Higher Total Testosterone Levels Linked to Less Pain in Severe Knee OA

Higher serum testosterone levels were associated with less WOMAC pain in the operated knee in both men and women, and less WOMAC disability in women.

According to study results published in Arthritis Care & Research, men and women undergoing total knee replacement who had higher total testosterone levels (T-levels) experienced less pain in the operated knee, and women in particular had less disability.

To investigate the association between serum total T-level and knee pain and function in older men and women with knee osteoarthritis (OA), researchers assessed 272 patients (average age 70.4 years; 53% women) who underwent unilateral total knee replacement for severe knee OA. A total of 56% of patients had radiographic OA in the nonoperated knee with a Kellen-Lawrence grade ≥2.

After 6 to 8 weeks of surgery, participants were assessed for T-levels and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function in the operated and contralateral knees.

At the operated knee, higher T-levels were associated with less WOMAC pain in men (B = −0.62; P =.046) and women (B = −3.79; P =.02) and reduced WOMAC disability scores in women (B = −3.62; P =.02) and obese men (B = −1.99; P =.02). Conversely, at the contralateral knee, there was no significant association between T-levels and WOMAC pain in men or women. However, higher T-levels were associated with less disability in women (B = −0.95; P =.02).

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Furthermore, although there was an inconsistent association between T-levels and pain and disability in subgroups of male body mass index, among obese women, T-levels were inversely related with radiographic knee OA (odds ratio, 0.10; P =.003).

Limitations included an inability to infer causation because of the study’s cross-sectional design.

“[T]he present study suggests a possible advantage of higher gender-specific physiological T-levels among both men and women undergoing unilateral [total knee replacement] due to severe knee OA,” said the authors. “Additional studies with a prospective design are needed to further explore and clarify the role of higher physiological T-levels in patients with symptomatic knee OA.”

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Freystaetter G, Fischer K, Orav EJ, et al. Total serum testosterone and WOMAC pain and function among older men and women with severe knee OA [published online September 26, 2019]. Arthritis Care Res. doi:10.1002/acr.24074