With the increasing popularity of SoMe a large number of men utilize these outlets as a source of health information. This is the first study to characterize the volume and accuracy of men’s health content on both TT and IG.
We found that men’s health content was extremely popular on both TT and IG, with over 2.3 billion impressions on TT and 3 million posts on IG. Since the start of the pandemic, TT has become the premiere source for public health information and has been a valuable tool for physicians to share accurate information to the general public.(12) Fowler et al showed that TT has become a popular source for sexual education amongst teens with the more frequently searched topics including female anatomy, sexual pleasure and sexual health.(13) Our data reinforce these findings, indicating a large presence of men’s health content on these platforms.
Despite a very high volume of posts related to men’s health content on both TT and IG, overall accuracy of these posts was low. These data are consistent with prior studies examining urologic content accuracy across SoMe platforms. Babar et al. examined video content addressing ED on SoMe, comparing TT and YouTube. The authors found higher engagement (likes and views) but significantly lower accuracy among the TT posts. Moreover, TT posts were more likely to recommend supplements for ED treatment, an approach not supported by the American Urological Association (AUA) guidelines.(14, 15) Likewise, multiple studies have examined the accuracy of information regarding prostate cancer on SoMe, finding a high degree of misinformation across platforms.(11, 16)
The accuracy pitfalls of health content on SoMe are best depicted by our findings on the topic of semen retention. Semen retention is the male practice of avoiding ejaculation by either abstaining from sexual activity, discontinuing sexual activity prior to ejaculation, or the practice of achieving orgasm without ejaculation. Semen retention is an ancient practice, similar to celibacy, motivated by the belief that ejaculation weakens a man’s overall health. Those who practice semen retention ascribe various health benefits such as improved fertility, testosterone levels, and mental and physical health. More recently, the concept of “NoFap” or no masturbation has emerged, expanding upon the practice of semen retention in an extreme manner, focusing on the benefits of not masturbating or watching pornography altogether. Importantly, the benefits of semen retention are not based on robust clinical evidence. Only two small studies have been cited in support of this practice. Exton et al. (N = 10) found that men achieved significantly higher basal testosterone levels during and after sexual arousal in addition to more intense orgasms after a three-week period of abstinence, whereas Jiang et al. (N = 28) found that men who abstained for 1 week had increased testosterone levels by 145.7% from their baseline but then had significantly declining testosterone levels starting day 8 of abstinence.(17, 18) Both studies were limited by small sample size and methodological concerns (ex. the impact of anticipatory cues), so much so that the Jian study was retracted in December of 2021. In contrast, multiple, rigorous studies have demonstrated the negative impact of delayed and/or infrequent ejaculation, particularly with respect to semen quality.(19–21)
Despite the lack of clinical data to support the practice of semen retention, semen retention was by far the most popular men’s health topic on TT and IG according to metrics of overall impressions, posts, and engagement. Not surprisingly, all posts on this topic were created by non-physicians, and these posts were associated with an overall misinformation index score of 1.5, the lowest of all topics. The high popularity of a practice that is both unsupported by the medical literature and potentially harmful indicates a need for interventions to improve the quality of content on SoMe.
In aggregate, these data suggest an important role for physicians and other healthcare workers in addressing misinformation on SoMe. Overall, physician created content was significantly more accurate than non-physician content, indicating a potential avenue to increase overall content accuracy on SoMe through greater physician engagement. These efforts can occur not only at the level of the individual physician but also, more broadly, through physician organizations. For example, societies with interest in men’s health such as the American Urological Association (AUA), the Sexual Medicine Society of North America (SMSNA), the Society for the Study of Male Reproduction (SSMR), the Society for Male Reproduction and Urology (SMRU), and others have begun to develop a SoMe footprint. These organizations should continue to expand upon their SoMe presence with the goal of more actively disseminating accurate medical information based on rigorous medical literature.
Our study should be interpreted within the context of certain limitations. First, video review was performed predominantly by a two reviewers with adjudication by a third reviewer, as needed. While there is potential bias in the accuracy scoring from a single reviewer, this reviewer was a fellowship-trained urologist with expertise in both SoMe and men’s health. Second, this was a cross-sectional study based upon the most popular videos and posts at a single point in time. Due to the nature of both IG and TT, the most popular videos and posts will constantly evolve, and the reported popularity and engagement statistics may be rendered obsolete in the future. However, the primary objective was to provide a broad characterization of the information encountered on these platforms, which we believe is offered through these cross-sectional data.