Testosterone Gel Reduces Visceral Fat During Hip Fracture Recovery

When an older woman sustains a hip fracture, recovery plans usually focus on bone repair, pain control and physiotherapy.

Yet fat redistribution, another significant part of recovery, is seldom discussed during the healing process. Emerging research indicates that it deserves attention.

Clinicians tracking older women as they recovered from hip fractures found that harmful abdominal fat consistently rises over these months. Surprisingly, a hormone commonly linked with men appears to prevent this increase.

Damage caused by fat

Body fat does not all act alike. The soft layer immediately beneath the skin, known as subcutaneous fat, provides cushioning and insulation and stores energy with relatively little harm.

Visceral fat, by comparison, sits deep in the abdomen, surrounding the liver and other organs. Extensive research has associated it with diabetes, heart disease and chronic inflammation.

An increasing amount of evidence shows that abdominal fat can continue to accumulate in risky ways even when the number on the scales changes very little.

Hormones drive the change

Fat distribution is not random. As sex hormone levels rise and fall over the decades, they steer fat towards different areas of storage.

Testosterone in particular influences where the body keeps its reserves, especially in later life.

Professor Jacob Earp of the University of Connecticut (UConn) set out to examine this theory in women recovering from a hip fracture.

Earp describes the biological basis of the trial in direct terms.

“There is a direct link between sex hormones and fat distribution throughout the body,” said Earp.

Hip fractures are devastating

Hip fractures can devastate the lives of older people. They occur almost three times as frequently in women as in men, and a serious fracture can mark the beginning of a far longer decline.

Research into falls among older adults illustrates how often a single fracture results in longer hospital admissions, further injuries and a lasting loss of independence.

Recovery itself creates an additional challenge. Movement is often restricted and rehabilitation becomes more difficult. Body composition then begins to shift in an unhealthy direction, with visceral fat increasing as lean tissue declines.

A look inside the clinical trial

Earp’s researchers recruited 66 women aged over 65, each in the first months after a hip fracture. Every woman underwent a DXA scan before the trial began.

This low-dose X-ray scan separately measures fat, bone and lean tissue, revealing where weight is carried rather than simply how much there is.

All participants undertook the same exercise programme. The sole distinction between the groups was the gel used.

Half of the women applied testosterone gel each day, while the others received no additional treatment. Both groups returned for a second scan six months later.

What the hip scans revealed

The main finding was subtle. Overall body-fat percentage remained broadly unchanged in both groups. On the scales, there would have been no clear way to distinguish the women.

The view inside the abdomen told a different story, however. Women who used testosterone gel had noticeably less visceral fat than at the beginning of the study.

Meanwhile, the exercise-only group put on visceral fat. This is the typical pattern following a hip fracture, and one that doctors have struggled to disrupt for many years.

Reversing a stubborn trend

Before this trial, nobody had demonstrated that testosterone gel applied to the skin could reduce visceral fat in older women recovering from a hip fracture.

Earp’s team is the first to reverse this course. Rather than merely slowing accumulation, the gel reduced visceral fat while participants continued with rehabilitation.

“If you have injury and just generally as we age, we expect an increase in visceral fat,” Earp said. “This really bucked that trend and caused selective reduction of fat in that visceral compartment.”

That targeted effect is particularly notable. Conventional weight-loss methods remove whatever tissue is most readily lost, including muscle mass that older adults cannot afford to lose.

Instead, the gel reduced harmful fat without affecting lean tissue.

Limitations of the sample

The trial involved only 66 women, all aged over 65 and recovering from a recent hip fracture. This restricted sample limits the extent to which the findings can be applied more widely.

The study did not include younger women, women without a recent injury or those with differing health profiles. Further research will need to establish whether the results persist in larger and more diverse populations.

Potential changes in treatment

The trial identifies something new: a hormone gel applied to the skin can reduce visceral fat in older women during hip fracture recovery while total body weight remains stable.

Doctors caring for older women after a fracture have long had limited and difficult choices.

Without intervention to address body composition, harmful fat continues to build up. If clinicians encourage weight loss, however, patients may lose muscle and bone.

A focused hormonal intervention that reduces dangerous fat without diminishing lean tissue provides a third possibility.

“These are devastating injuries that most women don’t ever recover from,” said Earp.

“In this case, any kind of intervention that can have a beneficial effect on health, you could potentially have a huge improvement in quality of life for the individual.”