Testosterone Replacement Therapy Is Associated With Increased Rates of Trigger Finger and De Quervain's Tenosynovitis With Increased Rates of Requiring Surgical Release

Anabolic steroid therapy has been associated with tendon injury. Testosterone Replacement Therapy (TRT) is becoming a very popular treatment for hypogonadism. Its use is increasing throughout the world. Unfortunately, there is a paucity of evidence associating physiologic testosterone replacement therapy (TRT) with tenosynovitis of the hand, specifically trigger finger and De Quervain's tenosynovitis. The purpose of this study is to evaluate the relationship between TRT and tenosynovitis of the hand. The Pearl-Diver database, which contains a large sample of patients with Medicare, Medicaide and comercially insured patients. It allows for representative sampling of the US population. The database was queried for all patients receiving TRT form 2010 to 2021. It was then used to compile a matched retrospective cohort. This is a one-to-one exact matched retrospective cohort study could then be evaluated to find differences among the groups. Rates of new onset trigger finger and De Quervain's tenosynovitis and subsequent surgery were identified using ICD-9, ICD-10, and CPT billing codes. Single-variable Chi-square analyses and multiple variable logistic regression were used to compare rates in the TRT and control cohorts while controlling for potential confounding variables. Both unadjusted and adjusted odds ratios (OR) are reported for each comparison. In the adjusted analysis, patients undergoing TRT were more than twice as likely to develop trigger finger (adjusted odds ratio (aOR) = 2.20, 95% confidence interval (CI), 2.02-2.40, p < 0.001) compared to their matched controls. TRT was also associated with an increased likelihood of experiencing De Quervain's tenosynovitis (aOR = 1.72, 95% CI, 1.46-2.03, p < 0.001). Of the patients diagnosed with either trigger finger or De Quervain's tenosynovitis over the two-year period, patients with prior TRT were over twice as likely to require surgical release for both trigger finger (aOR = 2.10, 95% CI, 1.68-2.63, p < 0.001) and De Quervain's tenosynovitis (aOR = 2.02, 95%CI, 1.15-3.68, p = 0.017) compared to the controls. TRT is associated with an increased likelihood of both trigger finger and De Quervain's tenosynovitis, and an increased likelihood of requiring surgical release for both conditions. These results elucidate the potential clinical consequences of persistent TRT use and provide insight to physicians when counseling patients about the potential risks of TRT. Further studies aimed at finding the mechanism of testosterone's effect on tendons may allow clinicians to modulate these risks.