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.

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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