In total, 189 patients were included, with 84 receiving perioperative testosterone and 105 receiving placebo or a control intervention. One study investigated patients undergoing elective anterior cruciate ligament reconstruction. One study evaluated patients undergoing elective total knee arthroplasty. Demographic data, surgical indications, details of testosterone use, and outcomes were recorded and analyzed. Three reviewers independently screened all titles, abstracts, and full texts of articles investigating perioperative testosterone use in orthopaedic surgery. All 4 studies showed significant improvements in functional independence, BMD, muscle volume in the operative and nonoperative leg, Harris hip score, gait speed, Katz score, lean body mass, and strength. Prior studies of perioperative testosterone supplementation have used 600 mg/wk of testosterone enanthate for 4 weeks and 600 mg/wk for 10 weeks.2,7 The goal in dosing was to elevate testosterone levels in the testosterone group to approximately 1000 to 1200 ng/dL; however, serum levels reached a peak mean value of 860 ng/dL. This may in part be because of the baseline difference in injured leg strength between the 2 study groups, which approached significance. Line plot of the change in peak extension torque of the injured leg from baseline to 1 day before surgery and 6, 12, and 24 weeks after surgery. Effect of testosterone on the change in strength of the injured leg from baseline. Line plot of the change in peak extension torque of the uninjured leg from baseline to 1 day before surgery and 6, 12, and 24 weeks after surgery. Secondary outcomes include evaluations of specific surgical complications requiring revision, like prosthetic joint infection (PJI), broken prosthesis, periprosthetic fracture, and mechanical loosening. With respect to arthroplasties, there remains a gap in knowledge of the risks that hormonal therapies may have on the success of a surgery like RSA . The number of transgender patients in the United States is estimated to be around 1.5 million, with the numbers expected to increase over the next decade . TRT is also used for female-to-male gender transitions, where it has proven to be very successful in providing masculinizing effects 13,14. This study queried the database in order to identify the patient cohorts, including patients undergoing RSA, and those that received TRT. To our knowledge, there are no current studies that investigate the effect of TRT on patients undergoing RSA. One study demonstrated an increased risk of prosthetic joint infection following any form of total shoulder arthroplasty (TSA) in patients who were on TRT . While there is established research on the basic science of the musculoskeletal system, there remains a paucity of literature on the effect of TRT on the clinical outcomes of orthopedic shoulder surgeries . Given the prevalence of transgender individuals who may be on TRT during the perioperative period of an orthopedic procedure, understanding the proper management of these patients is important. You can prevent bone density loss with treatments and exercise. The relation between testosterone replacement therapy (TRT) and anterior cruciate ligament injury risk has garnered attention in recent orthopaedic research. Your provider will discuss your health history with you along with the results from your tests to determine if you could benefit from testosterone therapy. You can start therapy as soon as your blood tests come back with evidence of low testosterone and your provider has determined you are a good candidate for treatment. Your provider will order additional tests to help determine the cause of your low testosterone levels and rule out any underlying health issues that could affect (or prevent) your treatment.
