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Testosterone, Anabolic Steroids at Kalusugan ng Musculoskeletal System

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Anabolic steroids and testosterone are linked to a higher risk of tendon rupture, including the rotator cuff, biceps and quadriceps. How steroids and TRT affect tendons, joints, bone and recovery from surgery.

Updated Sep 2026
Isang molecular structure sa tabi ng isang maliit na vial.
Naiimpluwensyahan ng testosterone ang kalamnan at buto; ang antas nito at ang pag-inom ng dagdag na testosterone ay may mga epekto sa musculoskeletal system na mahalagang maunawaan. Kieran Hirpara 4.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ano ito

Ang anabolic steroids ay mga gawang-taong bersyon ng testosterone, ang hormone na nagpapalakas ng kalamnan at buto sa mga lalaki. Ang testosterone replacement therapy (TRT) ay isang anyo ng testosterone na inirereseta para sa mga taong mababa ang sariling antas nito. Ang isang mas bagong grupo ng mga gamot na tinatawag na SARMs (selective androgen receptor modulators) ay kumikilos sa katulad na paraan, na nagpapalaki ng kalamnan nang hindi gumagamit ng testosterone mismo.

Ginagamit ng ilang tao ang mga gamot na ito para gamutin ang isang kondisyong medikal. Ginagamit naman ito ng iba para magpalaki ng kalamnan para sa sports o sa itsura. Dapat malaman ng parehong grupo na nakaaapekto ang mga gamot na ito sa mga tendon, ang matitibay na litid na nagdudugtong sa kalamnan at buto. Iniugnay ng pananaliksik ang paggamit ng testosterone sa mas mataas na panganib ng pagkapunit ng rotator cuff [1], mga pinsala sa biceps tendon [2], at mga pinsala sa quadriceps tendon sa loob ng 1 taon matapos kunin ang reseta [3]. Natuklasan ng isang pag-aaral na ang mga gumagamit ng testosterone ay may 2.9 na beses na mas mataas na panganib ng pagkaputol ng tendon kumpara sa mga hindi gumagamit [4]. Ang paggamit ng SARM ay nauugnay din sa pinsala sa tendon [5].

Mukhang dalawang direksyon ang kaugnayang ito. Ang sobrang testosterone ay mukhang nagpapabigat sa mga tendon at kasukasuan. Nagdudulot din ng problema ang kakulangan nito, dahil ang hypogonadism (napakababang testosterone) ay mukhang may masamang epekto sa musculoskeletal system [6]. Iniugnay din ng mga pag-aaral ang antas ng testosterone sa osteoarthritis, ang wear-and-tear na uri ng arthritis [7].

Kung umiinom ka ng inireresetang testosterone at haharap sa operasyon, sabihin sa iyong doktor. Binabago nito ang ilang pagtantiya ng panganib sa mga operasyon tulad ng shoulder replacement at rotator cuff repair.

Gumagana ba ito?

Walang simpleng sagot dito, dahil iba-iba ang ginagawa ng mga gamot na ito sa iba't ibang bahagi ng iyong katawan.

Kayang palakasin ng testosterone ang kalamnan at buto. Natuklasan ng apat na randomised controlled trial (mga pag-aaral kung saan random na binibigyan o hindi binibigyan ng paggamot ang mga tao) na ang testosterone na ibinigay sa panahon ng operasyon ay nagpabuti ng mga klinikal na resulta, komposisyon ng katawan, at bone mineral density sa mga orthopaedic na operasyon [8]. Itinuro din ng pananaliksik ang isang posibleng paraan para mapabuti ang paghilom ng bali sa pamamagitan ng pagtutok sa androgen/androgen receptor axis sa periosteum (ang manipis na patong ng tisyu na bumabalot sa buto) [9].

Ngunit ang parehong mga hormone ay maaaring magpabigat sa mga tendon at kasukasuan. Ang mga pasyenteng kumuha ng reseta para sa testosterone replacement therapy ay mas malamang na magkaroon ng pinsala sa quadriceps na kalamnan o tendon sa loob ng 1 taon matapos kunin ang kanilang reseta, at mas mataas ang panganib nilang mangailangan ng operasyon para ayusin ang quadriceps tendon [3]. Ang mga pasyenteng niresetahan ng hindi bababa sa 3 buwan ng testosterone replacement therapy ay nagkaroon ng mas mataas na insidente ng mga pinsala sa ACL kumpara sa mga control sa loob ng 2 taong follow-up [10]. Ang paggamit ng injectable na testosterone replacement therapy sa loob ng 1 taon ng unang ACL reconstruction ay nauugnay sa 3.3 na beses na pagtaas ng antas ng revision ng ACL reconstruction sa loob ng 2 taong follow-up [11]. Sinuportahan ng isang bidirectional Mendelian randomised study (isang genetic na pag-aaral na sumusubok ng sanhi at epekto) ang isang sanhing kaugnayan sa pagitan ng antas ng bioavailable testosterone at osteoarthritis, at tinukoy ang antas ng bioavailable testosterone bilang risk factor para sa osteoarthritis [7].

Magkakahalo ang mga resulta ng operasyon. Ang mga pasyenteng niresetahan ng dagdag na testosterone ay may mas mataas na panganib ng muling operasyon dahil sa anumang dahilan at ng muling operasyon dahil sa impeksyon pagkatapos ng total shoulder arthroplasty (shoulder replacement) [12]. Ang paggamit ng testosterone replacement therapy bago ang operasyon ay hindi naiugnay sa mas maraming panandaliang komplikasyon pagkatapos ng arthroscopic rotator cuff repair (keyhole na operasyon sa tendon ng balikat) [13]. Ang mga pasyenteng nasa testosterone therapy ay dapat payuhan tungkol sa kanilang mas mataas na panganib ng mga komplikasyon pagkatapos ng distal biceps tendon repair, at dapat gamitin ang parehong pagtatasa ng panganib at paghahanda bago ang operasyon para mabawasan ang panganib sa panahon ng operasyon [14]. Ang pagtigil sa testosterone replacement therapy bago ang rotator cuff repair ay dapat pag-isipan batay sa kalagayan ng bawat pasyente [15]. Ang paggamit ng anabolic steroids ay maaaring makapag-ambag sa pectoralis major rupture (pagkapunit ng malaking kalamnan ng dibdib), ngunit ang pagpapatuloy nito habang nagpapagaling ay mukhang walang masamang epekto sa paggaling ng paggana [16].

Parehong ang sobra at ang kulang na testosterone ay mukhang may masamang epekto sa musculoskeletal system (ang iyong mga kalamnan, tendon, buto at kasukasuan) [6].

Ano ang mga panganib?

Ang pinakamalinaw na panganib ay nasa iyong mga tendon. Iniuugnay ng pananaliksik ang paggamit ng testosterone sa mas mataas na tsansa ng pinsala sa quadriceps tendon [17]. Madalas na umiinom ang mga gumagamit ng SARM ng mas mataas na dosis kaysa sa mga pinag-aralan, at iniuugnay iyon ng mga case report sa pinsala sa tendon [18]. Parehong ang anabolic steroids at ang napakababang testosterone ay maaaring makapinsala sa iyong mga kalamnan, tendon, buto at kasukasuan [6].

Maaari ring maapektuhan ang iyong mga kasukasuan. Natuklasan ng isang genetic na pag-aaral ang isang sanhing kaugnayan sa pagitan ng antas ng bioavailable testosterone at osteoarthritis [7]. Hindi tuwid na linya ang kaugnayang ito, kaya ang pagpapanatili ng testosterone sa malusog na saklaw ay maaaring mahalaga para sa kalusugan ng kasukasuan [19].

Kung umiinom ka ng testosterone at kailangan mo ng operasyon, nagbabago ang mga panganib. Ang paggamit ng testosterone ay nauugnay sa mas mataas na panganib ng muling operasyon pagkatapos ng shoulder replacement, dahil man sa impeksyon o sa anumang dahilan [20]. Isa rin itong posibleng risk factor para sa mga komplikasyon at muling operasyon pagkatapos ng rotator cuff repair, bagaman walang natuklasang kaugnayan ang isang pag-aaral sa mga panandaliang problema pagkatapos ng keyhole na operasyon sa rotator cuff [15] [13]. Ang pagtigil sa testosterone bago ang rotator cuff repair ay desisyong ginagawa batay sa bawat kaso [15]. Mas mataas ang panganib ng mga komplikasyon pagkatapos ng distal biceps tendon repair para sa mga pasyenteng nasa testosterone, kaya maingat kang susuriin at ihahanda ng mga doktor bago ang operasyon para mapababa ang panganib na iyon [14].

May ilang natuklasan na tumuturo sa kabilang direksyon. Natuklasan ng apat na randomised controlled trial na ang testosterone na ibinigay sa panahon ng operasyon ay nagpabuti ng mga klinikal na resulta, komposisyon ng katawan, at bone mineral density sa mga orthopaedic na operasyon [8]. Ang paggamit ng anabolic steroid ay maaaring makapag-ambag sa pectoralis major rupture, isang pagkapunit ng malaking kalamnan ng dibdib, ngunit ang pagpapatuloy ng mga gamot habang nagpapagaling ay mukhang hindi nakasasama sa kung gaano ka kahusay gumaling [16].

May ilang tanong na bukas pa. Limitado at kulang pa sa pag-aaral ang ebidensya kung ang pag-inom ng dagdag na testosterone ay nauugnay sa stroke sa mga batang adulto [21]. At pinapataas ng testosterone ang panganib ng pagkaputol ng tendon sa mga lalaki ngunit hindi sa mga babae, posibleng dahil magkaiba ang dosis na ibinibigay sa mga lalaki at babae [22].

Tama ba ito para sa iyo?

Angkop ang mga gamot na ito sa iba't ibang tao para sa iba't ibang dahilan. Makatutulong ang inireresetang testosterone kung mababa ang sarili mong antas, at kaya nitong palakasin ang kalamnan at buto. Natuklasan ng apat na randomised controlled trial na ang testosterone na ibinigay sa panahon ng operasyon ay nagpabuti ng mga klinikal na resulta, komposisyon ng katawan, at bone mineral density sa mga orthopaedic na operasyon [8]. Ngunit ang parehong mga hormone ay maaaring magpabigat sa mga tendon at kasukasuan, at iniuugnay ng pananaliksik ang paggamit ng testosterone sa mas mataas na tsansa ng pinsala sa quadriceps tendon [17]. Natuklasan din ng isang genetic na pag-aaral ang isang sanhing kaugnayan sa pagitan ng antas ng bioavailable testosterone at osteoarthritis [7]. Hindi tuwid na linya ang kaugnayang ito, kaya ang pagpapanatili ng testosterone sa malusog na saklaw ay maaaring mahalaga para sa kalusugan ng kasukasuan [19].

Mas mahirap magpasya tungkol sa SARMs. Kaya nitong dagdagan ang lean body mass sa mababang dosis, ngunit ipinahihiwatig ng mga case report na umiinom ang mga gumagamit ng mas mataas na dosis kaysa sa mga pinag-aralan, na nagpapataas ng panganib ng pinsala sa tendon, pinsala sa atay at mga cardiovascular event (problema sa puso at mga daluyan ng dugo) [18]. Ang paggamit ng SARM ay nauugnay din sa pinsala sa atay at puso at sa mga androgenic na side effect sa buong katawan [5]. Walang magandang trial na nagpapakitang ligtas ang mga ito, at nanawagan ang mga pampublikong ahensya sa kalusugan ng regulasyon sa mga compound na ito na ibinebenta sa grey market [23].

Kung nasa testosterone ka at haharap sa operasyon, dapat suriin ng iyong doktor ang iyong indibidwal na risk profile bago kayo magpasya nang magkasama [14]. Kabilang ang iyong hormonal na kalagayan sa anumang pagtatasa ng mga panganib sa iyong kalamnan, tendon at kasukasuan [24]. Ito ay desisyong pinagsasaluhan, na ginagawa kasama ng iyong doktor, batay sa sarili mong kalusugan at mga layunin.

Ang pinaka-importanteng punto

Kung mababa ang antas ng iyong testosterone, makatutulong ang inireresetang testosterone sa iyong mga kalamnan at buto. Ngunit maaaring magpabigat ang mga hormone na ito sa mga tendon at kasukasuan, at tumataas ang mga panganib sa mas mataas na dosis. Kung haharap ka sa operasyon, sabihin sa iyong doktor ang anumang paggamit ng testosterone o SARM, dahil binabago nito kung paano tinatasa ang iyong mga panganib. Ang pinakamahalagang paalala: parehong ang sobra at ang kulang na testosterone ay maaaring makapinsala sa iyong katawan, kaya ang anumang desisyon ay dapat gawin batay sa bawat kaso kasama ng iyong doktor.

Mga Sanggunian

[1] The Relationship Between Testosterone Therapy and Rotator Cuff Tears, Repairs, and Revision Repairs. Journal of the American Academy of Orthopaedic Surgeons. 2023. DOI: 10.5435/jaaos-d-22-00554

[2] The use of prescription testosterone is associated with an increased likelihood of experiencing a distal biceps tendon injury and subsequently requiring surgical repair. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.02.122

[3] Testosterone Therapy Is Associated With Increased Odds of Quadriceps Tendon Injury. Clinical Orthopaedics & Related Research. 2023. DOI: 10.1097/corr.0000000000002744

[4] Poster 374: Tendon Tears Among Patients Treated with Exogenous Therapeutic Anabolic Steroids: An Eight Year Retrospective Analysis in a Single Institution. Orthopaedic Journal of Sports Medicine. 2024. DOI: 10.1177/2325967124s00339

[5] Athlete Selective Androgen Receptor Modulators Abuse: A Systematic Review. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465241252435

[6] Testosterone. JBJS Reviews. 2024. DOI: 10.2106/jbjs.rvw.24.00061

[7] The causal impact of bioavailable testosterone levels on osteoarthritis: a bidirectional Mendelian randomized study. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08626-8

[8] Perioperative Testosterone Supplementation Improves Outcomes of Orthopaedic Surgeries: A Systematic Review of Heterogeneous Studies. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.12.026

[9] Targeted activation of androgen receptor signaling in the periosteum improves bone fracture repair. Cell Death & Disease. 2022. DOI: 10.1038/s41419-022-04595-1

[10] Prescription Testosterone Is Associated With an Increased Risk of Anterior Cruciate Ligament Injury. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.10.032

[11] Injectable Testosterone Replacement Therapy Within 1 Year Before ACL Reconstruction Is Associated With Increased Revision Rates. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671251399845

[12] Poster 149: Supplemental Testosterone Increases Risk of Reoperation after Total Shoulder Arthroplasty. Orthopaedic Journal of Sports Medicine. 2024. DOI: 10.1177/2325967124s00118

[13] Association of preoperative testosterone replacement therapy with postoperative complications following rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.12.013

[14] Paper 30. Comparative Outcomes of Distal Biceps Tendon Repair in Patients With and Without Testosterone Therapy. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/2325967126s00288

[15] Preoperative testosterone replacement therapy: a potential risk-factor for complications and reoperation after rotator cuff repair. JSES International. 2026. DOI: 10.1016/j.jseint.2025.10.002

[16] Pectoralis major rupture in body builders: a case series including anabolic steroid use. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06382-1

[17] CORR Insights®: Testosterone Therapy Is Associated With Increased Odds of Quadriceps Tendon Injury. Clinical Orthopaedics & Related Research. 2023. DOI: 10.1097/corr.0000000000002835

[18] Poster 390: Systematic Review of SARMs Abuse in Athletes. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/2325967123s00352

[19] Correlation between low testosterone levels and the risk of osteoarthritis: a cross-sectional analysis of NHANES data (2011–2016). BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-024-08272-6

[20] Prescription testosterone is associated with increased risk of infection-related and all-cause reoperations after primary total shoulder arthroplasty in male patients. JSES International. 2026. DOI: 10.1016/j.jseint.2026.101634

[21] Testosterone supplementation and stroke in young adults: a review of the literature. Frontiers in Neurology. 2024. DOI: 10.3389/fneur.2024.1422931

[22] Testosterone Therapy and Associated Rates of Tendon Tear and Surgical Repair: A Retrospective Analysis. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671261430731

[23] Athlete SARMs Abuse: A Systematic Review. Journal of ISAKOS. 2023. DOI: 10.1016/j.jisako.2023.03.427

[24] Testosterone levels and risk of adhesive capsulitis: a 1:1 propensity matched analysis. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.01.012

Reviewed by Kieran Hirpara · 13 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

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Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Testosterone replacement therapy is associated with increased odds of surgically treated tendon rupture [1].
  • Anabolic steroids did not induce ultrastructural collagen changes that might predispose to tendon rupture in humans [2].
  • Testosterone users had a 2.9-fold increased risk of tendon rupture compared to nonusers [3].
  • It is premature to imply causation between testosterone replacement therapy and ACL injuries based solely on existing results due to confounding variables [4].
  • Exogenous testosterone is a risk factor for increased postoperative complications following distal biceps tendon repair [5].
  • There is a threshold-dependent relationship between testosterone and shoulder pathology [6].
  • Patients with prior prescription testosterone exposure have an increased rate of distal biceps tendon injury and biceps tendon repair compared with patients without such exposure [7].
  • Surgeons should be more intentional about discussing endocrinologic history with patients and counseling those with testosterone deficiency on the risks for injury or re-injury [8].
  • TRT is associated with increased tendon rupture risk in men but not women, potentially due to sex-specific differences in dosing [9].
  • Patients who filled a prescription for testosterone replacement therapy were much more likely to experience a quadriceps muscle or tendon injury within 1 year of filling their prescription and were at increased risk of undergoing surgical repair of the quadriceps tendon [10].
  • SARM use is associated with tendon damage [11].
  • Cessation of TRT prior to rotator cuff repair should be considered on a patient-specific basis [12].

How It Works

  • Further research is needed to understand the mechanism by how testosterone increases the risk of reoperation after TSA [13].
  • Anabolic steroids use may contribute to pectoralis major injury [14].
  • Continuation of anabolic steroids during recovery does not seem to have a negative effect on functional recovery after pectoralis major injury [14].
  • Testosterone use is associated with a higher risk of both infection-related and all-cause reoperations after total shoulder arthroplasty [15].

What the Evidence Shows

Tendon Rupture Risk and Injury Association

  • Patients who filled a prescription for testosterone replacement therapy were much more likely to experience a quadriceps muscle or tendon injury within 1 year of filling their prescription [10].
  • Patients who filled a prescription for testosterone replacement therapy were at increased risk of undergoing surgical repair of the quadriceps tendon [10].
  • There is increased risk of rotator cuff tears in patients prescribed testosterone [16].
  • There is increased risk of rotator cuff repairs in patients prescribed testosterone [16].
  • There is increased risk of subsequent rotator cuff repairs in patients prescribed testosterone [16].
  • TRT is associated with increased tendon rupture risk in men but not women [9].
  • The association between TRT and increased tendon rupture risk in men but not women is potentially due to sex-specific differences in dosing [9].

Postoperative Complications and Reoperation

  • Testosterone use is associated with a higher risk of infection-related reoperations after total shoulder arthroplasty [15].
  • Testosterone use is associated with a higher risk of all-cause reoperations after total shoulder arthroplasty [15].
  • Supplemental testosterone increases the risk of reoperation after total shoulder arthroplasty [13].
  • Preoperative testosterone replacement therapy is a potential risk factor for complications after rotator cuff repair [12].
  • Preoperative testosterone replacement therapy is a potential risk factor for reoperation after rotator cuff repair [12].

Mechanisms and Ultrastructure

Clinical Considerations and Causation

  • Clinicians should remain vigilant and prescribe TRT judiciously with a thorough assessment of each patient's unique risk profile [4].
  • Surgeons should be more intentional about discussing endocrinologic history with patients [8].
  • Surgeons should counsel patients with testosterone deficiency on the risks for injury or re-injury [8].
  • Further research is needed to understand the mechanism by which testosterone increases the risk of reoperation after total shoulder arthroplasty [13].
  • Hormonal status should be considered in musculoskeletal risk assessment [6].

Practical Considerations

Risk Assessment and Counseling

  • A threshold-dependent relationship exists between testosterone and shoulder pathology, highlighting the need to consider hormonal status in musculoskeletal risk assessment [6].

Operative Considerations

Anabolic Steroids and SARMs

  • SARM use is associated with increased muscle mass, hepatotoxicity, cardiotoxicity, tendon damage, and androgenic side effects throughout the body [11].
  • Anabolic steroids use may contribute to pectoralis major injury in body builders [14].
  • Continuation of anabolic steroids during recovery from pectoralis major injury does not seem to have a negative effect on functional recovery [14].

Key Evidence

  • [L3] Testosterone replacement therapy is associated with increased odds of surgically treated tendon rupture. [1] (10.1177/2325967125s00009)
  • [L4] The authors conclude that anabolic steroids did not induce ultrastructural collagen changes that might predispose to tendon rupture in humans. [2] (10.1016/s0020-1383(98)00183-1)
  • [L3] Testosterone users had a 2.9-fold increased risk of tendon rupture compared to nonusers. [3] (10.1177/2325967124s00339)
  • [L5] It is premature to imply causation between testosterone replacement therapy and ACL injuries based solely on existing results due to confounding variables; clinicians should remain vigilant and prescribe TRT judiciously with a thorough assessment of each patient's unique risk profile. [4] (10.1016/j.arthro.2024.11.086)
  • [L3] These findings suggest that exogenous testosterone is a risk factor for increased postoperative complications following distal biceps tendon repair. [5] (10.1177/2325967126s00288)
  • [L3] These findings suggest a threshold-dependent relationship between testosterone and shoulder pathology and highlight the need to consider hormonal status in musculoskeletal risk assessment. [6] (10.1016/j.jse.2026.01.012)
  • [L3] Patients with prior prescription testosterone exposure have an increased rate of distal biceps tendon injury and biceps tendon repair compared with patients without such exposure. [7] (10.1016/j.jse.2023.02.122)
  • [L5] The author advises surgeons to be more intentional about discussing endocrinologic history with patients and counseling those with testosterone deficiency on the risks for injury or re-injury. [8] (10.1097/corr.0000000000002835)
  • [L3] TRT is associated with increased tendon rupture risk in men but not women, potentially due to sex-specific differences in dosing. [9] (10.1177/23259671261430731)
  • [L3] Patients who filled a prescription for testosterone replacement therapy were much more likely to experience a quadriceps muscle or tendon injury within 1 year of filling their prescription and were at increased risk of undergoing surgical repair of the quadriceps tendon. [10] (10.1097/corr.0000000000002744)
  • [L4] SARM use is associated with increased muscle mass, hepatotoxicity, cardiotoxicity, tendon damage, and androgenic side effects throughout the body. [11] (10.1177/03635465241252435)
  • [L3] Cessation of TRT prior to rotator cuff repair should be considered on a patient-specific basis. [12] (10.1016/j.jseint.2025.10.002)
  • [L3] Further research is needed to understand the mechanism by how testosterone increases the risk of reoperation after TSA. [13] (10.1177/2325967124s00118)
  • [L4] Anabolic steroids use may contribute to the injury, but continuation during recovery does not seem to have a negative effect on functional recovery. [14] (10.1186/s12891-023-06382-1)
  • [L2] Testosterone use is associated with a higher risk of both infection-related and all-cause reoperations after total shoulder arthroplasty. [15] (10.1016/j.jseint.2026.101634)
  • [L3] There is increased risk of RCTs, RCRs, and subsequent RCRs in patients prescribed testosterone. [16] (10.5435/jaaos-d-22-00554)

References

[1] Testosterone Replacement Therapy Increases Odds of Tendon Ruptures Treated Surgically. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/2325967125s00009

[2] Ultrastructural analysis of ruptured tendon from anabolic steroid users. Injury. 1998. DOI: 10.1016/s0020-1383(98)00183-1

[3] Poster 374: Tendon Tears Among Patients Treated with Exogenous Therapeutic Anabolic Steroids: An Eight Year Retrospective Analysis in a Single Institution. Orthopaedic Journal of Sports Medicine. 2024. DOI: 10.1177/2325967124s00339

[4] Editorial Commentary: Testosterone Replacement Therapy and Anterior Cruciate Ligament Injury Risk: Insights and Cautions for Clinical Application. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.11.086

[5] Paper 30. Comparative Outcomes of Distal Biceps Tendon Repair in Patients With and Without Testosterone Therapy. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/2325967126s00288

[6] Testosterone levels and risk of adhesive capsulitis: a 1:1 propensity matched analysis. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.01.012

[7] The use of prescription testosterone is associated with an increased likelihood of experiencing a distal biceps tendon injury and subsequently requiring surgical repair. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2023.02.122

[8] CORR Insights®: Testosterone Therapy Is Associated With Increased Odds of Quadriceps Tendon Injury. Clinical Orthopaedics & Related Research. 2023. DOI: 10.1097/corr.0000000000002835

[9] Testosterone Therapy and Associated Rates of Tendon Tear and Surgical Repair: A Retrospective Analysis. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671261430731

[10] Testosterone Therapy Is Associated With Increased Odds of Quadriceps Tendon Injury. Clinical Orthopaedics & Related Research. 2023. DOI: 10.1097/corr.0000000000002744

[11] Athlete Selective Androgen Receptor Modulators Abuse: A Systematic Review. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465241252435

[12] Preoperative testosterone replacement therapy: a potential risk-factor for complications and reoperation after rotator cuff repair. JSES International. 2026. DOI: 10.1016/j.jseint.2025.10.002

[13] Poster 149: Supplemental Testosterone Increases Risk of Reoperation after Total Shoulder Arthroplasty. Orthopaedic Journal of Sports Medicine. 2024. DOI: 10.1177/2325967124s00118

[14] Pectoralis major rupture in body builders: a case series including anabolic steroid use. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06382-1

[15] Prescription testosterone is associated with increased risk of infection-related and all-cause reoperations after primary total shoulder arthroplasty in male patients. JSES International. 2026. DOI: 10.1016/j.jseint.2026.101634

[16] The Relationship Between Testosterone Therapy and Rotator Cuff Tears, Repairs, and Revision Repairs. Journal of the American Academy of Orthopaedic Surgeons. 2023. DOI: 10.5435/jaaos-d-22-00554

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Using Creative Commons Public Licenses

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Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.