With an increasing population over 65 years of age, the number of men who experience age-related androgen decline will also increase . Testosterone replacement therapy (TRT) has become more prevalent in recent decades for both hypogonadism and gender-affirming care 8,9. As RSA approaches its 20-year anniversary in the United States, implant survivorship has been increasingly studied, with a focus on implant design and placement and patient selection. While historically performed in older populations, the use of RSA in patients younger than 65 is increasing and has been shown to remain safe and effective in appropriately selected cases, contributing to the sharp rise in the number of surgeries performed . These results can assist surgeons when evaluating patients on TRT who also may be candidates for RSA.
Comparison of complications after reverse total shoulder arthroplasty (RSA) in testosterone replacement therapy (TRT) cohort and matched control cohort. Comparison of patient demographics of testosterone replacement therapy (TRT) cohort and matched control cohort. There were a total of 1906 patients who used TRT within 90 days of undergoing RSA and at least 2 years of follow-up after surgery. Patient demographics, comorbidities, and surgical complications were compared between the RSA group and the control group to determine if TRT use within 90 days of surgery has any effect on the surgical outcomes. For the present study, patients who were on TRT within 90 days of undergoing RSA were included (1906 patients).
Although the present study was sufficiently powered for the outcome of lean mass, the small sample size and wide age range of patients selected may have contributed to a failure to document differences in baseline leg strength and other factors affecting clinical outcomes. Prior research has suggested that perioperative supraphysiological testosterone supplementation may improve clinical outcomes, including rehabilitation milestones such as early standing after knee replacement surgery.2 The present study also did not find a significant difference in postoperative strength of the injured leg between the testosterone and placebo groups. Our results suggest that testosterone therapy may be useful as an adjunct to postoperative physical therapy in eugonadal patients by causing an increase in lean mass that persists for an extended period without residual disturbance of baseline serum testosterone levels. Nonetheless, the trauma of surgical repair and postoperative mobility limitations can exacerbate the loss of muscle mass and strength, which may prolong the already arduous rehabilitation process and potentially impair long-term outcomes.3,24 One study reported that 60% of patients undergoing ACL reconstruction did not return to preinjury activity levels within 2 years.17
Control participants in the placebo group followed the same schedule of injections with an intramuscular saline dose instead of testosterone. CONSORT (Consolidated Standards of Reporting Trials) diagram showing the flow of participants during the study. Twelve participants completed all evaluations, with 1 participant missing the 24-week study visit. Participants were randomly assigned to receive testosterone or placebo treatment. All aspects of the study were conducted at a tertiary-care academic center and were approved by the relevant institutional review board. Additionally, patients who had unstable, longitudinal meniscal tears that required repair and those with subsequent postoperative motion limitations that interfered with the rehabilitation protocol were excluded.
These blood tests should be completed in the morning when testosterone levels tend to be the highest. This includes two separate blood tests to measure your testosterone levels. The first step is to review your health history and perform a workup to determine if your testosterone levels are low enough to require treatment.
They’ll tell you how often you’ll need follow-up bone density tests. Your provider might suggest weight-bearing exercise to strengthen your muscles and train your balance. Staying active can strengthen your bones. The most important part of treating osteoporosis is preventing broken bones. Providers sometimes refer to bone density tests as DEXA scans, DXA scans or bone density scans. People in postmenopause lose bone mass even faster. This causes a gradual loss of bone mass.
The current literature on TRT is inconclusive; it has been shown that it facilitates bone–implant integration but also increases the risk of musculotendinous complications. This study demonstrated that TRT use within 90 days of RSA does not increase the rates of revision, fracture, or infection. While the present study provides a preliminary retrospective analysis, it is crucial that more research is conducted surrounding TRT use and shoulder arthroplasty. Understanding the differences in outcomes based on this is also an important topic for future research. Furthermore, when coding for periprosthetic fractures, fractures due to falls after surgery compared to intraoperative fractures was not able to be elucidated. This required the use of only an ICD code that refers to the RSA procedure, which may have led to an under-reporting of the total number of RSA patients that may have also been on TRT.
While testosterone levels decline naturally as you age, certain health conditions can also cause low testosterone. In addition to providing testosterone therapy, you will also be instructed on lifestyle changes you can make to help improve your testosterone levels. This is the first study investigating the effects of perioperative testosterone supplementation in young, healthy men after ACL reconstruction. Future studies may consider investigating the specific relationships between the presence of meniscal tears, graft type, and patient outcomes in the setting of testosterone supplementation.

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