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TOPLINE:

Higher testosterone levels were significantly associated with a lower prevalence of radiographic knee osteoarthritis (RKOA) and a lower risk for chronic knee pain (CKP) in women but not in men in a population-based prospective study.

METHODOLOGY:

• Researchers conducted a study to examine the association of total and free testosterone levels with the prevalence and incidence of RKOA and the prevalence of chronic hand and knee pain among women and men from the population-based prospective Rotterdam Study.
• They included 8685 participants aged 45 years or older (4766 women and 3919 men) for the analysis of RKOA and 8164 participants (4571 women and 3593 men) for the analysis of CKP.
• Total testosterone and sex hormone–binding globulin (SHBG) levels were measured in the serum, and free testosterone level was calculated using a formula on the basis of SHBG levels.
• Prevalent RKOA was defined as a Kellgren and Lawrence (KL) score of ≥ 2 or total joint replacement at baseline, and CKP was defined as having pain or stiffness in the knee for more than 3 months. The severity of hand OA was defined as the sum of KL scores across 30 joints in both hands of every participant, divided by the number of joints per hand (15 joints).

TAKEAWAY:

• After adjustment for several covariates, higher levels of total testosterone (risk ratio [RR], 0.83; 95% CI, 0.68-0.99) and free testosterone (RR, 0.84; 95% CI, 0.68-0.98) were significantly associated with lower prevalence of RKOA in women but not in men.
• Higher levels of free testosterone were also significantly associated with a lower incidence of CKP in women (RR, 0.85; 95% CI, 0.71-0.98) but not in men.
• In contrast, higher levels of free testosterone (RR, 1.07; 95% CI, 1.02-1.11) and total testosterone (RR, 1.08; 95% CI, 1.03-1.13) were significantly associated with a higher severity of hand OA in men but not in women.

IN PRACTICE:

“Our findings suggest that free and [total testosterone] may play a role in prevalence of RKOA, and free testosterone may decrease the risk of CKP in middle-aged and older females,” the authors wrote.

SOURCE:

This study was led by Ingrid A. Szilagyi, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands, and was published online on April 9, 2025, in Osteoarthritis and Cartilage.

LIMITATIONS:

Data on muscle strength and body composition were only available for a sub-cohort of the Rotterdam Study, which may have influenced the interpretation of the findings. Additionally, participants included in the longitudinal analysis may have been healthier than the general population, introducing potential selection bias. The study estimated free testosterone levels based on the assumption of a constant serum albumin level, as actual serum albumin data were not available for the studied population.

DISCLOSURES:

This study was funded by the Netherlands Organisation for Health Research and Development (ZonMw). One author reported doing consultancy and receiving grants from various organizations and pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.