Hormonal Shifts and Belly Fat: A New Approach to Recovery in Older Women
As women age, changes in hormone levels can lead to an increase in abdominal fat, posing significant health risks. Recent research suggests a targeted approach—combining testosterone therapy with exercise—may offer a way to selectively reduce dangerous visceral fat, particularly during recovery from injuries like hip fractures.
The Shift in Fat Storage with Age
Body fat distribution changes as we age. Even as subcutaneous fat (stored under the skin) is a normal part of the body, an increase in visceral fat—which accumulates deeper in the abdomen around internal organs—is strongly linked to health problems like diabetes and heart disease. These shifts are driven, in part, by hormonal changes.1
The Role of Hormones
Hormones play a crucial role in regulating metabolism and fat distribution. Several hormonal changes contribute to increased abdominal fat in aging adults:
- Decreased Growth Hormone (GH): Lower GH levels can lead to reduced muscle mass and a slower metabolic rate, contributing to abdominal fat accumulation.3
- Increased Cortisol: Elevated levels of the stress hormone cortisol can promote the storage of visceral fat.3
- Imbalance in Estrogen and Testosterone: Declining estrogen levels in women after menopause and lower testosterone levels in men can influence fat distribution, leading to increased abdominal fat.2, 3
- Insulin Resistance: As we age, some individuals develop insulin resistance, which can promote fat storage, especially around the abdomen.3
Why Visceral Fat Matters
Visceral fat is more metabolically active than subcutaneous fat and is associated with increased inflammation and a higher risk of chronic diseases. Standard weight loss strategies often reduce overall body weight but don’t specifically target visceral fat and can lead to muscle loss—a critical concern for older adults during recovery and healthy aging.1
A Novel Approach: Testosterone Therapy and Exercise
Researchers at the University of Connecticut conducted a study on 66 women over the age of 65 recovering from hip fractures to investigate a more targeted approach. Hip fractures are a significant health concern for older women, occurring nearly three times more often in women than in men and often leading to loss of independence.1
The study, published in Obesity Pillars, involved a therapeutic exercise program for all participants. One group also received topical testosterone gel. After six months, while overall body fat levels were similar between the groups, women who received testosterone showed lower levels of visceral fat, while the control group experienced an increase.1
“If you have injury and just generally as we age, we expect an increase in visceral fat,” says Jacob Earp, assistant professor of kinesiology. “This really bucked that trend and caused selective reduction of fat in that visceral compartment.”1
Implications for Recovery and Quality of Life
These findings suggest that targeted interventions, like testosterone therapy combined with exercise, could improve recovery outcomes and quality of life for older women after hip fractures and potentially other injuries. Further research is needed to determine the long-term effects and optimal protocols for this approach.
Key Takeaways
- Hormonal shifts with age contribute to increased abdominal fat, particularly visceral fat.
- Visceral fat is linked to a higher risk of chronic diseases.
- Standard weight loss methods don’t selectively target visceral fat and can lead to muscle loss.
- Testosterone therapy, combined with exercise, may selectively reduce visceral fat in older women recovering from hip fractures.
Reference: Earp, J. E., et al. “Testosterone therapy effects adipose distribution in older females post hip-fracture: The STEP-HI study.” Obesity Pillars, 12 Jan. 2026, doi: 10.1016/j.obpill.2026.100247.
2 PMC