Research Summary

Testosterone and Exercise in Women Aged 65 Years or Older After Hip Fracture

Miranda Manier, BA

Key Highlights:

  • In women aged 65 years or older post–hip fracture, exercise plus testosterone gel did not significantly improve 6-minute walking distance compared with placebo.
  • Greater improvement in physical performance was observed in the testosterone group.
  • No significant differences were found in other secondary outcomes or adverse events across groups.

In a phase 3 double-blind, placebo-controlled randomized clinical trial, women aged 65 years or older recovering from recent hip fracture surgery showed no significant improvement in long-distance walking after receiving 24 weeks of supervised exercise plus topical testosterone gel compared with exercise plus placebo gel. The primary outcome—change in 6-minute walking distance (6MWD)—was not significantly different between the two groups, with mean increases of 42.7 m and 40.5 m, respectively.

Hip fractures frequently result in long-term mobility loss in older adults, even after standard rehabilitation. Previous studies have shown structured exercise to be beneficial, but the potential added value of anabolic therapy, such as testosterone, remained unclear—especially in postmenopausal women. This trial investigated whether topical testosterone could augment exercise-induced gains in mobility.

The multicenter, double-blind trial enrolled 129 community-dwelling women aged 65 years or older with mobility impairments following femur fracture repair. Participants were randomized to receive either supervised high-intensity exercise plus testosterone gel, exercise plus placebo gel, or enhanced usual care. Adherence to exercise was high in both intervention groups, and testosterone dosing was titrated to achieve supraphysiologic serum levels.

While 6MWD did not differ significantly across groups, secondary outcomes revealed a significantly greater improvement in Short Physical Performance Battery (SPPB) score in the testosterone group compared with placebo (1.5 vs 0.7; P = .009). Additionally, more participants in the testosterone group no longer required assistive devices by study end. No other secondary outcomes, including lean body mass, handgrip strength, or daily function scores, showed significant between-group differences.

This study was limited by its reduced enhanced usual care group size, possible underpowering for smaller effects, and lack of racial and ethnic diversity. The trial also may not apply to patients in earlier recovery phases or with differing functional status.

“These findings do not support prescribing testosterone therapy to women to enhance long-distance walking mobility after hip fracture,” the authors concluded. “However, testosterone combined with exercise might benefit physical performance and mobility for short distances and warrants further study.”

Reference:
Binder EF, Bartley JM, Berry SD, et al. Combining exercise training and testosterone therapy in older women after hip fracture: the STEP-HI randomized clinical trial. JAMA Netw Open. 2025;8(5):e2510512. doi:10.1001/jamanetworkopen.2025.10512