ADDING testosterone therapy to structured exercise may not significantly enhance long-distance mobility recovery in older women following hip fracture, according to findings from the STEP-HI (Starting a Testosterone and Exercise Program After Hip Injury) randomised clinical trial.
Conducted across eight US sites between 2018 and 2023, the double-blind, placebo-controlled phase 3 trial enrolled 129 community-dwelling women aged 65 years or older who had undergone surgical repair of a non-pathologic femur fracture and were experiencing mobility impairments. Participants were randomized into three groups: supervised exercise plus topical testosterone gel, supervised exercise plus placebo gel, or enhanced usual care involving home-based low-intensity exercise and monthly health education sessions.
Over 24 weeks, both exercise groups followed a high-intensity multimodal exercise regimen led by trained interventionists. The primary outcome was the change in six-minute walking distance (6MWD) from baseline to week 24. Results showed no statistically significant difference between the testosterone group and placebo: women receiving testosterone improved by 42.7 meters, compared to 40.5 meters in the placebo group. The enhanced usual care group improved by 37.7 meters.
These findings suggest that while supervised exercise remains beneficial, the addition of topical testosterone does not offer additional gains in long-distance mobility for this patient population. The authors highlight the need for further research to determine whether testosterone might still benefit short-distance performance or other aspects of physical recovery.
The STEP-HI trial underscores the importance of evidence-based approaches to post-fracture rehabilitation and cautions against routine use of hormonal therapy without clear functional benefit.
Reference
Binder EF 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.
