The Relationship Between TRT and Tendinopathies

In this episode, Zachary Long discusses the implications of testosterone replacement therapy (TRT) on tendinopathies, drawing from recent research and clinical observations. He highlights the increasing prevalence of TRT prescriptions and its correlation with tendon injuries. The conversation delves into the physiological effects of TRT on muscle mass and strength, as well as strategies to mitigate the risk of tendinopathies through dietary and training modifications.

Takeaways

• Testosterone replacement therapy (TRT) prescriptions have increased significantly.
• Men on TRT may experience tendinopathies more frequently than those not on TRT.
• Research shows a dose-response relationship between testosterone and muscle mass gains.
• Individuals on TRT are at a higher risk for tendon tears.
• Collagen protein supplementation may benefit tendon health.
• Slow tempo training can be effective for tendon rehabilitation.
• High rep band finishers can improve tendon stiffness.
• Increased energy from TRT may lead to higher training intensity.
• Tendons may be overloaded due to increased muscle strength from TRT.
• Athletes on TRT should consider specific strategies to manage tendon health.

Chapters

• 00:00 Introduction to TRT and Tendinopathies
• 02:53 Research Insights on Testosterone and Muscle Mass
• 06:11 Link Between Testosterone and Tendon Injuries
• 08:06 Strategies for Managing Tendinopathies on TRT

TRT and Tendinopathies Podcast Summary

Testosterone Replacement Therapy (TRT) has become increasingly popular, particularly among fitness enthusiasts and aging men. While TRT offers benefits like increased muscle mass, strength, and energy, it may also be associated with a higher risk of tendinopathies and tendon tears. Let’s explore how TRT impacts tendon health and what strategies can help mitigate potential risks.

How TRT Impacts Tendons

TRT is prescribed to enhance testosterone levels in men, which can lead to gains in muscle mass and strength, even without significant changes in training volume. A recent study found that men on TRT experienced a dose-dependent increase in fat-free muscle mass and quadriceps volume. However, these muscle gains aren’t always accompanied by corresponding improvements in tendon strength, leading to a mismatch in muscle-tendon adaptation.

This imbalance can result in increased tendon strain and a higher likelihood of tendinopathies—chronic tendon pain and dysfunction due to overuse or degeneration. Additionally, studies suggest that individuals on TRT have a 3.6 times greater risk of rotator cuff tears (PMID: 36745691) and more than twice the risk of distal biceps tendon injuries (PMID: 36918119) compared to those not on TRT. While the precise mechanisms remain unclear, it’s hypothesized that the rapid muscle growth and increased training intensity can contribute to tendon overload and breakdown.

Why Tendons Struggle to Adapt

Tendons adapt more slowly than muscles. While TRT rapidly boosts muscle strength and size, tendons do not experience the same accelerated adaptation, making them more prone to injury. Increased motivation and energy often lead to higher training intensity, further increasing tendon strain.

Strategies to Reduce Tendinopathy Risk on TRT

While specific research on preventing tendinopathies in individuals on TRT is limited, there are three recommended strategies that can help manage tendon health:

1. Collagen Supplementation

Collagen protein supplementation has shown promise in improving tendon structure and reducing symptoms in tendinopathy rehab (Hijlkema et. al., 2021). Emerging research suggests that collagen, combined with vitamin C, can enhance tendon repair and strength. While more studies are needed, collagen supplementation could potentially aid tendon adaptation for those on TRT.

2. Slow Tempo Resistance Training

Heavy, slow resistance training (HSRT) is a staple in tendinopathy rehab and may also serve as a preventive measure. Slow-tempo movements help build tendon resilience by providing time under tension, allowing tendons to adapt to increased loads. Incorporating slow tempos periodically (e.g., focusing on squat tempo one month, bench press the next) can be a proactive way to manage tendon health without compromising overall training goals.

3. High-Rep Band Finishers

High-repetition band exercises, a common practice in powerlifting, can improve tendon elasticity and recovery. These exercises target tendon stiffness, which is critical for effective force transmission from muscle to bone. Alternating between slow-tempo exercises and high-rep band finishers can offer a balanced approach to tendon health, especially during intense training cycles on TRT.

Conclusion: Managing Tendon Health on TRT

While TRT offers substantial benefits in muscle mass and energy, it’s essential to consider the potential impact on tendon health. Balancing muscle growth with tendon adaptation through targeted training strategies and supplementation can help reduce the risk of tendinopathies and improve overall performance.

Looking for help rehabbing a tendon injury? Our partners at Onward Physical Therapy have locations around the US to help fitness athletes recover faster!