Joint Pain and Testosterone — The Link You Didn’t Know About

Joint Pain and Testosterone — The Link You Didn’t Know About

While testosterone plays a key role in muscle strength and body hair, one area you may not know about that testosterone impacts is joint health. If you have balanced testosterone levels, your joints are likely healthy and function well. If you experience low or imbalanced testosterone levels, your risk of experiencing joint pain increases.

Below, we provide helpful information for you to learn more about the link between low testosterone and joint pain and joint pain causes.

The Link Between Low Testosterone and Joint Pain

Testosterone is a male sex hormone that regulates many bodily functions, including:

• Body and facial hair growth
• Bone mass and density
• Fat distribution
• Male sex organ development
• Muscle mass and strength
• Red blood cell production
• Sex drive
• Sperm generation

In addition to these functions, there is increasing evidence linking testosterone levels with joint health. Research suggests that testosterone plays a crucial role in limiting inflammation throughout the body. Since joint problems generally involve inflammation, healthy testosterone levels help maintain joint health by limiting inflammation. Conversely, low testosterone can be a cause of joint pain.

Does testosterone help arthritis? Some studies have even demonstrated a link between low testosterone levels and an increased risk of rheumatoid arthritis (RA). RA is an autoimmune condition that attacks fluid in your joints. As a result, your joints become inflamed and release substances that wear away at the surrounding cartilage and bone.

Even though testosterone is not the primary regulator of joint health, it can influence whether you experience joint pain. In addition to the direct influence that testosterone has on joint pain in limiting inflammation, it also indirectly affects joint health through weight management and the maintenance of cartilage and bone health.

Testosterone helps with weight management by regulating carbohydrate, fat and protein metabolism. Conversely, low testosterone is associated with:

• Increased fat mass
• Low insulin sensitivity
• High blood sugar
• Low HDL cholesterol — or “good” cholesterol — and high LDL cholesterol — or “bad” cholesterol
• Elevated triglyceride levels

All of those factors contribute to weight gain and difficulties with weight management. Weight gain puts increased pressure on your joints. As a result, it also increases your risk of developing osteoarthritis (OA) and other conditions that cause joint pain and inflammation. As such, balanced levels of testosterone can help prevent arthritis symptoms.

With that in mind, the link between low testosterone and joint pain involves matters of inflammation, weight management and the health of your cartilage and bones.

How Testosterone Affects Your Cartilage and Bones

Testosterone is directly linked with bone health. In general, balanced testosterone levels lead to strong bones. However, when testosterone levels decrease, your bone density and mass follow suit.

For this reason, low testosterone is the leading contributing factor to bone loss in older men. As an androgen hormone, testosterone maintains bone health by stimulating the proliferation of osteoblast cells. Osteoblasts come from bone marrow and work with various proteins like collagen to produce new bones. They also regulate calcium and mineral deposits in your bones.

While older studies have suggested that testosterone has a protective effect on cartilage, recent research has yet to corroborate those findings. However, recent research has found that estrogen has a protective effect on cartilage, and estrogen comes from testosterone.

Although women mainly produce estrogen in the ovaries through a hormone known as androstenedione, testosterone produces approximately 20% of circulating estrogens in men. Consequently, low testosterone levels result in lower amounts of circulating estrogen to protect your cartilage. In this way, low testosterone indirectly weakens your cartilage and directly weakens your bones.

While bone loss does not directly impact your joints, cartilage degeneration does. The function of cartilage is to cushion bones and joints from rubbing against each other. As such, cartilage deterioration is a hallmark symptom of OA, which causes inflammation in your joints from bones rubbing together. Since testosterone plays a role in limiting inflammation, a testosterone deficiency can worsen the effects of conditions like OA or RA.

Testosterone and Osteoporosis

Osteoporosis is a condition where bones lose density and mass. As a result, they become more brittle and vulnerable to fractures. Doctors typically diagnose osteoporosis using a bone mineral density (BMD) test. The BMD test measures your bone density through a T-score.

Typical bone density levels have a T-score between +1 and -1 standard deviations (SD) of the mean for a young, healthy adult. Your doctor will diagnose osteoporosis if your BMD T-score is -2.5 SD or more below that mean.

As such, osteoporosis is defined as a certain degree of bone density loss. To understand how low testosterone impacts bone loss, knowing how bones form and stay healthy is helpful. Bone formation and maintenance involves three types of cells:

1. Osteoblasts: Osteoblasts are essential for initial bone formation and bone remodeling. They work in teams to gather and deposit minerals that eventually develop new bone or reinforce existing bone.
2. Osteoclasts: Osteoclasts are essential for bone resorption, which is the process of breaking down old bone so the osteoblasts can deposit new minerals to strengthen them.
3. Osteocytes: Osteocytes develop from osteoblasts and form in the inner structure of the bone. They sense cracks and fissures in the bone and direct osteoclasts to dissolve old bone so osteoblasts can reinforce those areas with stronger bone.

Testosterone supports bone health primarily through osteoblast activity. Consequently, testosterone deficiencies result in decreased osteoblast activity. However, osteoclast activity remains relatively unchanged with low testosterone.

Thus, low testosterone inhibits bone reinforcement after osteoclasts break down old bone, causing weakened bones. As a result, low testosterone increases your risk of developing osteoporosis.

Although osteoporosis is not generally a painful condition, the main concern is broken bones. As such, individuals with osteoporosis mostly experience pain from fracture injuries and healing periods.

Why Do Testosterone Levels Decrease?

As we age, testosterone levels naturally decrease. However, the gradual and natural decrease in testosterone with age does not usually lead to a diagnosis of low testosterone on its own. Low testosterone is often caused by other medical conditions, certain medications or lifestyle choices.

That said, here are some common reasons why testosterone levels decrease:

1. Age

Aging does not directly cause testosterone levels to drop. However, the various physical changes in our body that occur as we age often lead to gradual drops in testosterone.

Studies show that testosterone levels fall at an average of 0.4% to 2% per year in men over 30. At the same time, low testosterone is not necessarily inevitable with aging, as there are usually underlying causes at play. Even with andropause, where men experience significant drops in testosterone production, age-related conditions are often involved.

2. Injury

Various injuries can also lead to low testosterone. Since testosterone is produced in the testes, any trauma, infection or injury to that area could result in decreased testosterone production. However, studies have shown that other types of injuries can also cause low testosterone, such as concussions.

3. Medical Conditions

A wide variety of medical conditions can cause low testosterone, including:

• Chronic renal failure, involving a gradual loss of kidney function
• Cirrhosis of the liver, which is caused by scarring inside the liver
• Disorders involving the hypothalamus gland, which regulates hormonal function
• Genetic conditions like Klinefelter syndrome
• HIV/AIDS
• Hormone imbalances, such as estrogen excess or high prolactin levels
• Hypothyroidism
• Inflammatory conditions like sarcoidosis, which involves inflammation of the lungs and other organs
• Obesity
• Obstructive sleep apnea (OSA)
• Pituitary gland tumor or dysfunction
• Type 2 diabetes

4. Certain Medications or Therapies

Some medications and therapies decrease testosterone levels as a side effect, while others do it intentionally. Medications that often cause low testosterone as a side effect include:

• Certain antidepressants
• Chemotherapy or radiation therapy for cancer
• High blood pressure medications
• Opioids
• Some medications for fungal or yeast infections
• Steroids

In contrast, some medications for prostate cancer intentionally lower testosterone levels. Testosterone is known to stimulate the prostate gland, which can cause prostate cancer to grow if present. As such, physicians sometimes prescribe testosterone-lowering medications to inhibit prostate cancer growth.

5. Substance Use

Individuals who deal with alcohol or substance use may experience low testosterone. In some cases, substance use indirectly causes low testosterone through other medical conditions.

For example, alcohol use can lead to cirrhosis of the liver, of which low testosterone is a common symptom. However, alcohol use can also disrupt testosterone production by interfering with your hypothalamus and pituitary glands during testosterone synthesis in the testes.

Other substances that can cause low testosterone include opioids and anabolic steroids.

Common Symptoms of Low Testosterone

Since testosterone regulates numerous bodily functions, numerous symptoms occur with low testosterone. With that in mind, here are some common symptoms of low testosterone:

• Anxiety and depression: While the link between low testosterone and anxiety or depression is not fully developed, research has consistently shown that most individuals with low testosterone also experience anxiety, depression or both. As such, medical experts commonly list anxiety and depression as symptoms of low testosterone.
• Breast enlargement: Also known as gynecomastia, breast enlargement in men occurs due to imbalanced testosterone and estrogen levels. If testosterone levels drop below estrogen levels, gynecomastia can occur, especially if other factors like medication or illness also contribute to increased estrogen levels.
• Excessive fatigue: As testosterone plays a crucial role in red blood cell production, a testosterone deficiency can cause a low red blood cell count. This condition is known as anemia and often causes excessive fatigue.
• Low libido: While low sex drive, or libido, can occur due to a variety of different causes, it commonly occurs with low testosterone. The reasons low testosterone causes a diminished libido are not fully understood.
• Erectile dysfunction: In addition to diminished libido, low testosterone can contribute to erectile dysfunction (ED). In some cases, low sex drive either worsens or directly causes ED in men with low testosterone. In other instances, ED with low testosterone is due to impaired endothelial function, impacting blood flow.
• Risk of bone fractures: Since low testosterone can lead to osteoporosis or brittle bones, increased risk of bone fractures are a common symptom of low testosterone.
• Weight gain: As testosterone regulates fat distribution and various metabolic processes, low testosterone often causes weight gain.

How to Increase Testosterone Levels

There are options if you are experiencing joint pain with low testosterone levels. You can increase testosterone naturally with various lifestyle changes or through medical treatments like testosterone replacement therapy (TRT).

Some natural options for increasing testosterone levels include:

• Exercise and strength-building
• Diets rich in protein, healthy fats and whole carbohydrates
• Healthy stress management techniques
• Increased zinc and vitamin D intake
• Frequent, high-quality sleep
• Limit alcohol consumption

If natural methods for increasing testosterone levels are not enough to deal with your symptoms, TRT may be a good option for you. TRT works by supplementing your body’s testosterone production with a synthetic or bioidentical version of testosterone. While not everyone can take TRT, it is highly effective at balancing testosterone levels and is safe for most people to take as directed by their doctor.

You can receive TRT in several different forms, including:

• Skin patch: Your skin absorbs the testosterone replacement through a patch placed on your arm or upper body once a day.
• Gels: Like the skin patch, the testosterone replacement is absorbed by the skin after you apply the gel once a day.
• Mouth patch: Also known as a buccal patch, this form of TRT is a tablet you apply to your upper gums. Your oral tissues absorb the testosterone into the bloodstream.
• Intramuscular injection: A medical provider injects the testosterone into your muscles once every two to four weeks, as it circulates through your bloodstream.
• Implanted pellets: Your doctor inserts testosterone pellets into your subcutaneous tissue underneath your skin. The pellets are roughly the size of a grain of rice. They gradually release testosterone into your bloodstream over a period of three to six months.

Metropolitan Pain & Spine Institute Can Help With Joint Pain

Whether you are experiencing joint pain due to low testosterone or another cause, our pain management doctors at the Metropolitan Pain & Spine Institute can help. We have innovative and highly effective treatment options for joint pain, including numerous noninvasive interventions. Our physicians are committed to fostering an inclusive and honest environment for patients and providing the least invasive procedures possible.

Contact us today to learn more about our joint pain treatment options or schedule an appointment with one of our skilled and caring physicians.