Tendon Injury Is Associated With Sex Hormone Therapy in the Active-Duty Population

Area of Science:

• Musculoskeletal health
• Endocrinology
• Sports Medicine

Background:

• The effects of sex hormones on connective tissue health remain debated.
• Previous studies indicated potential risks with androgen therapy (e.g., increased rotator cuff tear odds) and mixed effects of estrogen therapy.

Purpose of the Study:

• To investigate the association between sex hormone therapy (androgen and estrogen) and the risk of connective tissue injuries in active-duty service members.
• To quantify the increased risk of specific injuries, including tendon ruptures, sprains, and overuse injuries, associated with androgen use.

Main Methods:

• Retrospective observational study utilizing de-identified data from the Medical Assessment and Readiness System (MARS).
• Inclusion of active-duty service members (ADSM) with and without connective tissue injuries, identified via ICD-9/10 codes.
• Analysis of demographic, military, and health data, including current or prior androgen/estrogen therapy.

Main Results:

• Males on androgen therapy showed a significantly increased risk for tendon rupture (AHR=1.85), trigger finger (AHR=2.03), carpal tunnel syndrome (AHR=2.44), and sprains (AHR=1.50).
• Estrogen contraceptive therapy was associated with a minimal increase in the time to connective tissue injury in female ADSM.
• A significant proportion of U.S. Army Rangers reported using illegal steroids or performance-enhancing drugs (PEDs).

Conclusions:

• Androgen therapy substantially elevates the risk of connective tissue injuries in males, nearly doubling the risk for some conditions.
• While estrogen therapy showed minimal impact on females, androgen use presents a clear and significant risk for musculoskeletal injuries.
• The findings underscore the heightened risk of tendon rupture and other injuries associated with androgen use, warranting further investigation into dose-response relationships.