Testosterone Replacement Therapy Increases Odds of Tendon Ruptures Treated Surgically

Objectives: Testosterone hormone replacement therapy is a common treatment for hypogonadal patients, and its use has been increasing in recent years. There are well documented risks associated with testosterone replacement therapy, including cardiovascular disease, thromboembolic events, sleep apnea and prostate disease. Tendon rupture may be debilitating for both athletes and non-athletes. However, the risk of tendon rupture in association with testosterone replacement therapy is not well understood. The objective of this study is to determine the association between testosterone replacement therapy and tendon rupture (including Achilles, patella, quadriceps, distal biceps and pectoralis major tendons) Methods: A retrospective chart review was performed using one institution’s electronic medical record. Patients treated from January 1, 2000 to January 1, 2024, ages 18-89, were included. All patients who used testosterone replacement were evaluated for rupture of the Achilles, patellar, quadriceps, distal biceps, and pectoralis major tendons. CPT codes were used to define tendon rupture that underwent surgery. This cohort was compared to a control group of patients who did not use testosterone and sustained tendon ruptures. Demographic, medical comorbidity, injury characteristics, and athletic participation data were obtained. Results: In total, 73 of 46,479 (0.16%) patients who had used testosterone sustained a tendon rupture that underwent surgery. The control group had 811 of 3,899,355 (0.02%) patients who did not use testosterone sustain a tendon rupture that underwent surgery. The odds of having a surgically treated tendon rupture given testosterone use was 7.53 times higher (95% CI = 5.93 to 9.57, p < 0.001) than the odds of those without testosterone use. The mean ages and BMIs for the testosterone group and non-testosterone group were 53.6 years and 43.2 years (p< 0.001) and 33.1 kg/m2 and 30.6 kg/m2 (p = 0.005), respectively. Conclusions: Testosterone replacement therapy is associated with increased odds of surgically treated tendon rupture.