Beware Urological Misinformation Aimed at Men on Social Media

One of the research papers presented at the AUA conference focused on videos related to testosterone issues, in addition to several other male urological conditions, such as erectile dysfunction (ED) and infertility. With difficult-to-discuss subjects like these, it's hardly a surprise the videos enjoy a wide audience.

"These men's health topics are sensitive: erectile dysfunction, premature ejaculation, decreased sex drive and fertility issues," said Justin Dubin, M.D., the recently named director of men's health at Memorial Healthcare Systems in Hollywood, Florida, and the lead author of one of the studies. "So they don't talk about it. And if they don't talk about it, where do these guys go when they have a problem? They go to the internet and social media."

Dubin and his team sought the top 10 hashtags for each of six topics on Instagram and TikTok. The topics were:

1. Vasectomy
2. Erectile dysfunction
3. Peyronie's disease
4. Testosterone
5. Male infertility
6. Semen retention

Then they took the top 20 videos on TikTok based on views and the top 20 posts on Instagram for likes (both referred to as "impressions" from here forward) for each of those hashtag terms and analyzed the quality of the information presented, as well as who was doing the presenting.

Here's what they found:

• Instagram had more than 900,000 impressions for testosterone-related hashtags.
• TikTok had 700 million such impressions.
• Among the top 40 videos for impressions on each platform, only three posts in total—two on Instagram and one on TikTok—were created by someone claiming to be a physician.
• Among the three physician posts, one was evaluated to be accurate, one inaccurate and one was posting promotional content.
• Of the videos claiming to be "educational," 52.6 percent of the Instagram posts provided accurate information, while just 29.9 percent of the TikTok educational videos did.

As mentioned in the opening installment of this series, one of the most fascinating subcommunities of the online bro-science world is centered around withholding ejaculation, or semen retention. This practice is based on the notion that not ejaculating for weeks or even months—that means no partnered sex or masturbation—provides health, emotional and even spiritual benefits.

The idea probably developed out of Reddit's "no-fap" community, a variously anti-masturbation and anti-porn addiction subreddit.

But of the guys who do cite sources on TikTok and YouTube semen retention videos—to be clear, most of them don't bother with sources—many are likely to be looking at dubious science in the first place.

Dubin took issue with a couple of papers that have been improperly referenced by semen-retention advocates.

"One, I think, was actually retracted in December of 2021 about how withholding semen can increase your testosterone," he said. "But this was all increases after you ejaculated, so it didn't even make sense [that the study would be used to promote semen retention]. And the way it was interpreted was completely wrong. There was no proof of any benefit of retaining semen."

But as is often the case with social media medical misinformation, even the glaring, logical inconsistencies contained within the tenets of bro-science don't really matter. Take the common claim in the semen retention community that if you stop ejaculating, not only will it increase your testosterone, but your skin will clear up.

"As an andrologist who gives men testosterone, one of the things we always ask when we give them testosterone is if they've developed acne, because they're at risk for it," Dubin said. "Think about the teenager who goes through puberty and has increased testosterone: They often have increased acne. So it literally makes no physiological sense. It makes zero sense and there's no data to support it."

But confused young men wondering why their acne hasn't gone away despite their blue balls are just the tip of the iceberg. Bro-science isn't limited to harmless-if-strange assertions like this.

Another study presented at the conference looked specifically at the bro-science of testosterone replacement therapy and found disturbing, and potentially dangerous, claims to be commonplace.

Lead author Zhenyue Huang, M.D., of Stony Brook Medicine in New York, and her team gathered the 88 top-viewed YouTube videos with the keyword "testosterone therapy." Here's what they found:

• Individual YouTubers with no medical training created 68 percent of the videos.
• A physician was featured in just 23 percent of the videos.
• A urologist was found in only 7 percent.
• According to the scientific publication rating tool DISCERN, 76 percent of the videos were of moderate to poor quality.
• While 43 percent of the videos mentioned TRT side effects, only 10 percent specifically talked about infertility.
• The 88 relevant videos that met their research criteria had a cumulative view count of more than 14 million.

"The other thing is they kind of exaggerate the benefits of the testosterone. They make their lives look so cool, they're all so muscular and successful and happy," Huang said. "But very few videos mention that testosterone has a side effect of infertility. Imagine a 15-year-old in high school who wants to become like them, but none of them mention that he could become infertile if he starts to get testosterone injections."

Let's face it: The genie appears to be completely out of the bottle when it comes to how many people get their information from influencers in online videos.

But in the next installment of this series, we'll look at some steps healthcare providers are taking to at least slow the flood of urological misinformation on social media.

For now, perhaps the best thing we can do with bro-science and other potentially dubious medical information we see online is to dig into sources and look for citations.

Also, keep an old adage in mind: If it sounds too good to be true, it probably is.