increased dramatically over the past 10 years or so in the USA (and in Australia). In the USA there are now many providers of testosterone replacement therapy (TRT), including walk-in clinics. In all areas of medicine, many patients are using the Internet to find health information and providers of testosterone therapy are increasingly using the Web to promote such therapies, with information of varying quality. There is concern that some web-based information is promoting the benefits of TRT much more so than potential side-effects.
The authors aimed to compare how providers of testosterone replacement therapy (TRT) in large US metropolitan cities promote androgen replacement on their patient-oriented websites.
The authors identified that Google was the most commonly used search engine. They used a standardised search string technique, similar to systematic literature review methodology, in accord with the American Public Health Association criteria for assessing quality of health information. TRT provider websites were identified using Google search and the terms “testosterone replacement” and the name of the five most populous US cities. These websites were assessed for (1) type or specialty of medical provider, (2) discussion of the benefits and risks of TRT, and (3) industry affiliations.
The authors assessed 75 websites. Twenty-seven of the 75 clinics (36%) were directed by non-physicians, 35 (47%) were overseen by non-urology or non-endocrine physicians, and only 13 (17%) were managed by specialists. Fourteen of 75 (18.6%) websites disclosed industry relationships. Ninety-five percent of websites promoted the benefits of TRT, citing at least one benefit: improved sex drive, cognitive improvement, increased muscle strength, and/or improved energy. Only 20 of 75 websites (26.6%) described any side-effects of TRT. Websites directed by specialists were twice as likely to discuss risks of TRT compared with non-specialist providers (41% vs 20%; odds ratio = 2.77; P < 0.01). Only 12% of websites of clinics managed by specialists mentioned possible cardiovascular risks of TRT and 0% of websites of non-specialist services. Nine of 75 (12%) of all websites went as far as refuting that TRT was associated with any side-effects.
This study of US websites showed that specialists (urologists and endocrinologists) are in the minority of providers promoting TRT on the Internet. Specialists were found to be more likely to discuss risks associated with TRT, although most of the reviewed websites do not mention treatment risks, including many of the specialist clinics. There is substantial variability in quality and quantity of information on provider websites which can contribute to misinforming patients about the benefits and risks of testosterone replacement, especially given many men may seek information on the web.
Points to Note
- Patients are increasingly turning to the internet for health information but may not be able to discern good quality evidence-based information from poor quality information or even advertising material that is not properly disclosed.
- Testosterone replacement therapy is an area that is being promoted heavily on the internet especially to older men.
- Although this was a study of American websites, the fact that many sites, even those managed by specialists, were found to not provide the full range of risks (or any risks) of testosterone therapy has relevance for Australians; men may be accessing these sites directly on the internet if they come up in Google searches or other sites accessed by Australian men may have similar problems.
- This study highlights the importance of talking to patients about information taken from the internet as part of broader discussions about pros and cons of treatments or in the case of testosterone, the unrealistic expectations of benefit given by some promoters of TRT.
- The websites managed by specialist physicians provided more balanced information, particularly compared to those of non-physician orgnanisations which may have had a commercial interest in promoting testosterone.
- Limitations of the study are that only a limited number of websites were reviewed and they were only from specific metropolitan areas of the USA. The authors did not assess the popularity of the website via number of hits or other measures.