The most immediate online sources for testosterone therapy information exceed the average reading level of most adults within the U.S., indicating more effort should be taken to publish accessible and readable material to improve patient health literacy.
Key Findings
Methods
77 unique online sources about testosterone therapy were identified from two Google search terms.
Search terms used were 'Testosterone Therapy' and 'Testosterone Replacement'
Sources were categorized into four types: Academic, Commercial, Institutional, or Patient Support
Patient support sources were most prevalent at 35% of results
Commercial sources were least prevalent at 14% of results
Results
Academic sources about testosterone therapy required a college senior reading level (grade 16) to understand.
The average grade level for understanding academic sources was 16, corresponding to a college senior level
This is 8 grade levels above the average U.S. adult reading level
Readability was evaluated using six validated tools: Flesch Reading Ease score, Flesch Kincade, Gunning Fog, SMOG, Coleman-Liau Index, and Automated Readability Index
Results
Commercial, institutional, and patient support sources required a college freshman reading level (grade 13) to understand.
Commercial, institutional, and patient support sources averaged a grade 13 reading level
This is 5 grade levels above the average U.S. adult reading level
All source categories exceeded the average reading level of most U.S. adults
Results
The overall average Flesch Reading Ease score for online testosterone therapy sources was 36.8, indicative of difficult-to-read material.
The average reading ease score was 36.8 across all 77 sources
A Flesch Reading Ease score of 36.8 is described as 'indicative of difficult-to-read material overall'
The Flesch Reading Ease score is one of six validated readability tools used in the analysis
Conclusions
Online testosterone therapy information consistently exceeds the reading level of the average U.S. adult across all source categories.
Even the most accessible source category (patient support) was still above the average U.S. adult reading level
Academic sources were 8 grade levels above the average U.S. adult reading level
Commercial, institutional, and patient support sources were 5 grade levels above the average U.S. adult reading level
The authors conclude that 'more effort should be taken to publish accessible and readable material to improve patient health literacy'
Pominville R, Tay K, Callegari M, Pei E, Sarica E, Jesse E, et al.. (2024). Evaluating the readability of online testosterone search results.. International journal of impotence research. https://doi.org/10.1038/s41443-023-00682-9