Does social media help to uncover pathology in men, or turn them into patients?

Introduction

A 32-year-old man comes into your clinic convinced he has low testosterone. He says his sexual desire isn’t what it used to be. He constantly feels tired during the day. Most concerning to him, he recently started going to the gym 3–4 days a week but feels frustrated that he is not gaining muscle “like everyone else”. As more history is obtained, he mentions spending hours on social media platforms and online forums where men describe similar symptoms and talk about how testosterone “fixed” their lives. By the time he comes into your office, he is no longer searching for answers; he is seeking confirmation. The discussion centers less on the cause of his symptoms and more on access to testosterone therapy. Encounters such as this are becoming increasingly common in Andrology and throughout medicine. Patients are not entering the clinical encounter at the start of the diagnostic journey, but after weeks or months of consuming health-related content online. This evolution in how patients get health information and engage with the healthcare system raises an important question: does social media help uncover pathology in men or turn them into patients? This editorial examines the benefits and unintended consequences of social media in men’s health, from reducing stigma and encouraging care-seeking to pathologizing normal physiology and challenging the physician-patient relationship.

A historical shift: silence→ digital exposure

Historically, men’s sexual health existed in a space marked by stigma, avoidance, and limited public discussion. Conditions such as erectile dysfunction, hypogonadism, infertility, and Peyronie’s disease were often associated with embarrassment and perceived threats to masculinity, leading many men to delay seeking care or avoid medical evaluation altogether. The early internet began to erode this barrier by offering anonymous access to medical information—but doing so required deliberate effort. Patients had to actively seek what they wanted to know. Social media fundamentally changed this dynamic. Recommendation-based platforms continuously expose users to health-related content regardless of initial intent. Topics that were once confined to private spaces or rarely discussed are now amplified across TikTok, Reddit, Instagram, YouTube, and podcast platforms, frequently through personal anecdotes, influencer content, and commercially motivated messaging. This transition from active search to passive exposure may influence how individuals interpret their health and what they perceive as signs of disease.

The scale of social media influence

The reach of social media is global and substantial. As of 2024, more than 5.04 billion individuals worldwide actively use social media platforms, representing approximately 62.3% of the global population (1). Average daily social media use now exceeds 2 hours and 20 minutes per person globally (1). Concurrently, approximately 80% of adults in the United States report searching for health information online, where algorithm-driven social media feeds have become a major source of health information alongside traditional search engines (2).

Patterns of digital engagement on social media vary across geographic regions and age groups. Asia represents the largest market for social media use, whereas Europe and North America exhibit some of the highest levels of internet penetration, and the adoption of internet and smartphones continues to drive rapid growth in social media engagement throughout Africa (3). Worldwide, Facebook remains the largest social network with more than 3 billion monthly active users, while YouTube reaches approximately 2.7 billion users globally (1). Instagram and TikTok each attract more than 1.5 billion users and are disproportionately utilized by younger adults, whereas Facebook and YouTube maintain broader demographic reach and remain among the few platforms with substantial representation across multiple generations (1).

These global trends are mirrored in the United States. According to Pew Research Center data, younger adults disproportionately utilize visually driven, short-form platforms such as TikTok and Instagram. Among United States adults aged 18–29 years, 62% report using TikTok and 78% report using Instagram, compared with only 10% and 15%, respectively, among adults aged 65 years and older (4). In contrast, older adults more frequently utilize Facebook and YouTube, platforms that tend to support longer-form educational content and discussion. YouTube remains the most broadly utilized platform overall, with usage rates exceeding 90% among adults younger than 50 years (4). X (formerly Twitter), despite a comparatively smaller global audience of approximately 600 million users (1), occupies a distinct niche as a fast-moving discussion- and opinion-based platform where commentary, anecdotal experiences, and health narratives may spread rapidly.

Beyond differences in user demographics, each platform promotes information through distinct mechanisms that influence the speed, reach, and presentation of health-related content. Short-form video platforms favor rapid, emotionally engaging, and highly simplified messaging, whereas longer-form content may offer greater nuance. Yet both formats remain inconsistently regulated, creating opportunities for the dissemination of inaccurate, incomplete, or misleading health information. The unprecedented scale and speed of dissemination allow medical narratives, accurate or otherwise, to shape public perception.

The case for engagement: destigmatization and earlier presentation

Increased digital exposure to men’s health content may help reduce the stigma surrounding conditions that were historically underreported and associated with delayed healthcare-seeking among men (5). Topics such as erectile dysfunction, hypogonadism, Peyronie’s disease, infertility, and low libido are now discussed openly across multiple digital platforms. While the clinical accuracy of this content varies widely, the normalization of these conversations has lowered the barrier to care-seeking and may encourage earlier medical evaluation. More commonly, clinicians are encountering patients who present with a baseline familiarity with medical terminology and treatment concepts (6). Patients may already be familiar with terms such as “testosterone replacement therapy”, “venous leak”, or “Peyronie’s disease”. Despite its limitations as a source of medical guidance, social media has played a meaningful role in reducing stigma and normalizing discussions of men’s health.

Who is producing medical content?

The more pressing concern is not access to information, but its authorship, intent, and reliability. Much of the medical content encountered online is not created by physicians or formally trained healthcare professionals. In a peer-reviewed analysis of men’s health content on TikTok and Instagram, Dubin et al. evaluated posts related to testosterone, erectile dysfunction, male infertility, Peyronie’s disease, semen retention, and vasectomy and found that physicians created only 10.3% of TikTok posts and 12.9% of Instagram posts (7). Across all evaluated topics, the overall accuracy of content was poor, with physician-created posts demonstrating significantly higher accuracy scores compared with non-physician content (4.2 vs. 2.3, P<0.001) (7). The authors concluded that while men’s health content has enormous digital reach, much of the information circulating online lacks appropriate medical accuracy or context, with the majority of content originating from non-physician creators including influencers and commercially affiliated accounts (7). Financial incentives further complicate this landscape. A recent JAMA Network Open analysis of social media posts related to medical testing found that many posts were promotional in nature, frequently involved financial conflicts of interest, and only a minority discussed potential risks or harm associated with testing (8).

The algorithm effect

The algorithm is the invisible system operating behind the scenes, determining what content is recommended to users based on a complex mix of quantitative and qualitative signals, including clicks, likes, watch time, shares, comments, and browsing behavior (9). This unseen puppeteer has a clear objective: to predict what will capture your attention next and keep you engaged for as long as possible. Modern recommendation systems operate through feedback loops driven by user behavior. Each interaction whether a click, like, share, or prolonged viewing time helps platforms identify content that is likely to maintain a user’s attention. Over time, these systems learn individual interests and recommend similar material, creating personalized streams of information that can reinforce existing beliefs, concerns, and health-related perceptions (9). An innocent curiosity about “low testosterone” may begin with a single 30-second video, but algorithms quickly transform that curiosity into a steady stream of related content. Built to maximize engagement, short-form platforms capitalize on short attention spans and the dopamine-driven reward cycle of scrolling, repeatedly exposing users to similar messages. The result is that patients may spend hours seeking answers online through an endless feed of content, even though many medical conditions require nuance, context, and individualized assessment that cannot realistically be distilled into a 30-second clip.

Furthermore, social media algorithms prioritize engagement over accuracy often amplifying emotionally charged, controversial, or highly simplified content (10). Within men’s health, this may manifest as exaggerated claims regarding testosterone optimization, sexual performance, fertility enhancement, or “biohacking” interventions that are not evidence-based and are presented with limited discussion of appropriate diagnostic evaluation, potential risks, and long-term outcomes. Importantly, algorithms do not differentiate between evidence-based content produced by healthcare professionals and content from non-experts promoting unsupported health claims.

One of the more subtle effects of algorithm-driven exposure is how it displaces men’s baseline understanding of normal physiology. Research consistently demonstrates that repeated exposure to idealized physique and performance content is associated with heightened body awareness and reduced body satisfaction in men (10). Clinically, this can manifest as men presenting with significant distress about normal testosterone levels, sexual performance, or body composition. Consequently, clinicians are encountering more patients who arrive with preconceived diagnoses and treatment expectations shaped by repeated digital exposure before formal medical evaluation. The result is not simply a more informed patient population. In practice, clinicians increasingly find themselves navigating the tension between a patient’s objective health status and an illness narrative that has been shaped, reinforced, and amplified by algorithm-driven content.

Testosterone replacement therapy (TRT) as a case study

No condition better illustrates this dynamic than the contemporary trajectory of TRT. TRT is indicated for men with biochemically confirmed hypogonadism, however, its use has expanded well beyond this population (11). Demand grew by 27% annually from 2018 to 2022, with the steepest increases in middle-aged male cohorts in the United States (12). The Royal Pharmaceutical Society has reported a 52% rise in testosterone-related consultations between 2020–2021 and 2024–2025, an increase that cannot be attributed to a commensurate rise in the prevalence of hypogonadism (13).

The commercial dimension of this trend is substantial. In an analysis of 46 social media posts regarding TRT, 70% of content creators were either directly involved in the hormone industry or had pharmaceutical sponsorship (14). These posts frequently framed TRT as a pathway toward an idealized masculine identity characterized by muscularity, energy, and sexual vitality, while largely overlooking the clinical complexity of appropriate prescribing.

Implications for clinical practice

Managing the algorithm-informed patient requires a deliberate communication strategy. Physicians should begin by eliciting and acknowledging the patient’s existing beliefs and concerns. Patients need to feel heard, particularly if they feel they have invested significant time doing their own research. Premature reassurance feels dismissive and risks damaging the physician-patient relationship. A physician who responds quickly to a patient’s concern with “there’s nothing wrong” may be clinically correct but risks the patient leaving feeling invalidated. Validating a patient’s experience and existing beliefs—rather than confronting the misinformation behind it—may be the more effective entry point for introducing evidence-based nuance. Physicians can gently correct misconceptions through evidence-based education that place symptoms within their appropriate clinical context. In practice, this might sound like: “What you’re describing—low libido, fatigue, and difficulty building muscle—is real, and I understand why you’re concerned. The good news is that your testosterone level is normal. That tells us we should broaden our thinking rather than stop our evaluation. There are other factors that can contribute to these symptoms, and I’d like us to work through them together”. This approach acknowledges the patient’s distress, fosters trust, and supports shared decision-making grounded in the best available evidence.

A call for physician engagement in digital spaces

Social media shouldn’t be seen as the antagonist of the health system, but as a tool to fight misinformation and empower the public. It is a platform that can be reclaimed for accurate health communication. This represents a meaningful opportunity for urologists and andrologists to establish a credible presence where their patients are already seeking information. Short-form and long-form videos, infographics, and patient-facing educational content produced in accessible, jargon-free language can serve as powerful counterweights to commercially motivated messaging (15). Platforms such as YouTube now offer physician credential verification, providing a mechanism for distinguishing clinician-created content from unregulated sources. Physicians should engage with social media because social media is already engaging with our patients.

Conclusions

Social media occupies a paradoxical position in men’s health. It has meaningfully reduced stigma and facilitated earlier engagement with conditions long defined by silence and avoidance. At the same time, it has introduced a powerful and largely unregulated force that can pathologize normal physiology, amplify commercial health narratives, and influence patient expectations before a clinical evaluation.

The clinical challenge is not to undo the patient’s digital literacy, but to recalibrate it. The most effective approach validates the patient’s experience while restoring the clinical complexity that algorithmic content is structurally unable to preserve. Social media is already shaping how patients understand their bodies and their symptoms—with or without physician input. The question is not whether this influence exists, but whether urologists & scientists will help refine it or leave it to unchecked narratives.

Acknowledgments

None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Translational Andrology and Urology. The article did not undergo external peer review.

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-2026-0627/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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