Can low testosterone cause joint pain?

Many men blame age or old injuries for aching knees and stiff shoulders. But if you also feel tired, weaker in the gym, and less interested in sex, low testosterone might be part of your joint pain story.

The relationship

Testosterone is the main male sex hormone that helps regulate sex drive, muscle mass, bone strength, and energy. It also has a quieter job: supporting healthy joints. Testosterone helps keep inflammation in check, strengthens bone around the joints, and supports the health of cartilage, the smooth tissue that cushions your bones.

So can low testosterone cause joint pain in men? The honest answer: it often contributes, but is rarely the only cause. Joint pain is usually a mix of wear and tear, past injuries, weight, activity level, and genetics. Low testosterone can tilt that mix in the wrong direction by increasing inflammation, weakening bone, and shrinking muscle that stabilizes your joints.

Recent research backs this up. A 2025 study in BMC Musculoskeletal Disorders followed men over time and found that those with low testosterone had about double the risk of developing osteoarthritis, the most common form of arthritis, compared with men whose levels were normal. Other studies suggest that low testosterone is more frequent in men with chronic inflammatory joint diseases and in men who have gained significant weight, which itself strains the joints.^,[1]

If you are a man with nagging joint pain and also notice classic low testosterone symptoms like low libido, fatigue, and muscle loss, hormones deserve a closer look. You may still have arthritis or overuse injuries, but low testosterone can make all of those feel worse and recover more slowly.

How it works

To understand how low testosterone can cause joint pain, it helps to see how this hormone interacts with several body systems at once: immune function, cartilage, bone, and muscle.

Testosterone and inflammation control

Inflammation is the immune system’s response to injury or irritation. Short bursts of inflammation help you heal. Chronic low-grade inflammation, the kind that quietly simmers for years, can damage joints and speed arthritis.

Testosterone influences cytokines, which are signaling proteins that tell immune cells when to turn inflammation on or off. In men, normal testosterone levels help limit pro-inflammatory cytokines and support anti-inflammatory pathways. When testosterone falls, this balance can shift toward more inflammation, including inside joint linings and cartilage.

This does not mean every man with low testosterone will develop an autoimmune disease. It does mean that in a man who already has early osteoarthritis, old sports injuries, or mild autoimmune tendencies, low testosterone can add fuel to the fire and make joint pain more frequent or more intense.

Cartilage health and protection

Cartilage is the smooth, rubbery tissue that covers the ends of bones in a joint so they glide easily. It has no blood supply of its own, so it depends on the right biochemical environment to stay strong.

Lab and human studies suggest that testosterone supports the cells inside cartilage, called chondrocytes, which help maintain and repair the cartilage matrix. When testosterone levels are low, chondrocytes may not keep up with daily wear and tear as well. Over time, that can mean thinner, weaker cartilage and more bone-on-bone contact, a hallmark of osteoarthritis.

Low testosterone is also linked with changes in joint lubrication and the health of the synovial membrane, the tissue that lines joints and makes joint fluid. More inflammation in this lining can lead to swelling, stiffness, and pain, especially after activity.

Bone density and joint stability

Bone mineral density is a measure of how solid and strong your bones are. Testosterone stimulates osteoblasts, the cells that build new bone. When testosterone is low over time, bones can lose density and develop tiny micro-fractures that strain nearby joints and ligaments.^[1]

Weaker bones around a joint can change alignment and load distribution. That can speed joint degeneration and make everyday loads feel more painful. This is especially important in weight-bearing joints such as the hips, knees, and lower spine.

Meta-analyses suggest that symptomatic men with total testosterone below about 350 ng/dL (≈12 nmol/L) are most likely to benefit from testosterone replacement. If total testosterone is borderline, measuring free testosterone, the active form in the blood, helps; values below 100 pg/mL (≈10 ng/dL) support a diagnosis of true hypogonadism.

Muscle strength, body weight, and joint load

Testosterone is a major driver of muscle mass and strength in men. When levels drop, men tend to lose lean muscle and gain fat, especially around the abdomen.^[2] Less muscle means less support for joints. At the same time, extra body weight increases mechanical load on the knees, hips, and spine.

Even a moderate weight gain can significantly increase pressure on the knee with each step. The combination of weaker stabilizing muscles and heavier load makes joints more vulnerable to strain, overuse injuries, and osteoarthritis flare-ups. This is one of the clearest ways low testosterone can cause joint pain to increase over time.

Conditions linked to it

Several joint-related conditions show up more often in men with low testosterone. That does not prove testosterone is the only cause, but it does mean it is a meaningful piece of the puzzle for many men.

• Osteoarthritis (OA): OA is the most common joint disease in men. The 2025 BMC Musculoskeletal Disorders study found that men with low testosterone had about twice the risk of developing OA compared with men with normal levels, even after adjusting for age and weight.
• Rheumatoid arthritis (RA): RA is an autoimmune disease where the immune system attacks joint linings. Multiple studies report that men with RA tend to have lower testosterone than healthy men, and that levels can drop further during active flares. Low testosterone may not cause RA by itself, but the extra inflammation and immune activation likely interact with hormones.
• Cartilage injuries and degeneration: Men with low testosterone may be more vulnerable to cartilage wear and slower to recover from meniscus tears or articular cartilage damage, likely because of impaired repair mechanisms and higher inflammatory activity.
• Weight gain and metabolic issues: Low testosterone is linked to increased body fat, metabolic syndrome, and insulin resistance.^[2] Extra weight and metabolic inflammation are strong, independent risk factors for knee and hip osteoarthritis and low back pain.

Limitations: Most of these links come from observational studies, which can show association but not prove that low testosterone alone causes these conditions. Genetics, lifestyle, injuries, and other illnesses all play roles.

Symptoms and signals

How can you tell if low testosterone might be involved in your joint pain? You cannot diagnose it by symptoms alone, but certain patterns should raise suspicion.

Pay attention if you notice joint pain along with several of these signs:

• Persistent joint stiffness in the morning that improves slowly as the day goes on
• Aches in multiple joints (knees, hips, shoulders, hands) rather than just one injured area
• Joint pain that worsens as you gain weight or lose muscle strength
• Reduced sex drive or fewer morning erections compared with your past baseline
• Low energy, mental fog, or feeling “flat” most days
• Noticeable loss of muscle mass or strength, even if you still work out
• Increased body fat, especially around the waist
• Lower mood, irritability, or less motivation to train or be active
• Slower recovery after lifting, running, or weekend sports, with more lingering soreness

None of these prove that low testosterone is the cause of your joint pain, and some men with healthy testosterone will have similar complaints. The key is the pattern: if you recognize both joint problems and classic low testosterone symptoms, it is worth asking your clinician to evaluate hormones as part of the workup.

What to do about it

If you are wondering “can low testosterone cause joint pain for me, personally,” the next step is a structured plan. Here is a simple 1‑2‑3 approach I use with my own patients.

1. Get evaluated and tested

Start with your primary care clinician or a urologist or endocrinologist who is comfortable managing male hormone issues.

• Describe your joint pain clearly: which joints, how long, what makes it better or worse, morning stiffness, swelling, or warmth.
• Mention all other symptoms: libido changes, energy levels, mood, sleep, strength, and weight changes.
• Ask for a focused joint exam to look for signs of osteoarthritis or inflammatory arthritis.

For hormones, guidelines recommend checking total testosterone with a blood test drawn in the early morning, when levels are highest.^[1],[3] If total testosterone is borderline, free testosterone can clarify the picture.

• Total testosterone below about 350 ng/dL in a man with symptoms supports testosterone deficiency.
• Free testosterone below about 100 pg/mL adds further evidence that low testosterone is clinically meaningful.

Your clinician may also order basic labs for inflammation, blood counts, and metabolic health, and imaging such as X‑rays if there is concern about osteoarthritis or other structural joint problems.

2. Address root causes with lifestyle and, when appropriate, testosterone therapy

The first layer of treatment usually focuses on lifestyle and joint mechanics. These steps support testosterone and directly help your joints:

• Strength training: Prioritize resistance training for major muscle groups 2–4 times per week to rebuild muscle mass that supports your joints and may modestly boost testosterone.^[2]
• Weight management: Even a 5–10% weight loss can reduce load on your knees and hips and improve pain, especially when combined with muscle-building exercise.
• Sleep and stress: Poor sleep and chronic stress can drag testosterone levels down and increase inflammation. Aim for consistent sleep and stress-management habits.
• Joint-focused care: Physical therapy, smart programming in the gym, and targeted mobility work can offload painful joints while you rebuild strength.

For men with clear testosterone deficiency and persistent symptoms, guidelines from major urology and endocrine societies support considering testosterone replacement therapy (TRT).^[1],[3] Options include injections, gels, and other forms chosen based on your health, lifestyle, and preferences.

Small clinical studies suggest that in hypogonadal men, TRT can improve muscle mass, reduce fat, and may reduce pain and improve function in men with osteoarthritis or chronic musculoskeletal pain.^[4] Results are mixed, and TRT should never be used as a stand‑alone “joint pain treatment,” but improving hormone balance can make other joint therapies work better.

TRT is not for everyone. It requires regular monitoring of blood counts, prostate health, and cardiovascular risk factors. Your clinician should review risks and benefits with you and rule out conditions where TRT is not appropriate.

Myth vs Fact

• Myth: Any joint pain in a man with low testosterone must be caused by hormones.
  Fact: Most joint pain still comes from wear and tear, injuries, or arthritis. Low testosterone is usually a contributing factor, not the sole cause.
• Myth: Testosterone therapy cures arthritis.
  Fact: TRT may help some symptoms by improving muscle, bone, and inflammation, but it does not reverse established cartilage damage or replace standard arthritis treatments.
• Myth: If your testosterone is “in the normal range,” hormones cannot be affecting your joints.
  Fact: The lab “normal range” is wide. Some men feel low‑T symptoms, including worse joint pain, at levels that are technically normal but low for them personally.
• Myth: Only very old men need to worry about low testosterone and joint pain.
  Fact: Men in their 30s and 40s with obesity, metabolic issues, or prior testicular problems can have low testosterone and joint symptoms too.

3. Monitor, adjust, and think long term

Whether you pursue lifestyle changes alone or add TRT, track your progress over months, not days. Joints and hormones both change slowly.

• Use a simple 0–10 pain scale and a few key moves (like stairs, squats, or walks) to rate pain and function every few weeks.
• Repeat testosterone and other relevant labs as your clinician recommends, often every 3–12 months.
• Fine‑tune your training and body weight goals based on how your joints respond.
• Revisit decisions about TRT or other medications as your health, goals, and joint status evolve.

Expect a team approach. For many men, the best results come when an endocrinologist or urologist coordinates with a primary care clinician, physical therapist, and sometimes a rheumatologist or orthopedic specialist.

Bottom line

So can low testosterone cause joint pain in men? It rarely acts alone, but it can clearly tilt the odds toward more pain, more stiffness, and faster joint wear by driving inflammation, weakening bone, and shrinking the muscles that protect your joints. The good news is that low testosterone is measurable and, in many cases, modifiable. If your joints hurt and the rest of your life feels “low gear” too, get evaluated. Bringing testosterone, weight, strength, and inflammation back into a healthier range will not just help your joints today; it will also support how you move, lift, and live decades from now.

References

1. Corona G, Goulis DG, Huhtaniemi I, et al. European Academy of Andrology (EAA) guidelines on investigation, treatment and monitoring of functional hypogonadism in males: Endorsing organization: European Society of Endocrinology. Andrology. 2020;8:970-987. PMID: 32026626
2. Isidori AM, Giannetta E, Greco EA, et al. Effects of testosterone on body composition, bone metabolism and serum lipid profile in middle-aged men: a meta-analysis. Clinical endocrinology. 2005;63:280-93. PMID: 16117815
3. Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and Management of Testosterone Deficiency: AUA Guideline. The Journal of urology. 2018;200:423-432. PMID: 29601923
4. Basaria S, Travison TG, Alford D, et al. Effects of testosterone replacement in men with opioid-induced androgen deficiency: a randomized controlled trial. Pain. 2015;156:280-288. PMID: 25599449