Background: Testosterone replacement therapy (TRT) use is increasing in both men and women with demonstrated benefits for muscle strength, sexual function, and well-being. However, previous studies have linked exogenous testosterone to elevated rates of tendon injury in upper and lower extremities. TRT has also been associated with higher rates of surgical repair and markedly elevated reoperation rates. Limited institutional data are available on tendon rupture rates and treatment trends. Purpose: To investigate the association between prescription TRT and tendon rupture risk, with a specific focus on rotator cuff tear (RCT) incidence and repair/revision rates at a single academic institution. Study Design: Cohort study; Level of evidence, 3. Methods: We queried 1 institution's electronic health records using International Classification of Diseases (ICD-10) codes for patients ≥18 years with tendon rupture and prescription TRT use within 90 days of injury between 2015 and 2023. Individuals with risk factors predisposing them to tendon injury were excluded. A subanalysis of RCT was performed using a chart review of a subgroup of TRT patients and propensity-matched controls. Outcomes of interest included rupture location and rate, and, for the RCT, tear severity and rates of surgical repair/revision. Outcomes were compared between TRT users and nonusers. Results: We identified 410 TRT users and 14,474 nonusers with tendon rupture. Men on TRT had significantly higher rupture rates (3.6% vs 1.3%; odds ratio OR, 2.88 95% CI, 2.59-3.20) across all ages and races. No significant increase in tendon rupture rate was observed in women on TRT. RCTs were the most common injury (77%). In the RCT subanalysis (78 TRT users, 355 matched controls), TRT users underwent nonoperative intervention more frequently than nonusers (74.4% vs 46.7%; OR, 3.3 95% CI, 1.91-5.72). Tear severity and revision rates did not differ significantly between groups. Conclusion: TRT is associated with increased tendon rupture risk in men but not women, potentially due to sex-specific differences in dosing. TRT users with RCT were less likely to undergo arthroscopic repair compared with matched controls, despite similar distributions of tear severity.
Dajani et al. (Wed,) studied this question.