Background
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.
Aim
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.
Methods
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.
Results
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.
Conclusion
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.
