What This Means
This research suggests that men who were taking testosterone replacement therapy (TRT) before undergoing a type of spinal surgery called posterior lumbar fusion had a significantly higher chance of needing another operation within 2 and 5 years compared to men not on TRT. Specifically, TRT users were about 2.4 times more likely to require reoperation at 2 years and about 2.2 times more likely at 5 years. However, in the short term (within 90 days of surgery), TRT users did not experience more complications such as blood clots, kidney injury, wound infections, readmissions, or persistent pain than non-TRT users.
The study used a large insurance claims database of over 5,000 male patients who had this type of spinal surgery between 2010 and 2020. To ensure a fair comparison, the researchers used a statistical technique called propensity-score matching to pair TRT users with similar non-TRT users based on age, overall health status, diabetes, and tobacco use, resulting in 904 matched pairs being analyzed.
This research suggests that while TRT does not appear to make the immediate post-surgical period more dangerous, it may be linked to worse long-term outcomes after lumbar spine surgery. The authors propose that rather than directly causing complications, TRT use might signal that a patient has a more complex underlying condition that makes them more likely to need additional surgery down the road. Practically, these findings suggest that doctors may want to provide more detailed counseling to TRT users about long-term expectations after spinal fusion and consider closer follow-up monitoring, though TRT alone should not disqualify a patient from having the surgery.