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Anabolikong Steroyd, Testosterona, at Risk ng Pagputol ng Tendin

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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 Aug 2026
Isang istruktura ng molekula sa tabi ng isang maliit na bote.
Ang testosterone ay nakakaapekto sa kalamnan at buto; ang mga antas at suplementasyon nito ay may mga implikasyon sa muskuloskeletal na sistema na mahalagaintindihin. 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 ang nararamdaman mo

Maaaring mapansin mo ang sakit sa iyong balikat na lumalala kapag gumagawa ng gawain. Ang kaguluhan na ito ay madalas na lumala sa gabi, na nagpapakahirap sa pagtulog sa gilid na iyon. Maaaring mahirap para sa iyo na abutin ang likod ng iyong likod upang isara ang bra o itabi ang damit. Ang mga simpleng gawain tulad ng pag-angat ng mga bagay o pagtaas ng iyong braso ay maaaring maging hamon.

Isasalang-aling ng iyong doktor ang iyong hormonal na kalagayan habang sinusuri ang mga sintomas na ito. Ang mababang antas ng testosterone ay nauugnay sa mas mataas na panganib ng arthritis na dulot ng pagkasira sa kasukasuan. Ang kondisyong ito ay maaaring magdulot ng katigasan at sakit habang nababasag ang cartilage. Ang pagpapanatili ng optimal na antas ng hormone ay maaaring makatulong upang protektahan ang kalusugan ng iyong kasukasuan, ngunit ang kakulangan nito ay maaaring magpalaki ng panganib ng pinsala o muling pinsala.

Kung may reseta ng testosterone para sa iyo, maging mapagbantay na ito ay nauugnay sa mas mataas na panganib ng pagputol ng rotator cuff. Ang rotator cuff ay isang grupo ng mga kalamnan at tendon na nagpapatatag sa iyong balikat. Maaaring maranasan mo ang biglang kahinaan o sakit kung may pagputol. Mayroon ding mas mataas na panganib ng pangangailangan ng karagdagang pagkukumpuni upang ayusin ang mga pagputol na ito.

Sa ilang kaso, ang paggamit ng testosterone ay nauugnay sa mas mataas na panganib ng mga reoperation na dulot ng impeksyon pagkatapos ng total shoulder replacement. Ang total shoulder arthroplasty ay isang proseso kung saan ang mga sira na ibabaw ng kasukasuan ay pinalitan ng mga artipisyal na bahagi. Maaaring harapin mo ang mas mataas na panganib ng anumang uri ng reoperation pagkatapos ng operasyong ito. Kailangan pa ng karagdagang pananaliksik upang maunawaan kung bakit eksaktong pinapataas ng testosterone ang panganib ng pangangailangan ng karagdagang operasyon pagkatapos ng shoulder replacement.

Kung gumagamit ka ng anabolic steroids, dapat talakayin ng iyong doktor ang iyong endocrinologic na kasaysayan sa iyo. Ang anabolic steroids ay mga sintetikong sangkap na katulad ng lalaking sex hormone na testosterone. Ang paggamit nito ay maaaring mag-ambag sa pectoralis major rupture, na isang pagputol sa malaking kalamnan ng dibdib. Ang pinsalang ito ay madalas na nagdudulot ng matulis na sakit at pamumula sa harap ng balikat.

Habang patuloy na ginagamit ang anabolic steroids sa panahon ng paggaling mula sa pectoralis major rupture, hindi tila negatibong nakakaapekto ito sa functional recovery, ngunit inirerekomenda ang pag-iingat. Ang mga kliniko ay dapat magreseta ng testosterone replacement therapy nang may pag-iingat. Ibig sabihin, mabigyang-pansin nang maigi ang mga benepisyo laban sa mga panganib para sa iyong natatanging profile. Magbibigay ng payo ang iyong doktor sa mga panganib na ito upang matulungan kang gumawa ng mga desisyon na may kaalaman tungkol sa iyong paggamot.

Ano ang nangyayari talaga

Ang antas ng testosterone sa iyong katawan ay gumagana tulad ng dimmer switch para sa kalusugan ng kasu-kasuan at tendon. May partikular na threshold kung saan masyadong mababa o masyadong mataas ang mga antas, at ang parehong mga extreme ay maaaring mahinain ang iyong mga tisyu. Kapag ang mga antas ay suboptimal, ang makinis na coating sa mga dulo ng iyong buto—tinatawag na cartilage—ay maaaring mas mabilis na magkasuot. Ang arthritis na dulot ng wear-and-tear ay nagbabawas ng cushioning sa iyong mga kasu-kasuan, na nagpapataas ng posibilidad na mas madali silang masira.

Ang iyong mga tendon ay makapal na lubid ng mga hibla na nag-uugnay ng kalamnan sa buto. Sa ilang mga kaso, ang paggamit ng testosterone ay nauugnay sa mas mataas na panganib na masira ang mga lubid na ito. Halimbawa, ang mga bodybuilder na gumagamit ng anabolic steroids ay nakaranas ng mas maraming pectoralis major ruptures. Gayundin, ang mga pasyente na may reseta ng testosterone ay may pinataas na panganib ng rotator cuff tears sa balikat. Ang mga tear na ito ay nangyayari dahil nagbabago ang istruktura ng tisyu, na nagpapababa ng kakayahan nitong harapin ang stress.

Ang panganib na ito ay umaabot sa mga malalaking operasyon tulad ng total shoulder replacement. Ang mga lalaking gumagamit ng testosterone ay may mas mataas na tsansang kailanganin ang pangalawang operasyon pagkatapos ng unang shoulder replacement. Ito ay madalas dahil sa mga impeksyon o ibang komplikasyon na nagpapigil sa tamang paggaling. Kailangan ng iyong surgeon na malaman ang iyong kumpletong history ng hormone dahil ang mababang testosterone ay maaari ring magpalaki ng panganib ng osteoarthritis. Ang pagpapanatili ng balanseng antas ay susi upang panatilihing malakas at matatag ang iyong mga kasu-kasuan.

Habang ang ilang maikling-term na paggamit ng testosterone bago ang operasyon ay maaaring tumulong sa bone density at body composition, ang long-term o high-dose na paggamit ay may mga panganib. Ito ay maaaring magdulot ng reoperations o impeksyon na nagpapakumplikado sa iyong paggaling. Ang iyong surgeon ay susuriin ang iyong natatanging risk profile bago desisyonin ang anumang hormone therapy. Ang pag-unawa sa mga koneksyong ito ay tumutulong sa iyo at sa iyong medical team na protektahan ang iyong mga kasu-kasuan habang ginagamot at nagpapagaling.

Ano ang inaasahan

Titingnan ng iyong surgeon ang iyong kalusugan sa hormona bilang bahagi ng iyong kabuuang panganib sa pinsala. Ang antas ng testosterone ay may kumplikadong ugnayan sa mga problema sa balikat. Ang mababang testosterone ay nauugnay sa mas mataas na panganib ng arthritis na dulot ng pagkasira sa kasu-kasuan. Ang pagpapanatili ng malusog na antas ay maaaring tumulong upang panatilihing malakas ang iyong mga kasu-kasuan. Gayunpaman, ang paggamit ng testosterone o anabolic steroids ay maaari ring baguhin ang paraan ng pagtugon ng iyong mga tendon sa stress.

Kung i-prescribe sa iyo ang testosterone, maaaring harapin mo ang mas mataas na panganib ng pagputol ng mga tendon ng rotator cuff sa iyong balikat. Ang grupo ng mga pasyenteng ito ay nakakaranas din ng mas maraming follow-up na operasyon upang ayusin ang mga putol na ito. Kung gagamit ka ng anabolic steroids, may partikular na panganib ng pagputol ng malaking kalamnan sa dibdib. Ito ay pinakakaraniwan sa mga body builder. Kung ikaw ay naaapi na ng pagputol ng kalamnan sa dibdib, ang pagpapatuloy ng paggamit ng steroids ay tila hindi nakakasama sa iyong functional recovery.

Para sa mga lalaking nagsasagawa ng shoulder replacement surgery, ang paggamit ng testosterone ay nauugnay sa mas mataas na mga panganib. Maaaring harapin mo ang mas malaking pagkakataon ng reoperation na dulot ng impeksyon. Maaari ring harapin mo ang mas mataas na panganib ng anumang uri ng reoperation pagkatapos ng iyong pangunahing shoulder replacement. Tatalakayin ng iyong surgeon ang iyong endocrinologic history sa iyo. Bibigyan ka nila ng payo tungkol sa mga panganib ng pinsala o muling pinsala kung ikaw ay may kakulangan sa testosterone.

Kung kailangan mo ng testosterone replacement therapy, ito ay i-prescribe nang maingat. Masyadong maaga pa upang sabihin na direktang sanhi nito ang mga pinsala sa ligamento ng tuhod tulad ng pagputol ng ACL. Ngunit mahalaga ang iyong natatanging risk profile. Ilang pag-aaral ang nagpapakita na ang pagbibigay ng testosterone sa paligid ng oras ng operasyon ay maaaring mapabuti ang komposisyon ng katawan at densidad ng buto. Maaari rin nitong mapabuti ang iyong mga clinical outcome pagkatapos ng orthopaedic surgery.

Ang datos tungkol sa ibang mga panganib, tulad ng stroke sa mga kabataang matanda, ay nananatiling limitado. Kailangang bigyang-balansin ng iyong surgeon ang mga benepisyo na ito laban sa tumaas na panganib ng pagputol ng tendon at reoperations. Maging tapat tungkol sa iyong paggamit ng steroids o testosterone. Tumutulong ito sa iyong koponan na magplano ng pinakaligtas na landas para sa iyong recovery at pangmatagalang kalusugan ng kasu-kasuan.

Reviewed by Kieran Hirpara · 13 June 2026.

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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].
  • Testosterone users had a 2.9-fold increased risk of tendon rupture compared to nonusers [2].
  • It is premature to imply causation between testosterone replacement therapy and anterior cruciate ligament injuries based solely on existing results due to confounding variables [3].
  • Clinicians should remain vigilant and prescribe testosterone replacement therapy judiciously with a thorough assessment of each patient's unique risk profile [3].
  • There is a threshold-dependent relationship between testosterone levels and shoulder pathology [4].
  • Hormonal status should be considered in musculoskeletal risk assessment [4].
  • The use of prescription testosterone is associated with an increased likelihood of experiencing a distal biceps tendon injury [5].
  • The use of prescription testosterone is associated with an increased likelihood of subsequently requiring surgical repair for distal biceps tendon injury [5].
  • Patients with prior prescription testosterone exposure have an increased rate of distal biceps tendon injury compared with patients without such exposure [5].
  • Patients with prior prescription testosterone exposure have an increased rate of biceps tendon repair compared with patients without such exposure [5].
  • Surgeons should be more intentional about discussing endocrinologic history with patients [6].
  • Surgeons should counsel patients with testosterone deficiency on the risks for injury or re-injury [6].
  • Testosterone replacement therapy is associated with increased tendon rupture risk in men [7].
  • Testosterone replacement therapy is not associated with increased tendon rupture risk in women [7].
  • The lack of increased tendon rupture risk in women may be due to sex-specific differences in dosing [7].
  • 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 [8].
  • Patients who filled a prescription for testosterone replacement therapy were at increased risk of undergoing surgical repair of the quadriceps tendon [8].
  • Anabolic steroid use may contribute to pectoralis major rupture in body builders [9].
  • Continuation of anabolic steroids during recovery from pectoralis major rupture does not seem to have a negative effect on functional recovery [9].
  • Selective androgen receptor modulator (SARM) use is associated with tendon damage [10].
  • Preoperative testosterone replacement therapy is a potential risk factor for complications after rotator cuff repair [11].
  • Preoperative testosterone replacement therapy is a potential risk factor for reoperation after rotator cuff repair [11].
  • Cessation of testosterone replacement therapy prior to rotator cuff repair should be considered on a patient-specific basis [11].

How It Works

  • It is premature to imply causation between testosterone replacement therapy and ACL injuries based solely on existing results due to confounding variables [3].
  • Clinicians should remain vigilant and prescribe TRT judiciously with a thorough assessment of each patient's unique risk profile [3].
  • Findings suggest a threshold-dependent relationship between testosterone and shoulder pathology [4].
  • The use of prescription testosterone is associated with an increased likelihood of experiencing a distal biceps tendon injury and subsequently requiring surgical repair [5].
  • 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 [5].
  • 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 [6].
  • TRT is associated with increased tendon rupture risk in men but not women [7].
  • The association between TRT and increased tendon rupture risk in men but not women may be due to sex-specific differences in dosing [7].
  • Testosterone therapy is associated with increased odds of quadriceps tendon injury [8].
  • Anabolic steroids use may contribute to pectoralis major rupture injury [9].
  • SARM use is associated with tendon damage [10].
  • Cessation of TRT prior to rotator cuff repair should be considered on a patient-specific basis [11].
  • Further research is needed to understand the mechanism by which testosterone increases the risk of reoperation after total shoulder arthroplasty [12].
  • Prescription testosterone is associated with increased risk of infection-related and all-cause reoperations after primary total shoulder arthroplasty in male patients [13].
  • Testosterone use is associated with a higher risk of both infection-related and all-cause reoperations after total shoulder arthroplasty [13].
  • There is increased risk of rotator cuff tears (RCTs), rotator cuff repairs (RCRs), and subsequent RCRs in patients prescribed testosterone [14].
  • The observed non-linear relationship between low testosterone levels and osteoarthritis risk suggests that maintaining optimal testosterone levels may be important for joint health [15].

What the Evidence Shows

  • The use of prescription testosterone is associated with an increased likelihood of subsequently requiring surgical repair of the distal biceps tendon [5].
  • TRT is associated with increased tendon rupture risk in men [7].
  • TRT is not associated with increased tendon rupture risk in women [7].
  • The association between TRT and tendon rupture risk may be due to sex-specific differences in dosing [7].
  • Anabolic steroids use may contribute to pectoralis major rupture [9].
  • SARM use is associated with increased muscle mass [10].
  • SARM use is associated with hepatotoxicity [10].
  • SARM use is associated with cardiotoxicity [10].
  • SARM use is associated with androgenic side effects throughout the body [10].
  • Supplemental testosterone increases the risk of reoperation after total shoulder arthroplasty [12].
  • Further research is needed to understand the mechanism by which testosterone increases the risk of reoperation after TSA [12].
  • Prescription testosterone is associated with an increased risk of infection-related reoperations after primary total shoulder arthroplasty in male patients [13].
  • Prescription testosterone is associated with an increased risk of all-cause reoperations after primary total shoulder arthroplasty in male patients [13].
  • There is an increased risk of rotator cuff tears (RCTs) in patients prescribed testosterone [14].
  • There is an increased risk of rotator cuff repairs (RCRs) in patients prescribed testosterone [14].
  • There is an increased risk of subsequent rotator cuff repairs (RCRs) in patients prescribed testosterone [14].
  • Four randomized controlled trials found that testosterone supplementation improved clinical outcomes in orthopaedic surgeries [17].
  • Four randomized controlled trials found that testosterone supplementation improved body composition in orthopaedic surgeries [17].
  • Four randomized controlled trials found that testosterone supplementation improved bone mineral density (BMD) in orthopaedic surgeries [17].
  • Evidence regarding orthopaedic perioperative use of testosterone replacement therapy is heterogeneous [17].
  • Patients prescribed at least 3 months of TRT had a significantly higher incidence of ACL injuries compared to controls within a 2-year follow-up period [18].
  • Injectable TRT use within 1 year of primary ACL reconstruction is associated with a 3.3-fold increase in ACLR revision rates with 2 years of follow-up [19].
  • Data regarding the safety of testosterone supplementation and its association with stroke in young adults remains limited and underexplored [20].

Practical Considerations

  • The association between testosterone replacement therapy and increased tendon rupture risk in men but not women may be due to sex-specific differences in dosing [7].
  • Anabolic steroid use may contribute to pectoralis major rupture [9].
  • Prescription testosterone is associated with increased risk of infection-related reoperations after primary total shoulder arthroplasty in male patients [13].
  • Prescription testosterone is associated with increased risk of all-cause reoperations after primary total shoulder arthroplasty in male patients [13].
  • Authors suggest future areas of investigation that may provide guidance on how surgeons can mitigate adverse risks while optimizing benefits of testosterone replacement therapy in the orthopaedic patient [16].

Key Evidence

  • [L3] Testosterone replacement therapy is associated with increased odds of surgically treated tendon rupture. [1] (10.1177/2325967125s00009)
  • [L3] Testosterone users had a 2.9-fold increased risk of tendon rupture compared to nonusers. [2] (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. [3] (10.1016/j.arthro.2024.11.086)
  • [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. [4] (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. [5] (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. [6] (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. [7] (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. [8] (10.1097/corr.0000000000002744)
  • [L4] Anabolic steroids use may contribute to the injury, but continuation during recovery does not seem to have a negative effect on functional recovery. [9] (10.1186/s12891-023-06382-1)
  • [L4] SARM use is associated with increased muscle mass, hepatotoxicity, cardiotoxicity, tendon damage, and androgenic side effects throughout the body. [10] (10.1177/03635465241252435)
  • [L3] Cessation of TRT prior to rotator cuff repair should be considered on a patient-specific basis. [11] (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. [12] (10.1177/2325967124s00118)
  • [L2] Testosterone use is associated with a higher risk of both infection-related and all-cause reoperations after total shoulder arthroplasty. [13] (10.1016/j.jseint.2026.101634)
  • [L3] There is increased risk of RCTs, RCRs, and subsequent RCRs in patients prescribed testosterone. [14] (10.5435/jaaos-d-22-00554)
  • [L3] The observed non-linear relationship suggests that maintaining optimal testosterone levels may be important for joint health. [15] (10.1186/s12891-024-08272-6)
  • [L5] The authors suggest future areas of investigation that may provide guidance on how surgeons can mitigate adverse risks while optimizing benefits of TRT in the orthopaedic patient. [16] (10.5435/jaaos-d-23-00348)
  • [L2] Although evidence regarding orthopaedic perioperative use of testosterone replacement therapy is heterogeneous, 4 randomized controlled trials reviewed here found that testosterone supplementation improved clinical outcomes, body composition, and BMD. [17] (10.1016/j.arthro.2024.12.026)
  • [L3] This study found that patients prescribed at least 3 months of TRT had a significantly higher incidence of ACL injuries compared to controls within a 2-year follow-up period. [18] (10.1016/j.arthro.2024.10.032)
  • [L3] Injectable TRT use within 1 year of primary ACLR is associated with a 3.3-fold increase in ACLR revision rates with 2 years of follow-up. [19] (10.1177/23259671251399845)
  • [L4] The review highlights that while testosterone supplementation is increasing, data regarding its safety and association with stroke in young adults remains limited and underexplored. [20] (10.3389/fneur.2024.1422931)

References

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

[2] 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

[3] 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

[4] 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

[5] 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

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

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

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

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

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

[11] 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

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

[13] 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

[14] 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

[15] 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

[16] Testosterone Replacement Therapy in Orthopaedic Surgery. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-23-00348

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

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

[19] 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

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

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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.