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Anabolizantes, Testosterona e Risco de Ruptura Tendinosa Folheto

Esta página foi traduzida automaticamente e ainda não foi verificada por um médico. A versão em inglês é a versão oficial.

O que você está sentindo

Você pode notar dor no ombro que piora com a atividade. Esse desconforto frequentemente se intensifica à noite, dificultando o sono deitado do lado afetado. Você pode ter dificuldade em alcançar as costas para fechar um sutiã ou alisar uma camisa. Tarefas simples, como levantar objetos ou elevar o braço, podem se tornar desafiadoras.

Seu cirurgião considerará seu status hormonal ao avaliar esses sintomas. Níveis baixos de testosterona estão associados a um maior risco de osteoartrite por desgaste na articulação. Essa condição pode causar rigidez e dor à medida que a cartilagem se degrada. Manter níveis hormonais ótimos pode ajudar a proteger a saúde da sua articulação, mas a deficiência pode aumentar o risco de lesão ou de nova lesão.

Se você recebeu prescrição de testosterona, esteja ciente de que ela está associada a um maior risco de lesões do manguito rotador. O manguito rotador é um grupo de músculos e tendões que estabilizam o ombro. Você pode experimentar fraqueza súbita ou dor se ocorrer uma lesão. Há também um risco aumentado de necessidade de reparos subsequentes para corrigir essas lesões.

Em alguns casos, o uso de testosterona está associado a um maior risco de reintervenções relacionadas a infecções após artroplastia total do ombro. A artroplastia total do ombro é um procedimento no qual as superfícies articulares danificadas são substituídas por componentes artificiais. Você pode enfrentar um risco maior de qualquer tipo de reintervenção após essa cirurgia. São necessárias mais pesquisas para entender exatamente por que a testosterona aumenta o risco de necessidade de outra cirurgia após a substituição do ombro.

Se você estiver usando esteroides anabolizantes, seu cirurgião deve discutir seu histórico endocrinológico com você. Esteroides anabolizantes são substâncias sintéticas semelhantes ao hormônio sexual masculino testosterona. Seu uso pode contribuir para a ruptura do peitoral maior, que é uma lesão no grande músculo do peito. Essa lesão geralmente causa dor aguda e equimose na parte frontal do ombro.

Embora o uso contínuo de esteroides anabolizantes durante a recuperação de uma ruptura do peitoral maior não pareça afetar negativamente a recuperação funcional, recomenda-se cautela. Os clínicos devem prescrever a terapia de reposição de testosterona com critério. Isso significa pesar cuidadosamente os benefícios contra os riscos para o seu perfil único. Seu cirurgião o aconselhará sobre esses riscos para ajudá-lo a tomar decisões informadas sobre seus cuidados.

O que está realmente acontecendo

Os níveis de testosterona no seu corpo atuam como um interruptor de intensidade para a saúde das articulações e dos tendões. Existe um limiar específico no qual os níveis se tornam muito baixos ou muito altos, e ambos os extremos podem enfraquecer seus tecidos. Quando os níveis estão subótimos, o revestimento liso nas extremidades dos ossos — chamado cartilagem — pode se desgastar mais rapidamente. Essa osteoartrite por desgaste reduz o amortecimento das suas articulações, tornando-as mais suscetíveis a danos.

Seus tendões são cordões grossos de fibras que conectam o músculo ao osso. Em alguns casos, o uso de testosterona está associado a um maior risco de ruptura desses cordões. Por exemplo, fisiculturistas que usam esteroides anabolizantes apresentaram mais rupturas do músculo peitoral maior. Da mesma forma, pacientes prescritos com testosterona enfrentam um risco aumentado de rupturas do manguito rotador no ombro. Essas rupturas ocorrem porque a estrutura do tecido muda, tornando-o menos capaz de suportar tensão.

Esse risco se estende a cirurgias de grande porte, como a substituição total do ombro. Homens que usam testosterona têm maior probabilidade de precisar de uma segunda cirurgia após a primeira substituição do ombro. Isso ocorre frequentemente devido a infecções ou outras complicações que impedem a cicatrização adequada. Seu cirurgião precisa conhecer seu histórico hormonal completo, pois a baixa testosterona também pode aumentar o risco de osteoartrite. Manter níveis equilibrados é fundamental para manter suas articulações fortes e estáveis.

Embora o uso de testosterona a curto prazo antes da cirurgia possa ajudar na densidade óssea e na composição corporal, o uso a longo prazo ou em doses altas carrega riscos. Pode levar a reintervenções cirúrgicas ou infecções que complicam sua recuperação. Seu cirurgião avaliará seu perfil de risco único antes de decidir sobre qualquer terapia hormonal. Compreender essas conexões ajuda você e sua equipe médica a proteger suas articulações durante o tratamento e a recuperação.

O que esperar

O seu cirurgião avaliará a sua saúde hormonal como parte do seu risco geral de lesão. Os níveis de testosterona têm uma relação complexa com os problemas do ombro. A testosterona baixa está associada a um maior risco de osteoartrite por desgaste na articulação. Manter níveis saudáveis pode ajudar a manter as suas articulações fortes. No entanto, o uso de testosterona ou de esteroides anabolizantes também pode alterar a forma como os seus tendões suportam o stress.

Se lhe for prescrita testosterona, pode enfrentar um risco maior de rotura dos tendões do manguito rotador no ombro. Este grupo de pacientes também apresenta mais cirurgias de seguimento para reparar estas roturas. Se utilizar esteroides anabolizantes, existe um risco específico de rotura do grande músculo peitoral. Isto é mais comum em fisiculturistas. Se já sofreu esta rotura do músculo peitoral, continuar a utilizar esteroides não parece prejudicar a sua recuperação funcional.

Para os homens que estão a ser submetidos a cirurgia de substituição do ombro, o uso de testosterona está associado a riscos mais elevados. Pode enfrentar uma maior probabilidade de reintervenções relacionadas com infeções. Pode também enfrentar um risco mais elevado de qualquer tipo de reintervenção após a sua substituição primária do ombro. O seu cirurgião irá discutir o seu histórico endocrinológico consigo. Eles irão aconselhá-lo sobre os riscos de lesão ou de nova lesão se tiver deficiência de testosterona.

Se precisar de terapia de reposição de testosterona, esta é prescrita com cuidado. Ainda é cedo para afirmar que causa diretamente lesões dos ligamentos do joelho, como as roturas do ligamento cruzado anterior (LCA). Mas o seu perfil de risco individual é importante. Alguns estudos mostram que a administração de testosterona no momento da cirurgia pode melhorar a composição corporal e a densidade óssea. Pode também melhorar os seus resultados clínicos após cirurgia ortopédica.

Os dados sobre outros riscos, como o AVC em adultos jovens, continuam a ser limitados. O seu cirurgião precisa de ponderar estes benefícios face ao risco aumentado de roturas tendinosas e reintervenções. Seja honesto quanto ao seu uso de esteroides ou de testosterona. Isto ajuda a sua equipa a planear o caminho mais seguro para a sua recuperação e saúde articular a longo prazo.

Reviewed by Kieran Hirpara · 13 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

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 [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 [6].
  • Surgeons should counsel patients with testosterone deficiency on the risks for injury or re-injury [6].
  • Testosterone replacement therapy is associated with increased tendon rupture risk in men [7].
  • Testosterone replacement therapy is not associated with increased tendon rupture risk in women [7].
  • The lack of increased tendon rupture risk in women may be due to sex-specific differences in dosing [7].
  • 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 [8].
  • Patients who filled a prescription for testosterone replacement therapy were at increased risk of undergoing surgical repair of the quadriceps tendon [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].
  • Selective androgen receptor modulator (SARM) use is associated with tendon damage [10].
  • Preoperative testosterone replacement therapy is a potential risk factor for complications after rotator cuff repair [11].
  • Preoperative testosterone replacement therapy is a potential risk factor for reoperation after rotator cuff repair [11].
  • Cessation of testosterone replacement therapy prior to rotator cuff repair should be considered on a patient-specific basis [11].

How It Works

  • 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].
  • The use of prescription testosterone is associated with an increased likelihood of experiencing a distal biceps tendon injury and subsequently requiring surgical repair [5].
  • 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].
  • Surgeons should be more intentional about discussing endocrinologic history with patients and counseling those with testosterone deficiency on the risks for injury or re-injury [6].
  • TRT is associated with increased tendon rupture risk in men but not women [7].
  • The association between TRT and increased tendon rupture risk in men but not women may be due to sex-specific differences in dosing [7].
  • Testosterone therapy is associated with increased odds of quadriceps tendon injury [8].
  • Anabolic steroids use may contribute to pectoralis major rupture injury [9].
  • SARM use is associated with tendon damage [10].
  • Cessation of TRT prior to rotator cuff repair should be considered on a patient-specific basis [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 increased risk of infection-related and all-cause reoperations after primary total shoulder arthroplasty in male patients [13].
  • Testosterone use is associated with a higher risk of both infection-related and all-cause reoperations after total shoulder arthroplasty [13].
  • There is increased risk of rotator cuff tears (RCTs), rotator cuff repairs (RCRs), and subsequent RCRs in patients prescribed testosterone [14].
  • The observed non-linear relationship between low testosterone levels and osteoarthritis risk suggests that maintaining optimal testosterone levels may be important for joint health [15].

What the Evidence Shows

  • The use of prescription testosterone is associated with an increased likelihood of subsequently requiring surgical repair of the distal biceps tendon [5].
  • TRT is associated with increased tendon rupture risk in men [7].
  • TRT is not associated with increased tendon rupture risk in women [7].
  • The association between TRT and tendon rupture risk may be due to sex-specific differences in dosing [7].
  • Anabolic steroids use may contribute to pectoralis major rupture [9].
  • SARM use is associated with increased muscle mass [10].
  • SARM use is associated with hepatotoxicity [10].
  • SARM use is associated with cardiotoxicity [10].
  • SARM use is associated with androgenic side effects throughout the body [10].
  • Supplemental testosterone increases the risk of reoperation after total shoulder arthroplasty [12].
  • Further research is needed to understand the mechanism by which testosterone increases the risk of reoperation after TSA [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].
  • There is an increased risk of rotator cuff tears (RCTs) in patients prescribed testosterone [14].
  • There is an increased risk of rotator cuff repairs (RCRs) in patients prescribed testosterone [14].
  • There is an increased risk of subsequent rotator cuff repairs (RCRs) in patients prescribed testosterone [14].
  • Four randomized controlled trials found that testosterone supplementation improved clinical outcomes in orthopaedic surgeries [17].
  • Four randomized controlled trials found that testosterone supplementation improved body composition in orthopaedic surgeries [17].
  • Four randomized controlled trials found that testosterone supplementation improved bone mineral density (BMD) in orthopaedic surgeries [17].
  • Evidence regarding orthopaedic perioperative use of testosterone replacement therapy is heterogeneous [17].
  • 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 [18].
  • Injectable TRT use within 1 year of primary ACL reconstruction is associated with a 3.3-fold increase in ACLR revision rates with 2 years of follow-up [19].
  • Data regarding the safety of testosterone supplementation and its association with stroke in young adults remains limited and underexplored [20].

Practical Considerations

  • 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 [7].
  • Anabolic steroid use may contribute to pectoralis major rupture [9].
  • Prescription testosterone is associated with increased risk of infection-related reoperations after primary total shoulder arthroplasty in male patients [13].
  • Prescription testosterone is associated with increased risk of all-cause reoperations after primary total shoulder arthroplasty in male patients [13].
  • Authors suggest future areas of investigation that may provide guidance on how surgeons can mitigate adverse risks while optimizing benefits of testosterone replacement therapy in the orthopaedic patient [16].

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] TRT is associated with increased tendon rupture risk in men but not women, potentially due to sex-specific differences in dosing. [7] (10.1177/23259671261430731)
  • [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. [8] (10.1097/corr.0000000000002744)
  • [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] Cessation of TRT prior to rotator cuff repair should be considered on a patient-specific basis. [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] There is increased risk of RCTs, RCRs, and subsequent RCRs in patients prescribed testosterone. [14] (10.5435/jaaos-d-22-00554)
  • [L3] The observed non-linear relationship suggests that maintaining optimal testosterone levels may be important for joint health. [15] (10.1186/s12891-024-08272-6)
  • [L5] The authors suggest future areas of investigation that may provide guidance on how surgeons can mitigate adverse risks while optimizing benefits of TRT in the orthopaedic patient. [16] (10.5435/jaaos-d-23-00348)
  • [L2] Although evidence regarding orthopaedic perioperative use of testosterone replacement therapy is heterogeneous, 4 randomized controlled trials reviewed here found that testosterone supplementation improved clinical outcomes, body composition, and BMD. [17] (10.1016/j.arthro.2024.12.026)
  • [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. [18] (10.1016/j.arthro.2024.10.032)
  • [L3] Injectable TRT use within 1 year of primary ACLR is associated with a 3.3-fold increase in ACLR revision rates with 2 years of follow-up. [19] (10.1177/23259671251399845)
  • [L4] The review highlights that while testosterone supplementation is increasing, data regarding its safety and association with stroke in young adults remains limited and underexplored. [20] (10.3389/fneur.2024.1422931)

References

[1] Testosterone Replacement Therapy Increases Odds of Tendon Ruptures Treated Surgically. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/2325967125s00009

[2] Poster 374: Tendon Tears Among Patients Treated with Exogenous Therapeutic Anabolic Steroids: An Eight Year Retrospective Analysis in a Single Institution. Orthopaedic Journal of Sports Medicine. 2024. DOI: 10.1177/2325967124s00339

[3] Editorial Commentary: Testosterone Replacement Therapy and Anterior Cruciate Ligament Injury Risk: Insights and Cautions for Clinical Application. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.11.086

[4] Testosterone levels and risk of adhesive capsulitis: a 1:1 propensity matched analysis. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.01.012

[5] The use of prescription testosterone is associated with an increased likelihood of experiencing a distal biceps tendon injury and subsequently requiring surgical repair. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.02.122

[6] CORR Insights®: Testosterone Therapy Is Associated With Increased Odds of Quadriceps Tendon Injury. Clinical Orthopaedics & Related Research. 2023. DOI: 10.1097/corr.0000000000002835

[7] Testosterone Therapy and Associated Rates of Tendon Tear and Surgical Repair: A Retrospective Analysis. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671261430731

[8] Testosterone Therapy Is Associated With Increased Odds of Quadriceps Tendon Injury. Clinical Orthopaedics & Related Research. 2023. DOI: 10.1097/corr.0000000000002744

[9] Pectoralis major rupture in body builders: a case series including anabolic steroid use. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06382-1

[10] Athlete Selective Androgen Receptor Modulators Abuse: A Systematic Review. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465241252435

[11] Preoperative testosterone replacement therapy: a potential risk-factor for complications and reoperation after rotator cuff repair. JSES International. 2026. DOI: 10.1016/j.jseint.2025.10.002

[12] Poster 149: Supplemental Testosterone Increases Risk of Reoperation after Total Shoulder Arthroplasty. Orthopaedic Journal of Sports Medicine. 2024. DOI: 10.1177/2325967124s00118

[13] Prescription testosterone is associated with increased risk of infection-related and all-cause reoperations after primary total shoulder arthroplasty in male patients. JSES International. 2026. DOI: 10.1016/j.jseint.2026.101634

[14] The Relationship Between Testosterone Therapy and Rotator Cuff Tears, Repairs, and Revision Repairs. Journal of the American Academy of Orthopaedic Surgeons. 2023. DOI: 10.5435/jaaos-d-22-00554

[15] Correlation between low testosterone levels and the risk of osteoarthritis: a cross-sectional analysis of NHANES data (2011–2016). BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-024-08272-6

[16] Testosterone Replacement Therapy in Orthopaedic Surgery. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-23-00348

[17] Perioperative Testosterone Supplementation Improves Outcomes of Orthopaedic Surgeries: A Systematic Review of Heterogeneous Studies. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.12.026

[18] Prescription Testosterone Is Associated With an Increased Risk of Anterior Cruciate Ligament Injury. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.10.032

[19] Injectable Testosterone Replacement Therapy Within 1 Year Before ACL Reconstruction Is Associated With Increased Revision Rates. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671251399845

[20] Testosterone supplementation and stroke in young adults: a review of the literature. Frontiers in Neurology. 2024. DOI: 10.3389/fneur.2024.1422931

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