睾酮、合成代谢类固醇与肌肉骨骼健康 资料

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].
• Anabolic steroids did not induce ultrastructural collagen changes that might predispose to tendon rupture in humans [2].
• Testosterone users had a 2.9-fold increased risk of tendon rupture compared to nonusers [3].
• It is premature to imply causation between testosterone replacement therapy and ACL injuries based solely on existing results due to confounding variables [4].
• Exogenous testosterone is a risk factor for increased postoperative complications following distal biceps tendon repair [5].
• There is a threshold-dependent relationship between testosterone and shoulder pathology [6].
• 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 [7].
• 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 [8].
• TRT is associated with increased tendon rupture risk in men but not women, potentially due to sex-specific differences in dosing [9].
• 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 [10].
• SARM use is associated with tendon damage [11].
• Cessation of TRT prior to rotator cuff repair should be considered on a patient-specific basis [12].

How It Works

• Further research is needed to understand the mechanism by how testosterone increases the risk of reoperation after TSA [13].
• Anabolic steroids use may contribute to pectoralis major injury [14].
• Continuation of anabolic steroids during recovery does not seem to have a negative effect on functional recovery after pectoralis major injury [14].
• Testosterone use is associated with a higher risk of both infection-related and all-cause reoperations after total shoulder arthroplasty [15].

What the Evidence Shows

Tendon Rupture Risk and Injury Association

• 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 [10].
• Patients who filled a prescription for testosterone replacement therapy were at increased risk of undergoing surgical repair of the quadriceps tendon [10].
• There is increased risk of rotator cuff tears in patients prescribed testosterone [16].
• There is increased risk of rotator cuff repairs in patients prescribed testosterone [16].
• There is increased risk of subsequent rotator cuff repairs in patients prescribed testosterone [16].
• TRT is associated with increased tendon rupture risk in men but not women [9].
• The association between TRT and increased tendon rupture risk in men but not women is potentially due to sex-specific differences in dosing [9].

Postoperative Complications and Reoperation

• Testosterone use is associated with a higher risk of infection-related reoperations after total shoulder arthroplasty [15].
• Testosterone use is associated with a higher risk of all-cause reoperations after total shoulder arthroplasty [15].
• Supplemental testosterone increases the risk of reoperation after total shoulder arthroplasty [13].
• Preoperative testosterone replacement therapy is a potential risk factor for complications after rotator cuff repair [12].
• Preoperative testosterone replacement therapy is a potential risk factor for reoperation after rotator cuff repair [12].

Mechanisms and Ultrastructure

Clinical Considerations and Causation

• Clinicians should remain vigilant and prescribe TRT judiciously with a thorough assessment of each patient's unique risk profile [4].
• Surgeons should be more intentional about discussing endocrinologic history with patients [8].
• Surgeons should counsel patients with testosterone deficiency on the risks for injury or re-injury [8].
• Further research is needed to understand the mechanism by which testosterone increases the risk of reoperation after total shoulder arthroplasty [13].
• Hormonal status should be considered in musculoskeletal risk assessment [6].

Practical Considerations

Risk Assessment and Counseling

• A threshold-dependent relationship exists between testosterone and shoulder pathology, highlighting the need to consider hormonal status in musculoskeletal risk assessment [6].

Operative Considerations

Anabolic Steroids and SARMs

• SARM use is associated with increased muscle mass, hepatotoxicity, cardiotoxicity, tendon damage, and androgenic side effects throughout the body [11].
• Anabolic steroids use may contribute to pectoralis major injury in body builders [14].
• Continuation of anabolic steroids during recovery from pectoralis major injury does not seem to have a negative effect on functional recovery [14].

Key Evidence

• [L3] Testosterone replacement therapy is associated with increased odds of surgically treated tendon rupture. [1] (10.1177/2325967125s00009)
• [L4] The authors conclude that anabolic steroids did not induce ultrastructural collagen changes that might predispose to tendon rupture in humans. [2] (10.1016/s0020-1383(98)00183-1)
• [L3] Testosterone users had a 2.9-fold increased risk of tendon rupture compared to nonusers. [3] (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. [4] (10.1016/j.arthro.2024.11.086)
• [L3] These findings suggest that exogenous testosterone is a risk factor for increased postoperative complications following distal biceps tendon repair. [5] (10.1177/2325967126s00288)
• [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. [6] (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. [7] (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. [8] (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. [9] (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. [10] (10.1097/corr.0000000000002744)
• [L4] SARM use is associated with increased muscle mass, hepatotoxicity, cardiotoxicity, tendon damage, and androgenic side effects throughout the body. [11] (10.1177/03635465241252435)
• [L3] Cessation of TRT prior to rotator cuff repair should be considered on a patient-specific basis. [12] (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. [13] (10.1177/2325967124s00118)
• [L4] Anabolic steroids use may contribute to the injury, but continuation during recovery does not seem to have a negative effect on functional recovery. [14] (10.1186/s12891-023-06382-1)
• [L2] Testosterone use is associated with a higher risk of both infection-related and all-cause reoperations after total shoulder arthroplasty. [15] (10.1016/j.jseint.2026.101634)
• [L3] There is increased risk of RCTs, RCRs, and subsequent RCRs in patients prescribed testosterone. [16] (10.5435/jaaos-d-22-00554)

References

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

[2] Ultrastructural analysis of ruptured tendon from anabolic steroid users. Injury. 1998. DOI: 10.1016/s0020-1383(98)00183-1

[3] 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

[4] 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

[5] Paper 30. Comparative Outcomes of Distal Biceps Tendon Repair in Patients With and Without Testosterone Therapy. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/2325967126s00288

[6] 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

[7] 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

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

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

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

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

[12] 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

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

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

[15] 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

[16] 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