Editorial Commentary: Testosterone Replacement Therapy and Anterior Cruciate Ligament Injury Risk: Insights and Cautions for Clinical Application

The relation between testosterone replacement therapy (TRT) and anterior cruciate ligament injury risk has garnered attention in recent orthopaedic research. With TRT's popularity on the rise, understanding its potential musculoskeletal risks is important for orthopaedic and sports medicine providers. Whereas some studies suggest an association, confounding variables such as activity level, number of hours of sports participation, dosing variations, physiological versus supraphysiological levels of testosterone, and individual patient characteristics may influence outcomes. In addition, the etiology may not be biological because patients undergoing TRT may experience increased motivation and energy levels, leading them to engage in higher-risk activities. Our research shows that supraphysiological testosterone supplementation (for short periods) increases lean body mass postoperatively, suggesting a potential benefit in recovery after anterior cruciate ligament surgery. Clinicians should remain vigilant, ensuring that TRT is prescribed judiciously, with a thorough assessment of each patient's unique risk profile.