Free testosterone may have protective effect against chronic knee pain among females: Study

A new study published in the Osteoarthritis and Cartilage journal found that testosterone levels are linked differently to joint health in men and women. The study within the extensive Rotterdam Study cohort, examined more than 8,600 individuals aged 45 and older to uncover how testosterone influences osteoarthritis (OA) and chronic pain outcomes in knee and hand joints.

This study focused on 2 types of testosterone measurements: total testosterone and free testosterone. Using advanced statistical models like generalized linear models and generalized estimating equations, this study adjusted their analysis for critical factors like age, body mass index (BMI), lifestyle habits, and co-morbidities to ensure robust and unbiased findings.

The results found higher levels of both total testosterone and free testosterone were significantly associated with a lower prevalence of radiographic knee osteoarthritis, in women. Also, women with higher total testosterone had a 16% reduced risk (Relative Risk (RR) 0.84, 95% Confidence Interval (CI) 0.69–1.00), and those with higher free testosterone had a 15% reduced risk (RR 0.85, 95% CI 0.70–1.00). Moreover, higher free testosterone was linked to a 15% lower incidence of chronic knee pain (RR 0.85, 95% CI 0.71–0.98) among women. These protective associations were not observed in men.

Also, higher testosterone levels in men were associated with worse outcomes in their hands. The study reported that higher free testosterone (RR 1.07, 95% CI 1.02–1.11) and higher total testosterone (RR 1.08, 95% CI 1.03–1.13) were significantly linked to greater severity of radiographic hand osteoarthritis in males.

This suggests that while testosterone may offer protection against knee issues in women, it could exacerbate hand joint problems in men. All findings remained consistent even after adjusting for BMI, lifestyle choices such as smoking and alcohol consumption, other health conditions, and, in women, years since menopause.

Overall, more testosterone meant less knee OA and chronic knee pain, in women. In men, more testosterone meant worse hand OA. No significant protective effect of testosterone was found for men’s knees or women's hands. These results illuminate the complexity of hormone interactions with musculoskeletal health and highlight the need for gender-specific approaches in future osteoarthritis prevention and management strategies.

Reference:

Szilagyi, I. A., Schiphof, D., Chaker, L., Boer, C. G., Aribas, E., Kavousi, M., Arfan Ikram, M., Bierma-Zeinstra, S. M. A., & van Meurs, J. B. J. (2025). Associations between testosterone and knee and hand osteoarthritis among males and females from the general population. Osteoarthritis and Cartilage. https://doi.org/10.1016/j.joca.2025.03.006