Promoting TRT online: Balanced information lacking

Chicago-Patients taking to the Internet for information about testosterone replacement therapy (TRT) are likely getting an incomplete picture of the potential risks and adverse effects linked with the treatment, say researchers from Northwestern University Feinberg School of Medicine, Chicago, and the University of Pennsylvania, Philadelphia.

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As testosterone replacement has become a popularized and controversial topic in recent years, the authors sought to explore what information patients will encounter when they search the Internet for providers of TRT.

The research, which was recently published in Urology (2015; 85:814-8), evaluated 75 websites and found that the majority were run by nonspecialists, either nonphysicians (36%) or nonurology or nonendocrine physicians (47%). Further, although nearly all (95%) discussed the potential health benefits of TRT, mentioning improvements in sex drive, cognitive function, muscle strength, and/or energy, only about one-fourth provided specific information about TRT’s potential risks. The websites directed by urologists or endocrinologists were twice as likely to include information on potential risks compared to those of the nonspecialists. Nevertheless, possible adverse effects were still only mentioned on 41% of the specialists’ websites.

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Dr. OberlinSpeaking to Urology Times, lead author Daniel T. Oberlin, MD, said that irrespective of website content, he and his co-authors suspect that most providers have a comprehensive discussion about the potential risks and benefits of TRT with patients during clinical encounters. However, the study’s findings raise concern about the information patients are accessing as they consider therapeutic options.

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“We urge all providers of TRT to provide balanced information to patients, and encourage urologists, in particular, to champion their web presence and help optimize the quality and quantity of information available about TRT,” said Dr. Oberlin, urology resident at Northwestern, who worked on the study with Robert E. Brannigan, MD, and Puneet Masson, MD.

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The websites evaluated in the study were identified by a Google search performed in November 2013 using the term “testosterone replacement” and the names of the five most populous U.S. cities (New York, Los Angeles, Chicago, Houston, and Philadelphia). The top 15 unique websites for each city returned in the search were included.

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Some sites refute TRT risks

A more detailed analysis of website content on potential risks showed that not only did about three-fourths of sites not discuss potential risks of TRT, but nine (12%) actually refuted that TRT could be associated with adverse events. Infertility was the most common potential side effect described overall, being mentioned on 41% of specialists’ websites but only about 13% of nonspecialists’ sites overall.

Gynecomastia was the second most commonly mentioned potential risk and was identified by 31% of specialists’ websites and 16% of nonspecialists’ websites. Potential cardiovascular risks were mentioned on 12% of specialists’ websites and on none of the websites under nonspecialist direction.

“As has been made evident by recent FDA Drug Safety Communications, the jury is still out on the possible cardiovascular risks of TRT, and questions about any associations with heart attack or stroke will remain largely unanswered until we have data from well-designed clinical trials,” Dr. Oberlin said.

“In the meantime, urologists should help distill the available information regarding these and other potential risks to patients, providing a balanced framework in which they can consider therapeutic options.”

Dr. Oberlin and colleagues consider their assessment timely and important, recognizing how patients are increasingly turning to the Internet as a source for health and medical information and considering that TRT providers seemed to be working to increase their web presence.

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