Testosterone Replacement Therapy and Associated Outcomes and Management of Trigger Finger

Purpose Testosterone replacement therapy is increasingly common but has been associated with poor treatment outcomes in tendon pathology, although its impact on conditions related to the hand is incompletely understood. This study aimed to investigate the association between testosterone replacement therapy (TRT) and rates of operative and nonoperative intervention, repeat intervention, and complications in male patients with trigger finger. Methods We performed a retrospective cohort study using the TriNetX Research Network (2014–2025). We identified men aged 40–90 years with trigger finger who were exposed to TRT within 6 months before diagnosis. A control cohort without TRT use was generated with 1:1 propensity score matching using age, body mass index, Charlson Comorbidity Index, and additional comorbidities. Outcomes of interest included rates of surgical release, corticosteroid injection, stiffness, postoperative triggering requiring intervention, and occupational therapy referrals. Kaplan–Meier analyses were conducted with hazard ratios (HR) and 95% confidence intervals (CIs). Results After matching, 7,337 patients were included in each cohort. TRT exposure was associated with a higher 2-year rate of A1 pulley release (16.3% vs 12.7%; absolute risk difference [ARD], 3.61%; HR, 1.42; 95% CI, 1.30–1.55; P < .001). Corticosteroid injection was more common in the TRT cohort (22.9% vs 21.5%, ARD 1.45%), although the proportional hazards assumption was not satisfied. Stiffness occurred in 0.4% of the TRT cohort and 0.2% of controls (ARD 0.20%) and was interpreted as exploratory. Rates of occupational therapy referral and postoperative triggering requiring intervention were not significantly different between the 2 groups. Conclusions TRT exposure was associated with greater treatment utilization among older male patients with trigger finger, notably A1 pulley release. Because patients receiving TRT may have more frequent healthcare contact, these findings may reflect surveillance or treatment-utilization bias rather than a direct effect of TRT on trigger finger severity. TRT status may be a useful contextual factor for patient counseling, although these findings should not be interpreted as evidence that TRT independently alters trigger finger management. Type of study/level of evidence Therapeutic III.