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Understanding the connection between TRT and tendonitis is important for both patients and healthcare providers. TRT aims to bring testosterone levels back to normal, helping patients feel better and live healthier lives. Older rats were also found to have Achilles tendons with lower maximum stresses and lower elasticities compared to those of younger rats, additional properties that make a tendon more susceptible to injury . As hypogonadism increases with age, the presence of this trend in the oldest age cohort regardless of patient hypogonadism status indicates that there is likely a separate explanation for this observation. Within both male and female cohorts in this study, the highest adjusted odds were seen in the aged 66 to 75 cohorts. Testa et al. found increased odds of rotator cuff tears in both male and female patients prescribed TRT, with males having a higher aOR of 4.73 in comparison to 3.49 for females . While the current body of literature regarding prescription TRT and musculotendinous injury is scarce, a recent study by Testa et al. in a similar analysis demonstrated a significant increase in rotator cuff tears and revision rotator cuff repair .
These pills typically maintain estradiol levels at ~25 pg/ml and decrease the ovulatory rise in estrogen (Mishell et al., 1972). In young women, estrogen is produced from cholesterol in a series of reactions within the ovaries. Future studies will be repeated with larger sample size, and include albumin and sex-binding globulin levels to help adjust for other biological factors that may influence these measures. Six males age 24-33, ten age 34-43, four age and two males age had FT and TT levels recorded as part of their care. The FT and TT levels of these injured men were directly compared to age matched historical data 5-7. 22 males diagnosed with Achilles injury that had their FT (nmol/L) and TT (nmol/L) levels measured as part of their initial clinical evaluation were retrospectively identified. Yet, in active young female athletes, physiological high concentration of estrogen may enhance the risk of injuries due to reduced fibrillar crosslinking and enhanced joint laxity.
Testosterone replacement therapy (TRT) has transformed how we approach hypogonadism and age-related testosterone decline. It is well known that elderly individuals show lower content of structural proteins in tendons, reduced magnetic resonance imaging tendon signal intensities, and an increase in tendon cross-links due to advanced glycation end products deposition. Engineered ligaments treated with serum obtained from young healthy men after exercise resulted in more collagen and improved tensile strength in comparison to those treated with serum from resting men. Besides these observations, patients with Ehlers-Danlos syndrome (an inherited connective tissue disorder), treated with 1 mg of IGF-1 injected in the patellar tendon, showed an increase in the protein synthesis rate in comparison with the controlateral tendon used as control35. These findings are substantiated by a retrospective study performed in 40 cases of horse superficial digital flexor tendonitis. IGF-1 injection promotes tendon and ligament healing after collagenase-induced tissue atrophy or ligament disruption48.
Although such instances are rare, and made up only 0.8% of Medicare and Medicaid payments in 2022, because this analysis relied on claims data, it is possible that uncharted complications were not captured.11 In addition, primary tendon tears were designated as the first time the diagnosis appeared in the patient’s database. To protect patient identities, the PearlDiver software displays exact patient counts only when defined buckets have ≥11 patients; however, all statistical tests performed in PearlDiver use exact patient numbers for said buckets with Rates of tendon tears and repairs within 1 and 2 years of primary care visit were compared using multivariable logistic regressions. All clinical characteristics (Table 1) that were significantly different between cohorts despite propensity score matching were controlled for in the appropriate multivariate logistic regressions to negate any potential confounding effects. To reduce confounding bias, propensity score matching was performed at a caliper of 0.20 to generate patient cohorts. Only patients with one of the codes for an acute rotator cuff tear, as defined in Online Appendix C, and either CPT or CPT-23410, were counted as having a rotator cuff repair to exclude repairs of chronic rotator cuff tears. These procedural codes can be found in Online Appendix D. To ensure tendon repairs were primary repairs, only the first instance of any of the procedural codes related to a particular tendon tear was queried in the 1- and 2-year period after primary care visit.
Ovulation is followed by a rapid decrease in estradiol, then estradiol, and progesterone both increase in the luteal phase giving a broad secondary peak. 17β-estradiol levels rise from 5 pg/ml at the early follicular phase, to a peak of 200–500 pg/ml just before ovulation. Beyond estrogen, the menstrual cycle is characterized by significant changes in other important plasma hormones such as follicle stimulating hormone (FSH), luteinizing hormone (LH), and progesterone (Figure 1). Estrogen secretion naturally varies in young women, increasing 10- to 100-fold over the menstrual cycle. Beyond the nucleus, estrogen has a variety of post-transcriptional effects such as regulating the redox state of the cell (Kumar et al., 2010), altering mitochondrial function (Yao and Brinton, 2012), and directly inhibiting the activity of specific enzymes (Lee C. A. et al., 2015). As a steroidal hormone, estrogen can freely pass through the plasma membrane and move into the nucleus where it can bind to its nuclear receptors, the estrogen receptors (ER)α and β, and modify gene expression (Heldring et al., 2007). The most prevalent estrogen is 17β-estradiol with smaller amounts of estrone and estriol circulating as well (Heldring et al., 2007).
The connection between Testosterone Replacement Therapy (TRT) and tendonitis is a topic that deserves careful attention. By taking proactive steps, individuals on TRT can enjoy its benefits while minimizing the risk of tendon problems. Regular monitoring, balanced exercise, and ongoing research are key to ensuring that tendon health is maintained during long-term TRT. While TRT offers significant benefits, it is important to be aware of its potential long-term effects on tendon health.
But risk stratification is of little benefit in the absence of pragmatic counseling to patients regarding their activity level when at risk. Evolutionarily, this makes sense since laxer joints and better repair following injury would facilitate healthy childbirth and recovery. Therefore, to date the data suggest that HRT is beneficial for musculoskeletal function in postmenopausal women, but extra care should be taken to maximize tendon function.
