Findings from the STEP-HI (Starting a Testosterone and Exercise Programme after Hip Injury) trial have provided new insight into the role of testosterone therapy in older women recovering from hip fractures. This multi-centre, randomised, double-blind controlled trial, published on 15 May in JAMA Network Open, aimed to assess whether adding low-dose testosterone gel to an exercise rehabilitation programme could enhance recovery, particularly regarding long-distance mobility. The study enrolled 129 community-dwelling women aged 65 or older who had recently undergone surgical repair for a hip fracture and exhibited impaired mobility. Participants were recruited from eight sites across the United States over five years, from 2018 to 2023, and were followed through a 24-week regimen of supervised exercise with or without testosterone therapy.
The motivation behind the study stems from the persistent difficulties many older women face following hip fractures. Despite improvements in surgical techniques and standard rehabilitation protocols, a significant proportion—nearly three out of four—do not recover their pre-fracture levels of mobility and independence. Hip fractures are not only physically debilitating but also increase vulnerability to further injury and death. Thus, researchers were keen to explore whether hormonal supplementation, specifically testosterone, might augment muscle strength and enhance the effects of physical therapy. Testosterone, while typically associated with male physiology, is also present in women, although levels decline with age. Its known anabolic properties led to the hypothesis that it might provide functional benefits when administered alongside strength training.
The study’s primary endpoint focused on long-distance mobility, assessed through the Six Minute Walk Distance—a standardised measure that evaluates endurance and the capacity to walk continuously. Results showed that while all participants improved with supervised exercise, those who received additional testosterone therapy did not demonstrate significantly greater improvements in long-distance mobility than those who exercised alone. This finding suggests that testosterone, at least in the dosage and duration tested, does not enhance endurance-related outcomes beyond what exercise can achieve. Therefore, structured exercise remains the cornerstone of effective rehabilitation for older women seeking to improve stamina and walking distance post-surgery.
However, the researchers noted secondary findings that warrant further investigation. Women in the testosterone group showed improved short-distance mobility and balance and were less reliant on assistive devices such as canes and walkers by the end of the study. While not the primary focus of the research, these effects point to the potential benefits of testosterone in specific functional domains. Dr George Kuchel, director of the UConn Center on Ageing and co-author of the study, highlighted that among women who used mobility aids at baseline, those receiving testosterone were likelier to walk unaided six months later than those receiving exercise alone or usual care. Although these results were not statistically conclusive, they suggest a promising area for further research into the nuanced effects of hormonal therapy.
Another notable outcome of the STEP-HI trial was the evident success of progressive resistance training among participants. Many older women, initially apprehensive about engaging in strength-based exercise, demonstrated remarkable gains in physical performance over the study period. Dr Jenna Bartley, principal investigator at the UConn site, reported that by the end of the study, some participants could leg press over 100 pounds—an outcome that underscores the resilience of older women and the powerful benefits of resistance training. These observations challenge commonly held assumptions about ageing and physical limitations, showing that even those who are frail or recently injured can make significant functional progress with the proper support and regimen.
In summary, the STEP-HI trial contributes meaningful knowledge to geriatric rehabilitation. While it did not confirm the anticipated benefit of testosterone on long-distance mobility, it reaffirmed the critical value of structured, supervised exercise for older women recovering from hip fractures. The study also opened new avenues for inquiry into how testosterone might influence other aspects of recovery, such as balance and short-distance mobility. Overall, the findings support a more refined and individualised approach to post-fracture care that emphasises physical training as a primary intervention while cautiously exploring the supplemental role of hormonal treatments.
More information: Jenna M. Bartley et al, Combining Exercise Training and Testosterone Therapy in Older Women After Hip Fracture, JAMA Network Open. DOI: 10.1001/jamanetworkopen.2025.10512
Journal information: JAMA Network Open Provided by University of Connecticut
