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Estrogen, Testosterone and Cartilage Regeneration

Estrogen, Testosterone and Cartilage Regeneration

By Renata Trister, DO


Use of opiate pain medication has increased dramatically over the past 20 years. These medications seem to affect hormonal pathways leading to abnormal levels of different hormones, such as testosterone, cortisol and prolactin. Men with androgen deficiency (low testosterone) brought on by overuse of painkillers and other pain medications, showed improvements in pain, sexual desire, body composition, and aspects of quality of life. In other research it was noted that some patients with severe and chronic pain failed to obtain adequate pain relief with standard pain medications, including low to moderate dosages of opioids. Patients complain that a standard opioid dosage is ineffective. These patients may be severely impaired, nonfunctional, and bedridden or housebound. Doctors often have difficulty trusting these patients. To help characterize these patients and develop strategies for their treatment, a serum hormone profile consisting of adrenocorticotropin, cortisol, pregnenolone, progesterone, dehydroepiandrosterone, and testosterone was obtained on 61 chronic pain patients who failed standard treatments; 49 patients (80.3%) demonstrated hormone abnormality and 7 patients (11.5%) showed a severe pituitary-adrenal-gonadal deficiency as indicated by deficient serum levels of adrenocorticotropin and  more than 2 adrenal-gonadal hormones. The doctors concluded hormone serum abnormalities are biomarkers of severe, uncontrolled pain, and, in a patient who has failed standard treatment, they are an indicator that enhanced analgesia is required and that hormone replacement may be indicated.


Hormones regeneration damaged cartilage


With cartilage injuries anabolic hormones such as testosterone play a role in regeneration. Estrogen receptors are present in cartilage and that estrogen stimulates cartilage growth.  A recent study in Sweden, focused on the effects of testosterone on chondrocytes. The research concluded that testosterone promotes differentiation of chondrocytes and increases collagen production.   A low testosterone level in men and women can cause difficulty in healing.


Various hormone factors that can affect knee cartilage


Women are more likely to be injures during ovulation when estrogen levels are highest. Women on birth control or Premarin have increased risk of injuries and chronic pain. Higher levels of estrogen make women more likely to be injured due to connective tissue laxity. Testosterone has the great effect of helping ligaments tighten and tissues heal whereas estrogen unfortunately for woman helps fat accumulate and ligaments not heal. Estrogen inhibits fibroblastic profileration, collagen synthesis is inhibited the more estrogen a woman has in her blood. So for women who take birth control pills or Premarin or other estradiol (main estrogen) driven hormone replacement, you may wish to seek an alternative if you have chronic pain. In another study – how androgens (anabolic hormones) reversed cartilage damage. Women are two to three more times more common and more likely to have the disease become more disabling and aggressive than men. It suggests that a long-term androgen replacement may help prevent joint damage and disability. In conclusion, testosterone can help improve cartilage health and making sure your hormonal levels are optimal is important for healthy joints. Avoiding degenerative NSAIDs and steroid injections, and choosing regenerative treatments such as Prolotherapy and stem cell injection therapy, will allow patients to regenerate their cartilage and avoid joint replacement surgery.