Written by Ben Bunting: BA(Hons), PGCert. Sport & Exercise Nutrition. L2 Strength & Conditioning Coach.
Did you know that your hormones can have an impact on many of your bodily functions, and that also includes bone health?
This article covers the following points:
- Low testosterone and joint pain
- Symptoms and causes of low T
Testosterone, also known as the male androgenic hormone, is an extremely important hormone produced by humans.
Hormones are some of the most important biological components of your body. These chemical messengers have numerous functions and are secreted in an astonishingly controlled fashion to maintain your body’s homeostasis.
Testosterone carries out various roles, particularly in males, including maintenance of male sexual characteristics and function, promoting blood cell growth, muscle mass, bone strength, and hair growth.
Recent studies have shown that people with low serum testosterone are more prone to skeletal diseases that cause pain, including rheumatoid arthritis (RA) and osteoporosis.
This isn’t to ascertain that testosterone deficiency itself causes the onset of these diseases rather the deficiency acts to decrease certain protective effects, leading to damage and pain2. Unfortunately, testosterone deficiency is relatively common with almost 10-40% of the general population around the globe facing this debilitating condition3.
According to the American Urological Association, a person with testosterone (T) levels lower than 300 nanograms per deciliter (ng/dL) of blood can be diagnosed with low testosterone.
Low testosterone and Joint Pain
Recent studies have indicated a positive relationship between low testosterone and joint pain. The most common cause of joint pain is arthritis or joint inflammation (swelling).
Inflammation is often caused by inadequate healing of the joint and certain autoimmune diseases like rheumatoid arthritis.
Some research has also shown that testosterone replacement therapy (TRT) can help alleviate symptoms like pain and inflammation. Luckily, replacing the hormone is seen as beneficial for many people3,4.
Although the exact mechanism of how low testosterone causes joint pain is unknown to science, one proposed theory of this relationship is the role of testosterone in regulating lipids and inflammation in the body.
Reviews of several pieces of research propose that normal T levels suppress the production and blood levels of cholesterol and lipoproteins like LDL. These lipid derivatives are associated with an inflammatory process that can damage the joints.
Moreover, people with low testosterone have increased levels of pro-inflammatory cytokines (signaling molecules) and decreased levels of anti-inflammatory cytokines, eventually leading to tissue damage in your joints and joint pain2.
Another suggested mechanism by which this relationship could be justified is the role of testosterone in the suppression of substance P in the spinal cord. Substance P is one of the main neurotransmitters that gets released upon a painful stimulus, such as joint inflammation.
In the central nervous system (CNS), endogenous opiate-mediated dampening of substance P occurs to suppress excessive pain. This suppression is partly promoted by testosterone.
The study enrolled patients with fibromyalgia, causing incapacitating and pain-causing disease. These patients had significantly low levels of testosterone, suggesting that the testosterone-mediated dampening of the pain transmitters was decreased. This could be considered as a likely mechanism for low T levels causing joint pain5.
The link between rheumatoid arthritis (RA) and testosterone deficiency has also received some attention recently. RA is an autoimmune disease in which the body’s immune (defense) system attacks its joints, causing inflammation (swelling) and pain. A 2013 study showed that there was a slight link between men who had low testosterone and RA6.
The absence of the protective effects (anti-inflammatory) due to low T levels were suggested to be some of the reasons for the development and progression of RA7.
To solidify the argument, hormone replacement therapy (TRT) proved helpful in alleviating the pain caused by RA and improve the disease’s progression7,8.
Additionally, an investigation proved that testosterone has a clear role in the development and maintenance of bone.
Testosterone stimulates osteoblasts (bone-forming cells) that work to enhance the bone mineral density and overall strength.
Also, testosterone, in elderly men, was likely to prevent fractures. Hence, low T levels, intuitively, would cause diminished bone strength leading to joint problems and joint pain9.
Symptoms and Causes of Low Testosterone
As mentioned above, testosterone is utilized by your body to perform various efficient functions. Disruption of any function can lead to health issues and decreased well-being of a person.
Some common symptoms that you might notice if you are facing low T levels in your body are:
- Sexual dysfunction, including decreased libido (low sex drive)
- Erectile dysfunction
- Muscle loss
- Fatigue, despite having a good diet
- Pale looking skin, especially pale palms
Testosterone deficiency is observed to be caused by many underlying reasons. Some of the reasons are directly related to the testosterone-producing organs i.e., testes or adrenal glands, while other factors indirectly affect the production of testosterone.
The following are some reasons you might have low T levels in your blood:
- Hypogonadism – this is a condition in which the male sex organs (testes) are not producing enough testosterone. This could further have many underlying influences.
- Hypothalamic-pituitary-gonadal axis problems – this is a broad term referring to low T levels caused by problems in your hypothalamus or pituitary gland. The hypothalamus and pituitary gland release several hormones that stimulate the testes to synthesize testosterone.
- Poor nutrition – nutrition plays a crucial role in the body’s wellness and productivity. Having low nutrition especially decreased intake of whole foods tends to lower your blood T levels10,11.
- Lack of exercise – muscle mass has a direct relationship with T levels. The more T levels you have, the stronger and muscular your body is.
- Inadequate sleep – sleeping for around 6-8 hours is essential for the body’s proper recovery and replenishment of hormones. So having a bad sleep routine could lead you to a T deficit.
- Age – men over 50-years-old tend to have a decline in their T levels.
- Other diseases – various diseases that affect testosterone production in your body. For instance, diabetes, obesity, hypothyroidism, etc. can cause low T levels12,13.
Just like many hormones, testosterone plays a significant role in the body’s homeostasis.
The effects are not just limited to sexual functions and muscle growth, but also various other disease processes like joint pain and inflammation.
There is, however, a need for more research on this relationship and on how testosterone plays protective roles for joints.
- Halpern JA, Brannigan RE. Testosterone Deficiency. JAMA. 2019;322(11):1116-1116. doi:10.1001/JAMA.2019.9290
- Vodo S, Bechi N, Petroni A, Muscoli C, Aloisi AM. Testosterone-induced effects on lipids and inflammation. Mediators of Inflammation. 2013;2013. doi:10.1155/2013/183041
- Anaissie J, DeLay KJ, Wang W, Hatzichristodoulou G, Hellstrom WJ. Testosterone deficiency in adults and corresponding treatment patterns across the globe. Translational Andrology and Urology. 2017;6(2):183. doi:10.21037/TAU.2016.11.16
- Almehmadi Y, Yassin AA, Nettleship JE, Saad F. Testosterone replacement therapy improves the health-related quality of life of men diagnosed with late-onset hypogonadism. Arab Journal of Urology. 2016;14(1):31. doi:10.1016/J.AJU.2015.10.002
- White HD, Robinson TD. A novel use for testosterone to treat central sensitization of chronic pain in fibromyalgia patients. International Immunopharmacology. 2015;27(2):244-248. doi:10.1016/J.INTIMP.2015.05.020
- Low Testosterone Linked to Later Arthritis in Study – WebMD. Accessed January 9, 2022. https://www.webmd.com/men/news/20130403/low-testosterone-linked-to-later-arthritis-in-study
- Lashkari M, Noori A, Oveisi S, Kheirkhah M. Association of serum testosterone and dehydroepiandrosterone sulfate with rheumatoid arthritis: a case control study. Electronic Physician. 2018;10(3):6500. doi:10.19082/6500
- Tengstrand B, Carlström K, Hafström I. Bioavailable testosterone in men with rheumatoid arthritis—high frequency of hypogonadism. Rheumatology. 2002;41(3):285-289. doi:10.1093/RHEUMATOLOGY/41.3.285
- Golds G, Houdek D, Arnason T. Male Hypogonadism and Osteoporosis: The Effects, Clinical Consequences, and Treatment of Testosterone Deficiency in Bone Health. International Journal of Endocrinology. 2017;2017. doi:10.1155/2017/4602129
- Kurniawan AL, Hsu CY, Rau HH, Lin LY, Chao JCJ. Dietary patterns in relation to testosterone levels and severity of impaired kidney function among middle-aged and elderly men in Taiwan: a cross-sectional study. Nutrition Journal. 2019;18(1). doi:10.1186/S12937-019-0467-X
- Hu TY, Chen YC, Lin P, et al. Testosterone-Associated Dietary Pattern Predicts Low Testosterone Levels and Hypogonadism. Nutrients. 2018;10(11). doi:10.3390/NU10111786
- Handisurya A, Rumpold T, Caucig-Lütgendorf C, et al. Are hypothyroidism and hypogonadism clinically relevant in patients with malignant gliomas? A longitudinal trial in patients with glioma. Radiotherapy and Oncology. 2019;130:139-148. doi:10.1016/J.RADONC.2018.10.014
- Kiyohara M, Son YL, Tsutsui K. Involvement of gonadotropin-inhibitory hormone in pubertal disorders induced by thyroid status. Scientific Reports. 2017;7(1). doi:10.1038/S41598-017-01183-8