Short term effects of intraarticular triamcinolone acetonide injection on serum testosterone, luteinizing hormone, and follicle stimulating hormone levels in male veterans: A prospective pilot study

Abstract

BackgroundDespite the common practice of intraarticular corticosteroid injections (ICSIs) for peripheral joint disease, little is known about their systemic effects on the hypothalamic–pituitary‐gonadal axis.ObjectiveTo assess the short‐term effects of ICSIs on serum testosterone (T), luteinizing hormone (LH), and follicle stimulating hormone (FSH) levels together with changes in Shoulder Pain and Disability Index (SPADI) scores in a veteran population.DesignProspective pilot study.SettingOutpatient musculoskeletal clinic.ParticipantsThirty male veterans, median age 50 (range 30–69) years.InterventionsUltrasound‐guided glenohumeral joint injection using 3 mL of 1% lidocaine HCl and 1 mL of 40 mg triamcinolone acetonide (Kenalog).Outcome Measure(s)Serum T, FSH, and LH levels, Quantitative Androgen Deficiency in the Aging Male (qADAM), and SPADI questionnaires at baseline, 1, and 4 week(s) post procedure.ResultsAt 1 week post injection, serum T levels decreased by 56.8 ng/dL (95% confidence interval (CI): 91.8, 21.7, p = .002) compared with baseline. Between 1and 4 weeks post injection, serum T levels increased by 63.9 ng/dL (95% CI: 26.5,101.2, p = .001), recovering to near baseline levels. SPADI scores were reduced at 1 week (–18.3, 95% CI: –24.4, –12.1, p < .001) and 4 weeks (–14.5, 95% CI –21.1, –7.9, p < .001).ConclusionsA single ICSI can temporarily suppress the male gonadal axis. Future studies are needed to evaluate for long‐term effects of multiple injections at a single setting and/or higher corticosteroid doses on male reproductive axis function.