Editorial Commentary: Testosterone Replacement Therapy and Anterior Cruciate Ligament Injury Risk: Insights and Cautions for Clinical Application.

TRT's popularity is rising, making it important for orthopaedic and sports medicine providers to understand its potential musculoskeletal risks.

• The editorial highlights growing clinical relevance of TRT in orthopaedic and sports medicine contexts.
• The authors call for clinicians to remain vigilant and ensure TRT is prescribed judiciously.
• A thorough assessment of each patient's unique risk profile is recommended.

Some studies suggest an association between TRT and anterior cruciate ligament injury risk, but confounding variables may influence outcomes.

• Confounding variables identified include activity level, number of hours of sports participation, and dosing variations.
• Distinctions between physiological versus supraphysiological levels of testosterone are noted as potentially influential.
• Individual patient characteristics are also cited as potential confounders.

The etiology of increased ACL injury risk with TRT may not be purely biological, as TRT may increase motivation and energy levels leading to higher-risk activities.

• Patients undergoing TRT may experience increased motivation and energy levels.
• These behavioral changes may lead patients to engage in higher-risk activities.
• This suggests a behavioral rather than solely biological mechanism for any observed association.

Supraphysiological testosterone supplementation for short periods increases lean body mass postoperatively, suggesting a potential benefit in recovery after ACL surgery.

• The authors' own research is cited as the basis for this finding.
• The effect was observed with supraphysiological (not physiological replacement) levels of testosterone.
• The supplementation was administered for short periods postoperatively.
• The finding suggests a potential role for testosterone supplementation in ACL surgical recovery.