Anabolikong Steroyd, Testosterona, at Risk ng Pagputol ng Tendin Impormasyon

Ano ang nararamdaman mo

Maaaring mapansin mo ang sakit sa iyong balikat o iba pang kasu-kasuan. Maaaring suriin ng iyong doktor ang iyong antas ng hormone dahil ang mababang testosterone ay may kaugnayan sa mas mataas na panganib ng arthritis na dulot ng pagkasira. Ang ugnayang ito ay kumplikado, ngunit mahalaga ang pagpapanatili ng malusog na antas para sa kalusugan ng kasu-kasuan. Kung masyadong mababa ang iyong antas, maaaring mas matigas o mas masakit ang iyong mga kasu-kasuan kaysa sa karaniwan.

Maaaring makita mong mahirap o masakit ang ilang mga galaw. Ang pag-abot sa likod upang isara ang bra o ang pagtupi ng damit ay maaaring maging hamon. Ang pagtaas ng mga bagay sa itaas ng ulo ay maaaring magdulot ng matulis na sakit o pakiramdam ng kahinaan. Karaniwang lumala ang mga sintomas na ito pagkatapos ng aktibidad o sa gabi, na nagpapakahirap sa pagtulog sa gilid. Maaari ka ring maranasan ang pangkalahatang pagkapagod o mapansin ang mga pagbabago sa lakas ng iyong kalamnan.

Magkaroon ng kamalayan na ang testosterone therapy ay maaaring baguhin ang paraan ng pagtugon ng iyong katawan sa sugat. Ang paggamit ng testosterone o anabolic steroids ay may kaugnayan sa mas mataas na panganib ng pagputol ng mga tendon, tulad ng mga nasa rotator cuff, biceps, o quadriceps. Maaaring maranasan ang biglaang "pop" o sakit kung mag-rupture ang isang tendon. Mas mataas ang panganib na ito sa mga lalaking gumagamit ng testosterone replacement therapy. Kung ikaw ay may nakaraang operasyon sa balikat, ang paggamit ng testosterone ay may kaugnayan din sa mas mataas na tsansang kailanganin ang isa pang operasyon o harapin ang impeksyon.

Usapin ng iyong doktor ang iyong kasaysayan ng hormone sa iyo. Tutulungan ka nitong maunawaan ang iyong natatanging panganib ng sugat o muling pagkasugat. Kung pinag-iisipan mo ang testosterone therapy, mahalagang balangkasin nang mabuti ang mga panganib na ito. Kailangan ng iyong medical team na malaman ang anumang supplements o reseta na iyong ginagamit upang mapanatili ang iyong kaligtasan habang nagre-recover.

Ano ang nangyayari sa totoong paraan

Ang testosterone ay gumagana tulad ng switch para sa mga tisyu ng iyong katawan, ngunit hindi nito palaging pinapagana ang mga bagay nang maayos. Tinitingnan ng iyong doktor ang iyong antas ng hormones dahil direkta nitong naaapektuhan ang iyong mga kalamnan, buto, at tendon. Isipin ang iyong mga tendon bilang makakapal na lubid na nag-uugnay ng kalamnan sa buto. Kapag masyadong mababa o sobrang lumalago-lago ang antas ng testosterone, maaaring maging maputik ang mga lubid na ito. Nawawala ang kanilang likas na elasticity at mas malaki ang tsansang maputol sa ilalim ng karaniwang stress.

Ipinapaliwanag ng pagiging maputik na ito kung bakit maaaring magkaroon ka ng mas mataas na panganib ng pagputol ng tendon. Ipakita ng mga pag-aaral na ang mga gumagamit ng testosterone ay may 2.9-fold na tumaas na panganib ng pagputol ng tendon kumpara sa mga hindi gumagamit. Kasama rito ang mga karaniwang sugat tulad ng rotator cuff tear sa balikat o distal biceps injuries sa braso. Hindi kayang hawakan ng tisyu ang bigat na kaya nito noong una. Hindi lang ito tungkol sa lakas; tungkol ito sa kalidad ng sariling connective tissue.

Ang iyong mga kasu-kasuan ay umaasa rin sa balanseng ito. Ang cartilage ay ang makinis na patong sa mga dulo ng iyong mga buto na nagpapahintulot sa kanilang maglisan nang walang friction. Ang mababang antas ng testosterone ay nauugnay sa mas mataas na panganib ng wear-and-tear arthritis (osteoarthritis). Ang ugnayan ay kumplikado, ngunit ang pagpapanatili ng optimal na antas ay tumutulong upang panatilihing malusog ang protektibong patong na ito. Kung wala ito, maaaring magkuskusan ang mga dulo ng buto, na nagdudulot ng sakit at stiffness.

Mayroon ding panganib ng impeksyon at reoperation pagkatapos ng joint replacement surgery. Ang paggamit ng testosterone ay nauugnay sa mas mataas na panganib ng reoperation na dulot ng impeksyon pagkatapos ng primary total shoulder arthroplasty sa mga pasyenteng lalaki. Pinataas nito rin ang panganib ng lahat-cause na reoperations. Kailangan ng iyong doktor na kilalanin ang iyong buong history upang pamahalaan ang mga panganing na ito. Susuriin nila ang iyong natatanging profile upang desisyunin kung ligtas ang hormone therapy para sa iyo. Ang maingat na pagpaplano na ito ay tumutulong upang protektahan ang iyong long-term joint health at bawasan ang tsansang kailanganin pa ang ibang surgery.

Ano ang maaari naming gawin dito

Magsimula sa sariling pag-aalaga at pisikal na terapiya. Maaaring rekomendahan ng iyong doktor ang mga tiyak na ehersisyo upang palakasin ang mga kalamnan sa paligid ng iyong mga kasu-kasuan at tendon. Tumutulong ito upang suportahan ang lugar at bawasan ang tensyon. Dapat mong bigyan ang pamamaraang ito ng sapat na oras upang maging epektibo, karaniwang ilang linggo. Ang pagiging patuloy ang susi. Madalas na mas nakakatulong ang banayad na galaw kaysa sa pagpapahinga lamang. Iwasan ang mga gawain na nagdudulot ng matulis na sakit. Pakikinig sa iyong katawan at huminto kung may nararamdaman mong mali. Ang pundasyong ito ang unang hakbang sa ligtas na pamamahala ng iyong mga sintomas.

Ang medikal na pamamahala ay kinabibilangan ng gamot at hormone therapy. Para sa sakit, maaaring imungkahi ng iyong doktor ang mga anti-inflammatory na gamot. Tumutulong ang mga ito upang bawasan ang pamamaga at hindi pagkakaayos. Kung mababa ang iyong testosterone, tatalakayin ng iyong doktor ang hormone therapy nang maingat. Ang testosterone replacement ay maaaring mapabuti ang komposisyon ng katawan at densidad ng buto pagkatapos ng operasyon. Gayunpaman, mayroon itong mga panganib. Ito ay nauugnay sa mas mataas na pagkakataon ng mga putol na tendon, kabilang ang sa biceps at quadriceps. Ang mga gumagamit ay may 2.9-fold na tumaas na panganib ng putol na tendon kumpara sa mga hindi gumagamit. Mayroon ding tumaas na panganib ng mga putol at pagkukumpuni ng rotator cuff. Timbangin ng iyong doktor ang mga benepisyo na ito laban sa mga panganib batay sa iyong natatanging profile ng kalusugan. Huwag magsimula o huminto sa hormone therapy nang walang gabay medikal.

Maghanap ng input mula sa espesyalista kung patuloy o lumalala ang mga sintomas. Kung hindi tumutulong ang sariling pag-aalaga at gamot, maaaring irefer ka ng iyong doktor para sa karagdagang pagsusuri. Sa ilang kaso, maaaring isaalang-alang ang isang proseso upang ayusin ang nasirang tisyu. Halimbawa, kung mayroon kang pectoralis major rupture, maaaring kailanganin ang operasyon. Nakakagulat, ang pagpapatuloy ng anabolic steroids habang nagre-recover mula sa ganitong uri ng rupture ay tila hindi nakakaapekto nang negatibo sa functional recovery. Gayunpaman, ang paggamit ng testosterone ay nauugnay sa tumaas na odds ng mga surgically treated na putol na tendon. Itatakda ng iyong doktor kung kinakailangan ang isang proseso batay sa iyong tiyak na sugat at kabuuang kalusugan. Laging sundin ang kanilang payo nang mahigpit upang masiguro ang pinakamainam na resulta.

Ano ang inaasahan

Titingnan ng iyong doktor ang iyong kalusugan sa hormona bilang bahagi ng iyong pangkalahatang panganib sa pinsala. Ang antas ng testosterone ay may partikular na threshold na nauugnay sa mga problema sa balikat. Ang mababang antas ay nauugnay din sa mas mataas na panganib ng wear-and-tear arthritis. Ang pagpapanatili ng iyong mga antas sa isang malusog na saklaw ay maaaring tumulong na protektahan ang iyong mga kasu-kasuan. Gayunpaman, kung mayroon kang mababang testosterone, dapat mong malaman na maaari nitong dagdagan ang iyong panganib sa pinsala o sa pagkakasakit muli.

Kailangan mong maging mapagbantay sa mga partikular na panganib kung ikaw ay gumagamit ng testosterone o anabolic steroids. Ang mga gamot na ito ay nauugnay sa mas mataas na pagkakataon ng mga putol ng tendon. Halimbawa, ang mga gumagamit ay may 2.9-fold na tumaas na panganib ng putol ng tendon kumpara sa mga hindi gumagamit. Mas malaki rin ang pagkakataon na masaktan ang iyong distal biceps tendon o kailanganin ang operasyon upang ayusin ito. Mayroon ding mas mataas na panganib ng mga putol ng rotator cuff at kailanganin ang mga subsequent na pag-aayos. Kung ikaw ay kumukuha ng testosterone replacement therapy, mas malaki ang pagkakataon na maranasan ang pinsala sa quadriceps muscle o tendon sa loob ng isang taon pagkatapos punan ang iyong reseta. Maaari itong magdulot ng surgical repair.

Mayroon ding mga posibleng benepisyo sa ilang mga konteksto ng operasyon. Ilang pag-aaral ay nagpapakita na ang testosterone supplementation ay maaaring mapabuti ang komposisyon ng katawan at density ng buto pagkatapos ng orthopaedic surgery. Maaari rin nitong mapabuti ang mga clinical outcomes. Kung mayroon kang pectoralis major rupture, ang pagpapatuloy ng anabolic steroids habang nagre-recover ay tila hindi nakakaapekto nang negatibo sa iyong functional recovery.

Mahalagang talakayin ang iyong endocrinologic history sa iyong doktor. Aaassessment nila ang iyong natatanging risk profile bago magreseta ng anumang gamot. Habang may ilang datos na nagpapakita ng ugnayan sa pagitan ng testosterone replacement at mga pinsala sa anterior cruciate ligament, masyadong maaga pa para magsabi ng tiyak dahil sa iba pang mga salik. Katulad nito, limitado pa rin ang datos tungkol sa panganib ng stroke sa mga kabataan. Magbibigay ng payo ang iyong doktor sa mga panganib na ito upang matulungan kang gumawa ng mga desisyong may kaalaman tungkol sa iyong musculoskeletal health.

Mas malalim na pagtalakay

Ang seksyong ito ay lumalabas nang mas malalim sa biyolohiya, sa antas ng mag-aaral. Hindi ito kailangan para gumawa ng desisyon tungkol sa paggamot, ngunit ipinapaliwanag nito kung bakit binabago ng mga anabolic steroid at testosterone ang paraan ng pag-uugali ng mga tendo.

Paano binabago ng mga androjen ang tendon at collagen

Ang mga tendon ay binubuo karamihan sa type I collagen, na ginagawa at pinapanatili ng mga sel na tinatawag na fibroblasts na may mga androgen receptor. Sa normal (pisyolohikal) antas ng testosterone, tumutulong ang mga androjen upang panatilihing malusog ang collagen na iyon. Sa napakataas na antas na nakikita sa paggamit ng anabolic-androgenic steroid, ang collagen na idinadagdag ay karaniwang mas hindi maayos ang pagkakasunod-sunod, na may mas maliit at hindi pantay na mga hibla at binagong crosslinking. Ang resulta ay isang tendon na mas matigas at mas kaunti ang elasticity, at na maaaring magkulang sa mas mababang pagkalastiko kaysa sa normal na tendon.

Bakit napuputol ang mga tendon ng mga gumagamit ng steroid

Ang mga anabolic steroid ay mabilis na nagpapalakas ng kalamnan, kaya’t mas malakas ang makakabuo nitong puwersa, habang ang tendon na hinahatak nito ay hindi nagpapalakas sa parehong bilis at maaaring mahina pa. Ang hindi pagkakasundo na ito (isang malakas na kalamnan na humahatak sa isang mas mahinang tendon) ang itinuturing na dahilan kung bakit ang mga gumagamit ng steroid ay nakakaranas ng biglaang pagputol ng tendon, madalas habang nagpapatibay ng isang mabigat na pagsisikap at kadalasan sa punto kung saan ang kalamnan ay nagtatagpo sa tendon. Karaniwang apektadong mga bahagi ay ang rotator cuff at biceps sa braso, at ang quadriceps at Achilles sa binti. Sa mga pag-aaral, ang paggamit ng testosterone o steroid ay may kaugnayan sa humigit-kumulang tatlong beses na mas mataas na panganib ng pagputol ng tendon kumpara sa mga hindi gumagamit.

TRT kumpara sa paggamit ng anabolic steroid

Nakatutulong na hiwalayin ang dalawang magkaibang bagay. Ang testosterone replacement therapy (TRT) ay naglalayong ibalik ang mababang antas pabalik sa normal na saklaw, sa ilalim ng medikal na pagmamasid. Ang paggamit ng anabolic-androgenic steroid ay kinabibilangan ng mga dosis na maraming beses na mas mataas kaysa sa kaya ng katawan na gumawa, madalas na may hinalong ilang gamot. Karamihan sa mga dramatikong epekto sa connective tissue ay nagmumula sa itaas na pattern ng mataas na dosis na walang pagmamasid, at tila tumataas ang panganib sa tendon ayon sa dosis. Ang TRT na may replacement-dose ay may mas maliit at hindi tiyak na panganib, na isa sa mga dahilan kung bakit ito pinagmamasdan.

Buto, cartilage, at operasyon

Hindi lahat ng androjen ay nakakasama sa muskuloskeletal na sistema. Sinusuportahan ng testosterone ang densidad ng buto, at ang mababang antas nito ay may kaugnayan sa mas mataas na panganib ng osteoporosis at posibleng arthritis na dulot ng pagkasira. Pagkatapos ng ilang operasyon, maaaring mapabuti ng testosterone ang dami ng kalamnan at buto. Sa kabilang banda, ang paggamit ng steroid at testosterone ay may kaugnayan sa mas mataas na rate ng impeksyon at pag-uulit ng operasyon pagkatapos ng pagpapalit ng balikat. Ito ang eksaktong dahilan kung bakit kailangang malaman ng iyong surgical at medical team ang buong kasaysayan ng iyong hormone at supplement.

Kailan pumunta sa doktor

Pumunta sa iyong GP kung mayroon kang patuloy na sakit na hindi gumagaling kahit magpahinga. Humingi ng pagsusuri ng espesyalista kung napapansin mo ang kahinaan o kawalan ng katatagan sa iyong mga kasu-kasuan. Humingi ng pag-aalaga para sa pakiramdam ng pagkakasara o pagkabigay ng tuhod. Kontakin ang iyong doktor kung ang mga sintomas ay nakakaapekto sa iyong pagtulog o trabaho. Pumunta sa urgent care kung biglaang lumala ang sakit. Magkaroon ng kaalaman na ang mababang antas ng testosterone ay may kaugnayan sa mas mataas na panganib ng osteoarthritis, kilala rin bilang wear-and-tear arthritis. Ang testosterone therapy ay maaaring magdagdag ng panganib ng pagputol ng tendon, kabilang ang mga sugat sa rotator cuff, biceps, at quadriceps. Ito ay may kaugnayan din sa mas mataas na tsansang makaranas ng sugat sa anterior cruciate ligament. Dapat talakayin ng iyong doktor ang iyong hormonal history upang masuri ang mga panganib na ito.

Evidence & references

Overview

Testosterone replacement therapy is associated with increased odds of surgically treated tendon rupture [1].
Testosterone users had a 2.9-fold increased risk of tendon rupture compared to nonusers [2].
It is premature to imply causation between testosterone replacement therapy and anterior cruciate ligament injuries based solely on existing results due to confounding variables [3].
Clinicians should remain vigilant and prescribe testosterone replacement therapy judiciously with a thorough assessment of each patient's unique risk profile regarding anterior cruciate ligament injury risk [3].
There is a threshold-dependent relationship between testosterone levels and shoulder pathology [4].
Hormonal status should be considered in musculoskeletal risk assessment [4].
The use of prescription testosterone is associated with an increased likelihood of experiencing a distal biceps tendon injury [5].
The use of prescription testosterone is associated with an increased likelihood of subsequently requiring surgical repair for distal biceps tendon injury [5].
Patients with prior prescription testosterone exposure have an increased rate of distal biceps tendon injury compared with patients without such exposure [5].
Patients with prior prescription testosterone exposure have an increased rate of biceps tendon repair compared with patients without such exposure [5].
Surgeons should be more intentional about discussing endocrinologic history with patients regarding quadriceps tendon injury risk [6].
Surgeons should counsel patients with testosterone deficiency on the risks for injury or re-injury [6].
Patients who filled a prescription for testosterone replacement therapy were much more likely to experience a quadriceps muscle or tendon injury within 1 year of filling their prescription [7].
Patients who filled a prescription for testosterone replacement therapy were at increased risk of undergoing surgical repair of the quadriceps tendon [7].
Testosterone replacement therapy is associated with increased tendon rupture risk in men [8].
Testosterone replacement therapy is not associated with increased tendon rupture risk in women [8].
The association between testosterone replacement therapy and increased tendon rupture risk may be due to sex-specific differences in dosing [8].
Anabolic steroid use may contribute to pectoralis major rupture [9].
Continuation of anabolic steroids during recovery from pectoralis major rupture does not seem to have a negative effect on functional recovery [9].
Selective androgen receptor modulator (SARM) use is associated with tendon damage [10].
Prescription testosterone is associated with a higher risk of infection-related reoperations after primary total shoulder arthroplasty in male patients [13].
Prescription testosterone is associated with a higher risk of all-cause reoperations after primary total shoulder arthroplasty in male patients [13].

Background & Causes

Testosterone replacement therapy is associated with increased odds of surgically treated tendon rupture [1].
Testosterone users had a 2.9-fold increased risk of tendon rupture compared to nonusers [2].
It is premature to imply causation between testosterone replacement therapy and anterior cruciate ligament injuries based solely on existing results due to confounding variables [3].
There is a threshold-dependent relationship between testosterone levels and shoulder pathology [4].
Prescription testosterone use is associated with an increased likelihood of experiencing a distal biceps tendon injury [5].
Patients with prior prescription testosterone exposure have an increased rate of biceps tendon repair compared with patients without such exposure [5].
Testosterone therapy is associated with increased odds of quadriceps tendon injury [6].
Patients who filled a prescription for testosterone replacement therapy were much more likely to experience a quadriceps muscle or tendon injury within 1 year of filling their prescription [7].
Patients who filled a prescription for testosterone replacement therapy were at increased risk of undergoing surgical repair of the quadriceps tendon [7].
Testosterone replacement therapy is associated with increased tendon rupture risk in men but not women [8].
The association between testosterone replacement therapy and increased tendon rupture risk in men but not women may be due to sex-specific differences in dosing [8].
Anabolic steroid use may contribute to pectoralis major rupture [9].
Continuation of anabolic steroids during recovery from pectoralis major rupture does not seem to have a negative effect on functional recovery [9].
Selective androgen receptor modulator (SARM) use is associated with tendon damage [10].
Testosterone replacement therapy within 1 year of rotator cuff repair appears to be a risk factor for multiple postoperative complications [11].
Testosterone replacement therapy within 1 year of rotator cuff repair appears to be a risk factor for subsequent shoulder surgery [11].
Further research is needed to understand the mechanism by which testosterone increases the risk of reoperation after total shoulder arthroplasty [12].
Prescription testosterone is associated with an increased risk of infection-related reoperations after primary total shoulder arthroplasty in male patients [13].
Prescription testosterone is associated with an increased risk of all-cause reoperations after primary total shoulder arthroplasty in male patients [13].
Bioavailable testosterone levels are a risk factor for osteoarthritis [17].
There is a causal relationship between bioavailable testosterone levels and osteoarthritis [17].
Low testosterone levels are independently associated with an increased risk of osteoarthritis in the U.S. population [18].

Symptoms & Presentation

Testosterone replacement therapy is associated with increased odds of surgically treated tendon rupture [1].
Testosterone users had a 2.9-fold increased risk of tendon rupture compared to nonusers [2].
It is premature to imply causation between testosterone replacement therapy and anterior cruciate ligament injuries based solely on existing results due to confounding variables [3].
There is a threshold-dependent relationship between testosterone levels and shoulder pathology [4].
Prescription testosterone use is associated with an increased likelihood of experiencing a distal biceps tendon injury [5].
Patients with prior prescription testosterone exposure have an increased rate of biceps tendon repair compared with patients without such exposure [5].
Testosterone therapy is associated with increased odds of quadriceps tendon injury [6].
Patients who filled a prescription for testosterone replacement therapy were much more likely to experience a quadriceps muscle or tendon injury within 1 year of filling their prescription [7].
Patients who filled a prescription for testosterone replacement therapy were at increased risk of undergoing surgical repair of the quadriceps tendon [7].
Testosterone replacement therapy is associated with increased tendon rupture risk in men but not women [8].
Anabolic steroid use may contribute to pectoralis major rupture [9].
Selective androgen receptor modulator (SARM) use is associated with tendon damage [10].
Testosterone replacement therapy within 1 year of rotator cuff repair appears to be a risk factor for multiple postoperative complications [11].
Testosterone replacement therapy within 1 year of rotator cuff repair appears to be a risk factor for subsequent shoulder surgery [11].
Supplemental testosterone increases the risk of reoperation after total shoulder arthroplasty [12].
Prescription testosterone is associated with an increased risk of infection-related reoperations after primary total shoulder arthroplasty in male patients [13].
Prescription testosterone is associated with an increased risk of all-cause reoperations after primary total shoulder arthroplasty in male patients [13].
Testosterone therapy is associated with rotator cuff tears, repairs, and revision repairs [15].
Testosterone deficiency is associated with poorer postoperative outcomes in total joint arthroplasty [16].

Management

Testosterone replacement therapy is associated with increased odds of surgically treated tendon rupture [1].
Testosterone users had a 2.9-fold increased risk of tendon rupture compared to nonusers [2].
It is premature to imply causation between testosterone replacement therapy and ACL injuries based solely on existing results due to confounding variables [3].
Clinicians should remain vigilant and prescribe TRT judiciously with a thorough assessment of each patient's unique risk profile [3].
Findings suggest a threshold-dependent relationship between testosterone and shoulder pathology [4].
Hormonal status should be considered in musculoskeletal risk assessment [4].
The use of prescription testosterone is associated with an increased likelihood of experiencing a distal biceps tendon injury [5].
The use of prescription testosterone is associated with an increased likelihood of subsequently requiring surgical repair for distal biceps tendon injury [5].
Patients with prior prescription testosterone exposure have an increased rate of distal biceps tendon injury compared with patients without such exposure [5].
Patients with prior prescription testosterone exposure have an increased rate of biceps tendon repair compared with patients without such exposure [5].
Surgeons should be more intentional about discussing endocrinologic history with patients [6].
Surgeons should counsel patients with testosterone deficiency on the risks for injury or re-injury [6].
Patients who filled a prescription for testosterone replacement therapy were much more likely to experience a quadriceps muscle or tendon injury within 1 year of filling their prescription [7].
Patients who filled a prescription for testosterone replacement therapy were at increased risk of undergoing surgical repair of the quadriceps tendon [7].
TRT is associated with increased tendon rupture risk in men [8].
TRT is not associated with increased tendon rupture risk in women [8].
The association between TRT and tendon rupture risk in men but not women may be due to sex-specific differences in dosing [8].
Anabolic steroids use may contribute to pectoralis major rupture injury [9].
Continuation of anabolic steroids during recovery from pectoralis major rupture does not seem to have a negative effect on functional recovery [9].
SARM use is associated with tendon damage [10].
TRT within 1 year of rotator cuff repair appears to be a risk factor for multiple postoperative complications [11].
TRT within 1 year of rotator cuff repair appears to be a risk factor for subsequent shoulder surgery [11].
Further research is needed to understand the mechanism by which testosterone increases the risk of reoperation after total shoulder arthroplasty [12].
Testosterone use is associated with a higher risk of infection-related reoperations after total shoulder arthroplasty in male patients [13].
Testosterone use is associated with a higher risk of all-cause reoperations after total shoulder arthroplasty in male patients [13].
Patients prescribed at least 3 months of TRT had a significantly higher incidence of ACL injuries compared to controls within a 2-year follow-up period [14].

Key Considerations

Testosterone replacement therapy is associated with increased odds of surgically treated tendon rupture [1].
Testosterone users had a 2.9-fold increased risk of tendon rupture compared to nonusers [2].
It is premature to imply causation between testosterone replacement therapy and anterior cruciate ligament injuries based solely on existing results due to confounding variables [3].
Clinicians should remain vigilant and prescribe testosterone replacement therapy judiciously with a thorough assessment of each patient's unique risk profile [3].
Findings suggest a threshold-dependent relationship between testosterone and shoulder pathology [4].
Hormonal status should be considered in musculoskeletal risk assessment [4].
The use of prescription testosterone is associated with an increased likelihood of experiencing a distal biceps tendon injury [5].
The use of prescription testosterone is associated with an increased likelihood of subsequently requiring surgical repair for distal biceps tendon injury [5].
Patients with prior prescription testosterone exposure have an increased rate of distal biceps tendon injury compared with patients without such exposure [5].
Patients with prior prescription testosterone exposure have an increased rate of biceps tendon repair compared with patients without such exposure [5].
Surgeons should be more intentional about discussing endocrinologic history with patients [6].
Surgeons should counsel patients with testosterone deficiency on the risks for injury or re-injury [6].
Patients who filled a prescription for testosterone replacement therapy were much more likely to experience a quadriceps muscle or tendon injury within 1 year of filling their prescription [7].
Patients who filled a prescription for testosterone replacement therapy were at increased risk of undergoing surgical repair of the quadriceps tendon [7].
Testosterone replacement therapy is associated with increased tendon rupture risk in men [8].
Testosterone replacement therapy is not associated with increased tendon rupture risk in women [8].
The association between testosterone replacement therapy and increased tendon rupture risk in men but not women may be due to sex-specific differences in dosing [8].
Anabolic steroid use may contribute to pectoralis major rupture in body builders [9].
Continuation of anabolic steroids during recovery from pectoralis major rupture does not seem to have a negative effect on functional recovery [9].
Testosterone replacement therapy within 1 year of rotator cuff repair appears to be a risk factor for multiple postoperative complications [11].
Testosterone replacement therapy within 1 year of rotator cuff repair appears to be a risk factor for subsequent shoulder surgery [11].
Further research is needed to understand the mechanism by which testosterone increases the risk of reoperation after total shoulder arthroplasty [12].

Key Evidence

[L3] Testosterone replacement therapy is associated with increased odds of surgically treated tendon rupture. [1] (10.1177/2325967125s00009)
[L3] Testosterone users had a 2.9-fold increased risk of tendon rupture compared to nonusers. [2] (10.1177/2325967124s00339)
[L5] It is premature to imply causation between testosterone replacement therapy and ACL injuries based solely on existing results due to confounding variables; clinicians should remain vigilant and prescribe TRT judiciously with a thorough assessment of each patient's unique risk profile. [3] (10.1016/j.arthro.2024.11.086)
[L3] These findings suggest a threshold-dependent relationship between testosterone and shoulder pathology and highlight the need to consider hormonal status in musculoskeletal risk assessment. [4] (10.1016/j.jse.2026.01.012)
[L3] Patients with prior prescription testosterone exposure have an increased rate of distal biceps tendon injury and biceps tendon repair compared with patients without such exposure. [5] (10.1016/j.jse.2023.02.122)
[L5] The author advises surgeons to be more intentional about discussing endocrinologic history with patients and counseling those with testosterone deficiency on the risks for injury or re-injury. [6] (10.1097/corr.0000000000002835)
[L3] Patients who filled a prescription for testosterone replacement therapy were much more likely to experience a quadriceps muscle or tendon injury within 1 year of filling their prescription and were at increased risk of undergoing surgical repair of the quadriceps tendon. [7] (10.1097/corr.0000000000002744)
[L3] TRT is associated with increased tendon rupture risk in men but not women, potentially due to sex-specific differences in dosing. [8] (10.1177/23259671261430731)
[L4] Anabolic steroids use may contribute to the injury, but continuation during recovery does not seem to have a negative effect on functional recovery. [9] (10.1186/s12891-023-06382-1)
[L4] SARM use is associated with increased muscle mass, hepatotoxicity, cardiotoxicity, tendon damage, and androgenic side effects throughout the body. [10] (10.1177/03635465241252435)
[L3] TRT within 1 year of rotator cuff repair appears to be a risk factor for multiple postoperative complications and subsequent shoulder surgery. [11] (10.1016/j.jseint.2025.10.002)
[L3] Further research is needed to understand the mechanism by how testosterone increases the risk of reoperation after TSA. [12] (10.1177/2325967124s00118)
[L2] Testosterone use is associated with a higher risk of both infection-related and all-cause reoperations after total shoulder arthroplasty. [13] (10.1016/j.jseint.2026.101634)
[L3] This study found that patients prescribed at least 3 months of TRT had a significantly higher incidence of ACL injuries compared to controls within a 2-year follow-up period. [14] (10.1016/j.arthro.2024.10.032)
[L3] This finding may represent a musculoskeletal consequence of TRT and is important for patients and clinicians to understand. [15] (10.5435/jaaos-d-22-00554)
[L3] Testosterone deficiency is associated with poorer postoperative outcomes in total joint arthroplasty, with distinct patterns observed in THA and TKA. [16] (10.5435/jaaos-d-25-00190)
[L1] The results of our study supported a causal relationship between bioavailable testosterone levels and OA, identifying bioavailable testosterone levels as a risk factor for OA. [17] (10.1186/s12891-025-08626-8)
[L3] Low testosterone levels are independently associated with an increased risk of OA in the U.S. population. [18] (10.1186/s12891-024-08272-6)

References

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