Discordance between online information and male hypogonadism clinical guidelines: a global multilingual content analysis
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Context
Testosterone prescriptions have increased up to 12-fold globally over the past 2 decades. EU and UK law tightly regulate the advertising of medical products.
Objective
To review the accuracy of publicly accessible information on websites offering testosterone treatment.
Design/Setting
Content analysis methodology using concept- and data-driven strategies to develop a coding frame for data extraction. Publicly accessible websites offering testosterone prescriptions were identified using predefined search terms, conducted in English, Arabic, Hindi, and Spanish, across 3 search engines. Virtual private network searches within multiple geographical regions were used to reduce location bias.
Main Outcome Measure
Accuracy of extracted data determined using international guidelines.
Results
A total of 253/1138 websites were included (144 US/Canada; 48 Europe; 17 Australia; 12 Asia; 11 South America; 10 Middle East). The following non-guideline-based practices (with numbers/percentages of clinics) were identified: routinely use nontestosterone androgens or testosterone secretagogues (eg, gonadotrophins) to treat symptomatic low testosterone (61/253; 24.4%); testosterone treatment reduces cardiovascular risk (52/253; 20.6%); microdosing improves treatment effects (30/253; 11.9%); testosterone is prescribed for men with normal serum testosterone (>12 nmol/L; 25/253;9.9%); testosterone has antiaging effects (25/253; 9.9%). US-based clinics more frequently made non-guideline-based claims compared with other geographical locations.
Conclusion
We identify serious and frequent breaches of advertising law and regulations by clinics around the world offering testosterone treatment, with the potential to cause harm to men. We recommend enforcement of existing laws by national regulators to address this widespread public health challenge and align patient expectations with clinical guidelines for the safe treatment of men.
Testosterone prescriptions have increased up to 12-fold globally over the past 2 decades. EU and UK law tightly regulate the advertising of medical products.
Objective
To review the accuracy of publicly accessible information on websites offering testosterone treatment.
Design/Setting
Content analysis methodology using concept- and data-driven strategies to develop a coding frame for data extraction. Publicly accessible websites offering testosterone prescriptions were identified using predefined search terms, conducted in English, Arabic, Hindi, and Spanish, across 3 search engines. Virtual private network searches within multiple geographical regions were used to reduce location bias.
Main Outcome Measure
Accuracy of extracted data determined using international guidelines.
Results
A total of 253/1138 websites were included (144 US/Canada; 48 Europe; 17 Australia; 12 Asia; 11 South America; 10 Middle East). The following non-guideline-based practices (with numbers/percentages of clinics) were identified: routinely use nontestosterone androgens or testosterone secretagogues (eg, gonadotrophins) to treat symptomatic low testosterone (61/253; 24.4%); testosterone treatment reduces cardiovascular risk (52/253; 20.6%); microdosing improves treatment effects (30/253; 11.9%); testosterone is prescribed for men with normal serum testosterone (>12 nmol/L; 25/253;9.9%); testosterone has antiaging effects (25/253; 9.9%). US-based clinics more frequently made non-guideline-based claims compared with other geographical locations.
Conclusion
We identify serious and frequent breaches of advertising law and regulations by clinics around the world offering testosterone treatment, with the potential to cause harm to men. We recommend enforcement of existing laws by national regulators to address this widespread public health challenge and align patient expectations with clinical guidelines for the safe treatment of men.
Date Issued
2026-06-01
Date Acceptance
2025-12-19
Citation
Journal of Clinical Endocrinology and Metabolism (JCEM), 2026, 111 (6), pp.1651-1663
ISSN
0021-972X
Publisher
Oxford University Press
Start Page
1651
End Page
1663
Journal / Book Title
Journal of Clinical Endocrinology and Metabolism (JCEM)
Volume
111
Issue
6
Copyright Statement
© The Author(s) 2026. Published by Oxford University Press on behalf of the Endocrine Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. See the journal About page for add itional terms.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/41489427
PII: 8414025
Subjects
TRT
andropause
content analysis
male hypogonadism
testosterone
Publication Status
Published
Coverage Spatial
United States
Article Number
dgaf689
Date Publish Online
2026-01-05