Achy Joints? Why Low Testosterone May Be to Blame

You don’t need to be an athlete to feel betrayed by your joints as you age. Maybe it’s a sharp twinge in your knee after a hike. Or a dull ache in your shoulder that wasn’t there a year ago. Joint pain has long been chalked up to aging, overuse, or old injuries, but for some men, there’s a less obvious factor: testosterone. ¹

Best known for regulating sex drive and muscle mass, testosterone also plays a protective role in joint health. ² It supports the integrity of cartilage, reduces inflammation, and influences bone density—all essential for joints that move well and stay pain-free. ³

If you’re dealing with unexplained joint stiffness or pain, especially alongside symptoms like low energy or reduced sex drive, testosterone might be part of the picture.

About the Experts:

Margaret E. Weirman, M.D., is a professor of medicine at the University of Colorado Anschutz Medical Campus.

Joshua Calvert, M.D., is a board-certified urologist.

The Connection Between Low Testosterone and Joint Pain 

Low testosterone can contribute to joint pain by disrupting the body’s natural balance of inflammation, muscle strength, and cartilage health.

Several conditions that cause joint pain have been linked to low testosterone levels, including:

• Osteoarthritis
• Rheumatoid arthritis  
• Cartilage issues
• Weight gain

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Low testosterone and osteoarthritis

Osteoarthritis (OA) is the most common joint disorder in the U.S., impacting about 33 million people. A 2025 study published in BMC Musculoskeletal Disorders shows men with low testosterone have twice the risk of developing OA compared to men with normal levels. ⁴

Here’s how low testosterone can cause arthritis joint pain:

• Bone strength: Testosterone stimulates osteoblasts (bone-building cells) and helps maintain bone mineral density. Low testosterone can weaken bones, increasing the risk of micro-fractures and joint instability.
• Joint function: Testosterone helps regulate cytokines that control joint inflammation. With low levels, chronic low-grade inflammation may set in, contributing to joint stiffness and pain.
• Collagen production: Testosterone supports collagen synthesis, which helps maintain cartilage and joint elasticity. Low testosterone levels may contribute to cartilage breakdown, reducing joint cushioning.

One large 2023 study even found that men with lower testosterone levels had a significantly higher risk of osteoarthritis, regardless of age, race, BMI, or other risk factors. ⁵

Low testosterone and rheumatoid arthritis 

While OA is a wear-and-tear condition, rheumatoid arthritis (RA) is autoimmune—caused by the immune system attacking healthy joint tissue. There’s no direct evidence that low testosterone causes RA, but it’s well established that testosterone has anti-inflammatory properties that help protect against auto-immune disease. ⁶,⁷

In other words, low testosterone may not trigger RA, but it could remove a layer of protection against the kind of inflammation that drives it.

Testosterone’s impact on bone health and cartilage

Testosterone plays a foundational role in producing and metabolizing cartilage, the connective tissue that cushions joints and prevents bones from grinding together. ⁸, ⁹

When testosterone dips, cartilage metabolism suffers. That means the body becomes less efficient at producing, repairing, and preserving this tissue, which can lead to joint pain. ¹⁰

Estrogen plays a role here, too. Men convert some testosterone into estrogen via aromatization, and estrogen also helps protect joints. ¹¹  When testosterone drops, estrogen may follow—compounding the joint issues. ¹²

Testosterone also stimulates the production of osteoblasts, which are the cells that build and repair bone. ¹³ The hormone’s absence can affect both bone and cartilage health, increasing the likelihood of joint pain from osteoarthritis or rheumatoid arthritis. ¹⁴,¹⁵

Low testosterone can lead to weight gain, causing more joint pain

Weight gain from low testosterone levels is another factor contributing to joint pain.

Low testosterone and weight gain have a circular relationship. For starters, low testosterone levels are linked to metabolic syndrome, which is in turn associated with obesity. Since testosterone helps regulate fat metabolism, low testosterone can also contribute to an increase in body fat.  

Fat tissue isn’t just passive—it converts testosterone to estrogen, further lowering testosterone levels. More fat means more load on joints like knees and hips, increasing the risk of joint pain, especially with movement. Increased body fat puts more pressure on joints, leading to more potential pain. ¹⁶, ¹⁷

How Do I Know If My Joint Pain Is from Low Testosterone? 

If joint pain is happening alongside other symptoms of low testosterone—such as decreased libido, erectile dysfunction, reduced muscle mass, sleep problems, increased body fat, and trouble concentrating—your joint pain could be hormone-related.

 “When these symptoms occur together with joint pain, that’s when treating with testosterone may be helpful,” says Margaret E. Weirman, M.D., a professor in medicine at the University of Colorado Anschutz medical campus.

There are three different biomarker tests that can help identify low testosterone, which may be contributing to joint pain. These tests include:

• Total testosterone test: Measures both free testosterone (which is active) and bound (inactive) testosterone. 
• Free Testosterone Test: Focuses only on the biologically active form of testosterone that influences cells directly. It won’t give doctors a full picture of your testosterone levels, but is sometimes used to diagnose certain medical conditions, like erectile dysfunction.
• Bioavailable Testosterone Test: Measures free testosterone plus testosterone loosely bound to albumin, which is also available to tissues.
  

If low testosterone isn’t suspected as the cause of your joint pain, your doctor may order a Rheumatoid Factor Test, which looks closely at proteins produced by the immune system that may be wreaking havoc on cells and tissues important to joint health.

How TRT Helps Joint Pain

Testosterone replacement therapy (TRT)  is not a treatment specifically for joint pain, but in men with low testosterone, it may reduce inflammation, increase bone density, improve muscle mass, and support cartilage health—all of which can ease joint pain. ¹⁸

“Many men report less joint stiffness and discomfort after a few months on TRT, especially those who previously had low testosterone and chronic inflammation,” says urologist Joshua Calvert, M.D.

Can TRT Cause Joint Pain? 

For all the good that TRT can do in the long term to treat low T symptoms and protect joints, in some instances it can initially make joint pain worse. This is usually temporary and related to three main issues:

• Water retention: Testosterone can cause the body to retain more water, leading to joint swelling and stiffness. ¹⁹
• Estrogen fluctuations: As testosterone increases, some is converted to estrogen. If estrogen rises too high (or too low), it can provoke joint inflammation. ²⁰
• Rapid muscle gain: Increased muscle mass from TRT can stress tendons and ligaments, especially in weight-bearing joints, causing joint pain during the adjustment phase. ²¹
  

For most men, side effects of TRT typically resolve within a few months as hormone levels stabilize, notes Calvert. However, if joint pain persists, your physician may adjust your TRT dose, monitor your estrogen levels more closely, or add anti-inflammatory strategies.