Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Readability, credibility and quality of patient information for hypogonadism and testosterone replacement therapy on the Internet


The incidence of hypogonadism and use of testosterone replacement therapy (TRT) are rising, while data evaluating the complexity and quality of health-care information available to patients on the Internet for hypogonadism or TRT are lacking. This study focuses on characterizing the readability, credibility and quality of patient-centered information for hypogonadism on the Internet. A Google search was performed to identify top-ranked websites offering patient-centered information on hypogonadism and TRT. Readability was quantified by reading grade level using several validated instruments. Credibility and quality were determined by several additional criteria, including authorship, references, health-care information quality certification and breadth of topic discussion. Twenty of 75 total sites identified (27%) met the inclusion and exclusion criteria and were evaluated. The mean reading grade level was 13.1 (interquartile range 11.7–15.1), with all websites demonstrating reading levels significantly above recommended levels. Less than half (45%) of the sites were neither authored nor reviewed by a physician, 60% contained at least one reference and 40% were certified for displaying quality health-care information. Over half (55%) did not comprehensively discuss management of hypogonadism or mention treatment-associated risks. In conclusion, the majority of patient-centered information available on the Internet regarding hypogonadism or TRT is of poor quality and too complex for the average patient to comprehend. These results highlight a critical shortage in easily accessible, high-quality, comprehensible online patient health-care information on hypogonadism and TRT.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Figure 1


  1. 1

    Mulligan T, Frick MF, Zuraw QC, Stemhagen A, McWhirter C . Prevalence of hypogonadism in males aged at least 45 years: the HIM study. Int J Clin Pract 2006; 60: 762–769.

    CAS  Article  Google Scholar 

  2. 2

    Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR . Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore Longitudinal Study of Aging. J Clin Endocrinol Metab 2001; 86: 724–731.

    CAS  Article  Google Scholar 

  3. 3

    Handelsman DJ . Global trends in testosterone prescribing, 2000-2011: expanding the spectrum of prescription drug misuse. Med J Aust 2013; 199: 548–551.

    Article  Google Scholar 

  4. 4

    Baillargeon J, Urban RJ, Ottenbacher KJ, Pierson KS, Goodwin JS . Trends in androgen prescribing in the United States, 2001 to 2011. JAMA Int Med 2013; 173: 1465–1466.

    Article  Google Scholar 

  5. 5

    Rohrmann S, Platz EA, Selvin E, Shiels MS, Joshu CE, Menke A et al. The prevalence of low sex steroid hormone concentrations in men in the Third National Health and Nutrition Examination Survey (NHANES III). Clin Endocrinol 2011; 75: 232–239.

    Article  Google Scholar 

  6. 6

    Pew Research Center. Health Fact Sheet. 2013; Available at (accessed 2 December 2015).

  7. 7

    Shuyler KS, Knight KM . What are patients seeking when they turn to the Internet? Qualitative content analysis of questions asked by visitors to an orthopaedics web site. J Med Int Res 2003; 5: e24.

    Google Scholar 

  8. 8

    Pruthi RS, Belsante J, Kurpad R, Nielsen ME, Wallen EM . Robotic cystectomy and the Internet: separating fact from fiction. Urol Oncol 2011; 29: 393–397.

    Article  Google Scholar 

  9. 9

    Eysenbach G, Powell J, Kuss O, Sa ER . Empirical studies assessing the quality of health information for consumers on the world wide web: a systematic review. JAMA 2002; 287: 2691–2700.

    Article  Google Scholar 

  10. 10

    Cline RJ, Haynes KM . Consumer health information seeking on the Internet: the state of the art. Health Educ Res 2001; 16: 671–692.

    CAS  Article  Google Scholar 

  11. 11

    Kim P, Eng TR, Deering MJ, Maxfield A . Published criteria for evaluating health related web sites: review. BMJ 1999; 318: 647–649.

    CAS  Article  Google Scholar 

  12. 12

    Kucukdurmaz F, Gomez MM, Secrist E, Parvizi J . Reliability, readability and quality of online information about femoracetabular impingement. Arch Bone Jt Surg 2015; 3: 163–168.

    PubMed  PubMed Central  Google Scholar 

  13. 13

    The Joint Commission. What did the doctor say? Improving health literacy to protect patient safety, 2007 Available at. (accessed 5 December 2015).

  14. 14

    Diviani N, van den Putte B, Giani S, van Weert JC . Low health literacy and evaluation of online health information: a systematic review of the literature. J Med Int Res 2015; 17: e112.

    Google Scholar 

  15. 15

    The Health Literacy of America's Adults. Results from the 2003 National Assessment of Adult Literacy, 2003. Available at (accessed 1 December 2015).

  16. 16

    Weiss B . Health literacy and patient safety: help patients understand, manual for clinicians, 2007. Available at (accessed 5 December 2015).

  17. 17

    Brigo F, Otte WM, Igwe SC, Tezzon F, Nardone R . Clearly written, easily comprehended? The readability of websites providing information on epilepsy. Epilepsy Behav 2015; 44: 35–39.

    Article  Google Scholar 

  18. 18

    Colaco M, Svider PF, Agarwal N, Eloy JA, Jackson IM . Readability assessment of online urology patient education materials. J Urol 2013; 189: 1048–1052.

    Article  Google Scholar 

  19. 19

    De Oliveira GS Jr., Jung M, McCaffery KJ, McCarthy RJ, Wolf MS . Readability evaluation of Internet-based patient education materials related to the anesthesiology field. J Clin Anesth 2015; 27: 401–405.

    Article  Google Scholar 

  20. 20

    Huang G, Fang CH, Agarwal N, Bhagat N, Eloy JA, Langer PD . Assessment of online patient education materials from major ophthalmologic associations. JAMA Ophthalmol 2015; 133: 449–454.

    Article  Google Scholar 

  21. 21

    Narwani V, Nalamada K, Lee M, Kothari P, Lakhani R . Readability and quality assessment of internet-based patient education materials related to laryngealcancer. Head Neck 2014; 38: 601–605.

    Article  Google Scholar 

  22. 22

    Ricci JA, Vargas CR, Chuang DJ, Lin SJ, Lee BT . Readability assessment of online patient resources for breast augmentation surgery. Plastic Reconstr Surg 2015; 135: 1573–1579.

    CAS  Article  Google Scholar 

  23. 23

    Tian C, Champlin S, Mackert M, Lazard A, Agrawal D . Readability, suitability, and health content assessment of web-based patient education materials on colorectal cancer screening. Gastroint Endosc 2014; 80: 284–290.

    Article  Google Scholar 

  24. 24

    Walsh TM, Volsko TA . Readability assessment of internet-based consumer health information. Respir Care 2008; 53: 1310–1315.

    PubMed  Google Scholar 

  25. 25

    Berland GK, Elliott MN, Morales LS, Algazy JI, Kravitz RL, Broder MS et al. Health information on the Internet: accessibility, quality, and readability in English and Spanish. JAMA 2001; 285: 2612–2621.

    CAS  Article  Google Scholar 

  26. 26

    Ubel PA, Jepson C, Baron J . The inclusion of patient testimonials in decision aids: effects on treatment choices. Med Decis Making 2001; 21: 60–68.

    CAS  Article  Google Scholar 

  27. 27

    Eysenbach G, Kohler C . How do consumers search for and appraise health information on the world wide web? Qualitative study using focus groups, usability tests, and in-depth interviews. BMJ 2002; 324: 573–577.

    Article  Google Scholar 

  28. 28

    Friedman DB, Hoffman-Goetz L . A systematic review of readability and comprehension instruments used for print and web-based cancer information. Health Educ Behav 2006; 33: 352–373.

    Article  Google Scholar 

  29. 29

    Ilic D, Bessell TL, Silagy CA, Green S . Specialized medical search-engines are no better than general search-engines in sourcing consumer information about androgen deficiency. Human Reprod 2003; 18: 557–561.

    CAS  Article  Google Scholar 

  30. 30

    Fast AM, Deibert CM, Boyer C, Hruby GW, McKiernan JM . Partial nephrectomy online: a preliminary evaluation of the quality of health information on the Internet. BJU Int 2012; 110 (11 Pt B): E765–E769.

    Article  Google Scholar 

  31. 31

    Sobota A, Ozakinci G . The quality and readability of online consumer information about gynecologic cancer. Int J Gynecol Cancer 2015; 25: 537–541.

    Article  Google Scholar 

  32. 32

    Steinberg PL, Ghavamian R . Searching robotic prostatectomy online: what information is available? Urology 2011; 77: 941–945.

    Article  Google Scholar 

  33. 33

    Tartaglione JP, Rosenbaum AJ, Abousayed M, Hushmendy SF, DiPreta JA . Evaluating the quality, accuracy, and readability of online resources pertaining to Hallux Valgus. Foot Ankle Spec 2015; 9: 17–23.

    Article  Google Scholar 

  34. 34

    Oberlin DT, Masson P, Brannigan RE . Testosterone replacement therapy and the internet: an assessment of providers' health-related web site information content. Urology 2015; 85: 814–818.

    Article  Google Scholar 

  35. 35

    Foundation HotN. HON code of conduct (HONcode) for medical and health information, 2011. Available at 2011. Accessed July 2015.

  36. 36

    Evans DS . The online advertising industry: economics, evolution, and privacy. J Econ Perspect 2009; 23: 37–60.

    Article  Google Scholar 

  37. 37

    Charnock D, Shepperd S, Needham G, Gann R . DISCERN: an instrument for judging the quality of written consumer health information on treatment choices. J Epidemiol Community Health 1999; 53: 105–111.

    CAS  Article  Google Scholar 

  38. 38

    Silberg WM, Lundberg GD, Musacchio RA . Assessing, controlling, and assuring the quality of medical information on the Internet: Caveant lector et viewor—Let the reader and viewer beware. JAMA 1997; 277: 1244–1245.

    CAS  Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to J A McBride.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

McBride, J., Carson, C. & Coward, R. Readability, credibility and quality of patient information for hypogonadism and testosterone replacement therapy on the Internet. Int J Impot Res 29, 110–114 (2017).

Download citation

Further reading


Quick links