If you or someone you know is living with rheumatoid arthritis (RA), you may have noticed symptoms that extend beyond joint pain and stiffness – fatigue, low mood, reduced muscle mass, or diminished libido. Research increasingly points to a connection between rheumatoid arthritis and low testosterone in men, with several studies finding that men with RA are more likely to have reduced testosterone levels than men without the condition. Understanding this relationship matters because hormone status can influence overall quality of life and may be worth evaluating as part of a broader, proactive approach to health.
This article reviews what rheumatoid arthritis is, what the science says about its association with lower testosterone, the proposed biological mechanisms, and what current research shows regarding testosterone therapy and arthritis outcomes. It also explores how comprehensive bloodwork and hormone optimization consultations can help men understand their hormone status alongside standard rheumatologic care.
What Is Rheumatoid Arthritis?
Rheumatoid arthritis is a chronic autoimmune condition in which the immune system mistakenly attacks the synovium, the tissue lining the joints. This produces persistent inflammation that can lead to joint pain, swelling, stiffness (especially in the morning), and, over time, joint damage and deformity if left unmanaged. Unlike osteoarthritis, which results from mechanical wear and tear, RA is driven by systemic immune dysregulation and elevated inflammatory cytokines, including tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-1 beta (IL-1β). Our article on rheumatoid arthritis and stem cells covers emerging options for managing this joint inflammation.
RA affects roughly three times more women than men, but men with RA often experience more significant systemic effects, including changes to the hypothalamic-pituitary-gonadal (HPG) axis – the hormonal signaling pathway that regulates testosterone production. Standard treatment typically involves disease-modifying antirheumatic drugs (DMARDs), biologics, and corticosteroids, managed by a rheumatologist. Hormone status is not part of standard RA treatment, but evidence suggests it may be a relevant piece of the broader health picture for men living with this condition.
Rheumatoid Arthritis and Low Testosterone: Proposed Mechanisms
Several biological pathways may help explain why RA and reduced testosterone appear to be linked in men.
Chronic inflammation and the HPG axis. Elevated inflammatory cytokines associated with RA, particularly IL-1β, IL-6, and TNF-α, have been shown to suppress steroidogenesis (testosterone production) in Leydig cells, the testicular cells responsible for making testosterone. Research also indicates this relationship may run in both directions: low testosterone is associated with increased pro-inflammatory cytokine activity, while adequate testosterone appears to have anti-inflammatory effects, potentially creating a self-reinforcing cycle in chronic inflammatory conditions like RA.
Corticosteroid use. Corticosteroids are commonly prescribed to manage RA flares and inflammation. Research dating back several decades has shown that chronic glucocorticoid therapy is associated with reduced serum testosterone levels in men, likely due to altered hypothalamic gonadotropin-releasing hormone (GnRH) secretion rather than direct testicular damage. This means that both the underlying disease process and a common treatment for it may independently contribute to lower testosterone (MacAdams et al., Annals of Internal Medicine, 1986).
Central versus peripheral hormonal changes. Some studies have found that men with RA have low-normal or suppressed luteinizing hormone (LH) levels alongside low testosterone, suggesting the disruption may originate centrally (in the brain’s signaling to the testes) rather than from testicular failure alone. This pattern is consistent with what researchers call hypogonadotropic hypogonadism.
What the Research Shows on Testosterone and Arthritis Symptoms
A growing body of research has examined testosterone levels in men with RA, as well as testosterone replacement and arthritis outcomes. Here is a summary of key findings:
A large population-based case-control study published in the Annals of the Rheumatic Diseases analyzed blood samples collected one to 28 years before RA diagnosis in 104 future RA cases and 174 matched controls. The researchers found that lower testosterone levels were associated with subsequent development of rheumatoid factor-negative RA, suggesting hormonal changes may precede clinical disease onset in some men (Pikwer et al., Annals of the Rheumatic Diseases, 2014).
A cross-sectional study of over 3,100 men using NHANES data found that low testosterone levels (under 300 ng/dL) were associated with more than double the odds of RA, and elevated sex hormone-binding globulin (SHBG) was also associated with increased RA risk (Wen et al., Frontiers in Immunology, 2024).
Research published in Rheumatology comparing 104 men with RA to 99 healthy controls found that men with RA had lower bioavailable testosterone across all age groups, and approximately one-third met criteria for hypogonadism, compared to about 7% of controls (Tengstrand et al., Rheumatology, 2002).
A longitudinal study following men from RA onset through two years found that testosterone levels tended to rise as disease activity (measured by DAS28 score) improved with treatment, suggesting that active inflammation itself may suppress testosterone and that hormone levels may partially normalize as inflammation is controlled (Tengstrand et al., Journal of Rheumatology, 2009).
Regarding testosterone supplements and arthritis symptom outcomes specifically, the evidence is mixed. A randomized controlled trial of monthly testosterone enanthate injections in 35 men with RA over nine months found no significant overall effect of testosterone therapy on disease activity compared to placebo (Hall et al., British Journal of Rheumatology, 1996). By contrast, a smaller earlier study of oral testosterone replacement in seven hypogonadal men with active RA found increases in CD8+ T cells, a decreased CD4+:CD8+ ratio, and a significant reduction in IgM rheumatoid factor concentration after six months (Cutolo et al., Arthritis & Rheumatism, 1991).
Taken together, this research indicates that testosterone replacement and arthritis disease activity have a complex, not fully settled relationship. Testosterone therapy is not established as a treatment for RA itself, and any decision about hormone therapy should be made in partnership with both a rheumatologist and a qualified hormone specialist. For a broader look at how hormone levels shift with age and health status, see signs of low testosterone in men by age group.
Hormone Optimization as Part of Proactive Health Management
Given the documented association between RA and reduced testosterone levels, many men managing RA may benefit from understanding their overall hormone status – not as a substitute for rheumatologic care, but as a complementary piece of a broader, personalized wellness strategy. Comprehensive bloodwork that includes total and bioavailable testosterone, LH, SHBG, and related markers can offer a clearer picture of whether hormonal factors may be contributing to fatigue, low libido, mood changes, or reduced muscle mass alongside RA symptoms.
Ways2Well’s approach centers on predictive, preventive, and proactive care, using advanced diagnostics to build a personalized picture of a person’s health rather than applying a one-size-fits-all protocol. For men with RA who are curious whether hormone imbalances may be part of their symptom picture, a hormone optimization consultation can help clarify next steps, always in coordination with their existing rheumatology care team.
Frequently Asked Questions
Does rheumatoid arthritis cause low testosterone?
Research suggests an association between RA and reduced testosterone in men, and several proposed mechanisms – including chronic inflammation and corticosteroid use – may contribute to this relationship. However, causation has not been definitively established, and more research is needed to fully understand the direction of this relationship.
Can low testosterone increase the risk of developing RA?
Some studies suggest that lower testosterone levels, measured years before diagnosis, may be associated with a higher likelihood of later developing certain RA subtypes, particularly rheumatoid factor-negative RA. This suggests hormonal changes may, in some cases, precede clinical disease rather than only resulting from it.
Does testosterone replacement therapy treat rheumatoid arthritis?
No. Testosterone replacement is not an approved or established treatment for RA. Research on testosterone therapy and RA symptom outcomes has produced mixed results, and RA should continue to be managed through standard rheumatologic care, including DMARDs and biologics as prescribed by a rheumatologist.
Why might corticosteroids used for RA lower testosterone?
Corticosteroids, commonly used to manage RA inflammation, have been shown in research to suppress the hypothalamic signaling that stimulates testosterone production, which may lower serum testosterone levels during chronic use.
What symptoms might suggest low testosterone in a man with RA?
Potential symptoms include persistent fatigue, reduced muscle mass, low libido, mood changes, and difficulty maintaining bone density. These symptoms can overlap with RA symptoms themselves, which is why bloodwork-based testing is useful for clarification.
How is low testosterone diagnosed?
Low testosterone is typically assessed through morning blood tests measuring total and free (or bioavailable) testosterone, often alongside LH and SHBG, to help determine whether the cause may be central (pituitary/hypothalamic) or testicular in origin.
Should men with RA get their testosterone tested?
This is a personal health decision best discussed with a healthcare provider. Given the documented associations between RA and lower testosterone, some men with RA – particularly those experiencing fatigue, low libido, or other related symptoms – may find it informative to include hormone markers as part of comprehensive bloodwork.
Are testosterone supplements safe for men with autoimmune conditions?
Testosterone therapy carries potential risks and benefits that vary by individual health status, and its interaction with autoimmune disease activity is not fully understood. Any consideration of testosterone supplements should involve a qualified healthcare provider who can evaluate personal health history, including autoimmune status.
Key Takeaways
- Multiple studies document an association between rheumatoid arthritis and low testosterone in men, with some research suggesting hormonal changes may even precede RA diagnosis.
- Proposed mechanisms include chronic inflammatory cytokines suppressing testicular testosterone production and corticosteroid use altering hypothalamic signaling.
- Research on testosterone supplements and arthritis symptom outcomes is mixed – some studies show immunologic changes, while a randomized trial found no significant effect on overall disease activity.
- Testosterone replacement and arthritis treatment are not the same thing; testosterone therapy is not an established RA treatment and should never replace rheumatologic care.
- Comprehensive bloodwork can help assess hormone status as part of a broader, personalized approach to proactive health management.
Understanding your hormone status can be a valuable part of managing overall health alongside standard RA care. Consider starting with comprehensive bloodwork to assess your baseline levels, or explore hormone optimization options through a personalized consultation with the Ways2Well team.
References
- Pikwer M, Giwercman A, Bergström U, Nilsson JÅ, Jacobsson LTH, Turesson C. “Association between testosterone levels and risk of future rheumatoid arthritis in men: a population-based case-control study.” Annals of the Rheumatic Diseases, 2014;73(3):573-579. DOI: https://doi.org/10.1136/annrheumdis-2012-202781
- Wen P, Wang Y, Yang M, Qiao X, Yang P, Hu S, Liu L, Yang Z. “Sex hormone imbalance and rheumatoid arthritis in American men: a cross-sectional analysis from NHANES 2011–2016.” Frontiers in Immunology, 2024;15:1501257. DOI: https://doi.org/10.3389/fimmu.2024.1501257
- Tengstrand B, Carlström K, Hafström I. “Bioavailable testosterone in men with rheumatoid arthritis-high frequency of hypogonadism.” Rheumatology, 2002;41(3):285-289. DOI: https://doi.org/10.1093/rheumatology/41.3.285
- Tengstrand B, Carlström K, Hafström I. “Gonadal hormones in men with rheumatoid arthritis-from onset through 2 years.” The Journal of Rheumatology, 2009;36(5):887-892. DOI: https://doi.org/10.3899/jrheum.080558
- Hall GM, Larbre JP, Spector TD, Perry LA, Da Silva JA. “A randomized trial of testosterone therapy in males with rheumatoid arthritis.” British Journal of Rheumatology, 1996;35(6):568-573. DOI: https://doi.org/10.1093/rheumatology/35.6.568
- Cutolo M, Balleari E, Giusti M, Intra E, Accardo S. “Androgen replacement therapy in male patients with rheumatoid arthritis.” Arthritis & Rheumatism, 1991;34(1):1-5. DOI: https://doi.org/10.1002/art.1780340102
- MacAdams MR, White RH, Chipps BE. “Reduction of serum testosterone levels during chronic glucocorticoid therapy.” Annals of Internal Medicine, 1986;104(5):648-651. DOI: https://doi.org/10.7326/0003-4819-104-5-648
Author: Ways2Well Editorial Team
Reviewed by: Scientific Advisory Board member