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The internet has profoundly altered how individuals obtain information regarding their health [1], and men's health is no exception. Although men are less likely than women to pursue preventative health care and more likely to develop chronic cardiovascular and metabolic disease [2,3], the rise of online social media

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Introduction:Due to the increasing prevalence of erectile dysfunction (ED) and pronounced distress for patients, a direct-to-consumer market for shock wave therapy (SWT) has emerged. We sought to evaluate trends in marketing and implementation of SWT as a restorative treatment for ED in large metropolitan areas by investigating cost to patients, provider credentials and treatment protocols.Methods:SWT providers in 8 of the most populous metropolitan areas were identified using Google search. Search queries included: “Shockwave therapy for erectile dysfunction in [city];” “Shockwave therapy for ED in [city];” and “GAINSWave in [city].” All clinics advertising SWT for ED within the boundaries of the selected metropolitan area were included. Using a “secret shopper” methodology, clinics were contacted by telephone with the goal of identifying the pricing, duration and provider administering the treatment.Results:Across 8 of the most populous cities in the U.S., 152 clinics offered SWT as a treatment for ED. Comprehensive information was available for 65% of the clinics; 25% of providers offering SWT were urologists while 13% were not physicians. The average price per treatment course was $3,338.28. Treatment duration was highly variable and ranged from 1 to indefinite courses based on individual patient circumstance.Conclusions:SWT, as a restorative therapy for ED, is performed primarily by nonurologists and is not standardized. Direct-to-consumer marketing is used to target distressed men. This study highlights concerning trends in major metropolitan markets, given the substantial financial impact for patients and inconsistent credentials among providers. Further, these findings suggest that patients are frequently seeking care for ED from nonurologists.