Despite the reported benefits of testosterone replacement therapy (TRT), prior studies have shown that TRT is correlated with increased incidence of adverse outcomes after orthopedic procedures. There is a paucity of literature assessing the outcomes of patients on preoperative TRT undergoing distal radius open reduction and internal fixation (DR-ORIF). Our purpose was to evaluate rates of surgical and medical complications in patients on TRT undergoing DR-ORIF with a matched control cohort.

The PearlDiver database was queried for patients who used TRT within 3 months prior to the index procedure. Patients were matched 1:4 with nonuser controls using propensity score matching. Matching was conducted based on age, Elixhauser Comorbidity Index, hypogonadism, osteoporosis, and other comorbidities. Complications were assessed at 90 days and 2 years. Statistical analyses were conducted using chi-square tests. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for each complication. Statistical significance was determined at a p-value of < 0.05.

The matched group included 657 TRT users and 2,236 controls. There were significant differences in depression (control: 40.6% vs. TRT: 45.7%, p = 0.02) and rates of hypogonadism (control: 74.1% vs. TRT: 77.9%, p = 0.05) between the groups. No other statistically significant demographic or characteristic differences were noted. TRT use was not associated with increased surgical or medical complication rates at 90 days postoperatively. At 2 years, TRT use was associated with a greater incidence of revision (OR: 2.80, 95% CI: 1.34–5.85) and nonunion (OR: 2.76, 95% CI: 1.59–4.81). There were no other associations noted at 2 years.

Preoperative TRT was associated with an increased risk of revision surgery and nonunion at 2 years postoperatively. No other significant associations in the risk of major or minor complications were observed.

Level III

Received: 29 August 2025

Accepted: 04 January 2026

Article published online:
14 January 2026

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