Perioperative Testosterone Supplementation Improves Outcomes of Orthopaedic Surgeries: A Systematic Review of Heterogeneous Studies
Author(s): Flynn ME, Cohen MF, O'Brien EJ, Domb BG
DOI Link:https://doi.org/10.1016/j.arthro.2024.12.026
Objective:
To assess whether perioperative testosterone supplementation improves surgical outcomes in orthopedic procedures.
Methodology:
A systematic review of five randomized controlled trials (RCTs) involving testosterone supplementation around the time of surgery. Procedures studied included hip fracture fixation, ACL reconstruction, and total knee arthroplasty. Four trials were Level I and one was Level II.
Key Findings:
- Four of five studies reported improved outcomes with testosterone, including gains in lean muscle mass, bone mineral density (BMD), strength, and functional recovery.
- Improvements also included earlier return to independence in post-operative care.
- One small RCT showed no statistically significant benefit.
- Significant heterogeneity in testosterone dosing, delivery method, patient populations, and outcome measures.
Conclusion:
Perioperative testosterone supplementation shows promise in enhancing orthopedic recovery, especially in specific subgroups such as older adults or those with sarcopenia. However, variability in study protocols limits generalizability.
What Does This Mean for Providers?
Orthopedic and perioperative providers should consider testosterone supplementation as a potential adjunct in select patients—particularly older, frail, or hypogonadal men—undergoing surgery. While evidence supports functional benefits, clinical decision-making must account for patient-specific risks, endocrine status, and surgical context. More standardized protocols and long-term safety data are needed before widespread adoption.