Endocrine Abstracts

Background: Worldwide testosterone prescribing has increased markedly within the last 20 years; this is partly due to increased testosterone seeking behaviour among men with age-related co-morbidities, obesity, and type 2 diabetes. Healthcare websites are the major source of information on male hypogonadism for the male population. A growing number of private ‘men’s health clinics’ have emerged specialising in male hypogonadism treatment. It is not known how closely publicly available information on male hypogonadism mirrors clinical guidelines.

Methods: Virtual private networks were used to conduct localised web-searches within Australia, Brazil, India, South Africa, United Kingdom and the United States using pre-defined terms. Searches were conducted in English, Hindi, Spanish and Arabic using three major platforms (Google, Yahoo and Bing). After duplicate removal, a coding frame was developed using a validated methodology. Identified themes were graded by concordance with consensus from international guidelines on male hypogonadism.

Results: Data were extracted from 176 websites (USA 59.7%; UK 16.5%); 86/176 (48.9%) were advertised as ‘Men’s Health Clinics’. 141/176 (80.1%) websites advertised at least one clinical practice discordant with male hypogonadism clinical guidelines. Specific discordant claims were as follows: testosterone treatment with a serum total testosterone >12nmol/l (19/176, 10.8%); recommending unlicenced drugs e.g. selective oestrogen receptor modulators or gonadotrophins (32/176, 18.2%) or non-testosterone androgens (11/176, 6.3%); recommending testosterone micro-dosing (18/176, 10.2%); claiming testosterone improves psychological symptoms despite lack of evidence consensus (99/176, 56.3%).

Conclusions: We utilised validated content analysis methodology with approaches mitigating geographical and linguistic bias to provide an unbiased appraisal of information accessible to symptomatic men in different geographical regions. We identified several areas where men are being encouraged to seek non-evidence-based treatment for their symptoms. Addressing the accuracy of publicly assessable data may offer a simple approach to improve the quality of healthcare for symptomatic men and restrict inappropriate testosterone treatment globally.