Social Media and Urological Misinformation: What's to Be Done?

With hundreds of thousands of TikTok creators and Instagram influencers cheerfully churning out endless and slick advice videos for their millions of followers, how on earth are urologists—who probably work 60 or 70 hours a week—supposed to compete?

"It's a big challenge," 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 discussed in this series. "These guys are putting out insane amounts of content. And with doctors, for most of us, this is like a hobby. It takes a lot of time to do editing, to make sure content's accurate and to make sure the production value is good."

One way Dubin works to provide better information for his patients and also potentially reach a wider audience is by co-hosting a medical podcast, "Man Up: A Doctor's Guide to Men's Health." While the podcast may not pull the numbers you see on men's health TikTok, it does provide a way to engage in sensitive topics in a casual atmosphere outside of the exam room.

"I'm online just like everyone else," Dubin said. "I've looked into these things. I have a podcast because my experience in talking with guys is we need to give them a safe space where they can get accurate information."

Acknowledging patients' preconceived beliefs and then gently guiding them to understanding new information using media, methods and language that speaks to them is the only way to create real change.

A great example of this came up during the COVID-19 pandemic when misinformation about the vaccine causing erectile dysfunction (ED) and infertility was swirling. When a production team was gearing up to create a humorous video featuring actor Tim Meadows, of "Saturday Night Live" fame, and highlighting a study showing that getting COVID makes you six times more likely to suffer ED, several urologists were quick to sign on.

"One of the guys from the production company sent me a direct message on Twitter," said Amy Pearlman, M.D., director of men's health at the Carver College of Medicine at University of Iowa Health Care and one of the urologists who appeared in the COVID public service announcement. "So then I reached out to a bunch of people I knew in urology to say that this person was legit and looking for [urologists] who were on social media."

In a perfect world, top doctors in every field would have the time, money, energy and camera-ready charisma to create tons of click-worthy content that would blow away the misinformation guys. That's not how it works, of course.

But maybe all that isn't strictly necessary.

"We don't have to be everything for everybody," Pearlman said. "If we don't want to be on TikTok, we don't have to be on TikTok. But we can find good TikTok videos with good content. My job is not to recreate good content. My job is to help vet the content for you and give you that content with links."

For her part, Pearlman has created packets appropriate for some of her patients' frequently asked questions. The packets include both written material and links that direct patients to high-quality, informative videos on whatever topics concern them.

"I had an epiphany maybe two years ago where I realized that everything my patient needs to know doesn't need to be told to them, by me, in words, during an office visit," Pearlman said. "So now I'll acknowledge to my patients, 'My goal today is to give you some educational info that's in written form and go over the highlights. And then when you go home, I'm going to ask you to read it and check out some online content.'"

Engaging with quality content that's already out there, as Pearlman suggested, is a great approach. But another, slightly more confrontational one is for clinicians to engage directly with the misinformation.

One of the most interesting tangential phenomena of the semen retention subculture (which we touched on in the men's installment of this series) is the way these guys have built a community. A quick read through the comment threads reveals guys offering one another encouragement and support. Long-term online friendships even seem to have sprung up, and members notice when someone stops posting for a while.

You also find some less scrupulous people jumping in to capitalize. People sell all kinds of dubious supplements and devices in comment threads of medical advice videos, and there are even "semen retention coaches."

For Dubin, being a "reply guy" might be another valid approach to combating these trends. By directly jumping into comment threads of inaccurate videos, actual physicians might be able to move some true believers to abandon the faith.

"If you see semen retention or something like that, respond in a thoughtful way," Dubin said. "There are issues with 'feeding the trolls' and things like that, so you have to be thoughtful, you have to be considerate. But engage the community."

Social media is here to stay, and the very nature of the beast means there's little that can be done about people posting urological misinformation.

However, it is heartening to see leading clinicians and researchers in urology recognizing the problem and doing something to address it.

"We can't use the excuse anymore that, 'Oh, I just don't do YouTube,'" Pearlman said. "You can't 'not do YouTube.' YouTube has been around for 20 years. You just have to figure it out. There's really good content on there. We don't have to create all the content ourselves."