Elsevier

Urology

Volume 85, Issue 4, April 2015, Pages 814-818
Urology

Infertility
Testosterone Replacement Therapy and the Internet: An Assessment of Providers' Health-related Web Site Information Content

https://doi.org/10.1016/j.urology.2014.11.043Get rights and content

Objective

To compare how providers of testosterone replacement therapy (TRT) in large metropolitan cities promote androgen replacement on their patient-oriented Web sites.

Materials and Methods

TRT provider Web sites were identified using Google search and the terms “Testosterone replacement” and the name of the 5 most populous US cities. These Web sites were assessed for (1) type or specialty of medical provider, (2) discussion of the benefits and risks of TRT, and (3) industry affiliations.

Results

In total, 75 Web sites were evaluated. Twenty-seven of the 75 clinics (36%) were directed by nonphysicians, 35 (47%) were overseen by nonurology or nonendocrine physicians, and only 13 (17%) were specialist managed. Fourteen of 75 (18.6%) Web sites disclosed industry relationships. Ninety-five percent of Web sites promoted the benefits of TRT including improved sex drive, cognitive improvement, increased muscle strength, and/or improved energy. Only 20 of 75 Web sites (26.6%) described any side effect of TRT. Web sites directed by specialists were twice as likely to discuss risks of TRT compared with nonspecialist providers (41% vs 20%; odds ratio = 2.77; P <.01). Nine of 75 (12%) of all Web sites actually refuted that TRT was associated with significant side effects.

Conclusion

Urologists and endocrinologists are in the minority of providers promoting TRT on the Internet. Specialists are more likely to discuss risks associated with TRT although the majority of surveyed Web sites that promote TRT do not mention treatment risks. There is substantial variability in quality and quantity of information on provider Web sites, which may contribute to misinformation regarding this prevalent health issue.

Section snippets

Materials and Methods

We used a methodology for our Internet search based on systematic literature reviews, using standardized search string techniques; our methodology was in accord with the American Public Health Association criteria regarding the assessment of quality of health information on the Internet.15 We searched English-language Internet Web sites in November 2013 using the search engine Google. The search engine Google was selected based on contemporary market data showing that Google is the most

Results

The results for 75 provider Web sites offering TRT were assessed. Sixteen Web sites were excluded because they were duplicates of already included Web sites. Two sites were excluded because they lacked evidence of the provision of TRT. Figure 2 displays the type of leadership at the clinic Web sites we assessed. A total of 27 of the 75 (36%) Web-advertised TRT clinics were directed by nonphysicians. Thirty-five clinics (47%) were directed by nonurology, nonendocrinology physicians, and only 13

Comment

As patients increasingly turn to the Internet for medical information, the quality and quantity of this information is critically important. As noted by the American Public Health Association, health-related Web sites often “blur the lines” between providing objective, factual, medical information vs providing promotional content and advertising material without proper disclosures.15 Patients using the Internet may be unaware of the differences and might be unable to discriminate between these

Conclusion

The Internet remains an open public forum for the wide-ranging dissemination of information. Web sites for clinical centers discussing the therapeutic uses of TRT often lack accurate health information as called for by the American Public Health Association. Unfortunately, the line between health education and advertising or promotion is often blurred within these provider Web sites. Web sites for clinical centers managed by either nonspecialist physicians or providers who are not physicians

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  • Cited by (0)

    Financial Disclosure: The authors declare that they have no relevant financial interests.

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