How common it is, and who gets itStrong evidence
Men see a GP about the hip less often than women, but more with every decade: in 12 English general practices in 2006, men's consulting rate rose from 38 per 10,000 a year at 15 to 44 to 111 at 45 to 64 and about 240 from 65. Women consulted 1.64 times as often, partly because men see a GP less in general: across 446 UK practices, men's rate was 32% lower, though similar for comparable illnesses.
In sport, half of 695 Danish sub-elite male footballers had hip or groin pain during a season, and among 894 sports medicine patients with long-standing hip and groin pain, 73% of them men, the hip joint was the commonest source. Cam shapes, groin hernias and kidney stones are commoner in men; the outer hip tendons, new hip arthritis, femoral hernias and broken hips are less common. These are differences between groups, not anyone's fault.
Sources 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12
Young active men: cam shapes, impingement and the labrumStrong evidence
A cam shape is a bony bump where the ball of the hip meets its neck. On magnetic resonance imaging (MRI) scans of volunteers without symptoms (average age 29), it showed in 24.7% of men against 5.4% of women. It is commoner in athletes, and in elite youth footballers it formed while the growth plates were open (from 2.1% to 17.7% of hips over 2.4 years), not after; the American Academy of Orthopaedic Surgeons says exercise does not cause impingement.
An international consensus calls it 'a mostly benign bony prominence'. It raises the chance of arthritis a little: across 9 cohorts of people averaging 62, 2.68% of male hips with a cam shape developed arthritis on X-ray within 4 to 8 years, against about 1.1% without one (our calculation). Labral tears show on scans of 54% of people without hip pain, against 62% with it, so femoroacetabular impingement (FAI) syndrome is diagnosed only when the symptoms, the examination and the scans agree, and other causes, such as a stress fracture or the back, have been considered. The pain is usually in the groin, brought on by turning, twisting and squatting, and a labral tear can add popping, catching or clicking.
Sources 5, 13, 14, 15, 16, 6, 17, 18, 19, 20
From mid-life: arthritis and the outer hipStrong evidence
From about 45, hip arthritis becomes the commonest cause: an ache in the groin, buttock or front of the thigh, worse with activity and stiff after rest. The National Institute for Health and Care Excellence (NICE) diagnoses it without a scan at 45 or over when activity brings on the pain and morning stiffness lasts 30 minutes or less. In a meta-analysis, men developed hip arthritis at about two thirds of women's rate.
The outer hip tendons (greater trochanteric pain syndrome, often called hip bursitis) trouble men less: one hip was affected in 6.6% of men against 15.0% of women aged 50 to 79 in a US study. They hurt over the bony point on the side of the hip, lying on it, on stairs and crossing your legs.
Sources 21, 10, 9
The bones: avascular necrosis, stress fractures, a slipped growth plate and a broken hip
Avascular necrosis, where part of the ball of the hip loses its blood supply, is uncommon. It affects both men and women, mostly young to middle-aged adults, and is linked with heavy drinking, high-dose steroids, sickle cell disease and lupus, though often no cause is found; an X-ray can be normal early on, so an MRI scan matters when it's suspected. Transient osteoporosis of the hip, pain that comes on with no injury and usually recovers fully within several months, affects middle-aged men as well as women late in pregnancy.
Stress fractures of the hip (femoral neck) are rare and commoner in women, but shouldn't be ruled out in men who have overdone their training, such as distance runners and military recruits; delay makes it more likely the bone shifts. A slipped growth plate at the top of the thighbone (slipped upper femoral epiphysis, SUFE) is rare, about 3 in 100,000 children aged 6 to 18 a year in Great Britain, usually at 12 to 14; it can feel like a pulled muscle, and it needs an operation.
In England in 2024, 31% of the 65,133 people who broke a hip were men, and men tend to be less healthy and recover less well. The NHS links osteoporosis in men with low testosterone. NICE asks for a fracture risk assessment from 50 after a broken bone in a minor fall or with long-term steroid tablets, and suggests one in all men from 75 and from 50 with other risks, such as hormone treatment for prostate cancer.
Sources 22, 23, 24, 25, 26, 27, 20, 28, 29, 30, 12, 31, 32
Pain from elsewhere, and the rare causes
NHS inform says a hip problem can come from the back even when the back doesn't hurt. The hip joint itself is felt most often in the buttock (71% of 51 people), then the thigh and the groin, and 47% of 60 people with hip arthritis had pain below the knee. With back pain, the NHS says numbness around the genitals or bottom, new trouble peeing or not being able to get or keep an erection need 999 or A&E: they can mean cauda equina syndrome.
Groin hernias are far commoner in men: the international hernia guideline (2018) puts the lifetime chance at 27% to 43% for men, against 3% to 6% for women. The lump may get bigger when you cough or strain and smaller when you lie down, sometimes with a heavy, dragging feeling in the leg. Femoral hernias mainly affect women over 50, but they can happen to anyone: men had 37% of 3,980 femoral hernia repairs in a Swedish register from 1992 to 2006.
Testicle pain should be checked as a testicle problem first: causes include a twisted testicle (testicular torsion), an infection and an inguinal hernia, and American urologists note that hip impingement can add to pelvic pain. Torsion needs treating straight away: in case series, mostly of children, about 97 in 100 testicles were saved within 6 hours, against about 43 in 100 at 19 to 24 hours. Kidney stones were reported by 10.6% of US men against 7.1% of women; their pain starts in the side or lower back, comes and goes, and can spread to the groin or testicles.
Gout can affect the hip, though rarely. Prostate cancer often has no symptoms at first, and the NHS lists back, hip or pelvis pain among its later signs, but in 217 men in Exeter general practices, the features that pointed to it before diagnosis included pee symptoms, erection problems, blood in the pee and weight loss, not bone pain, and an enlarged prostate is a commoner cause of pee symptoms. NICE suggests a prostate-specific antigen (PSA) blood test for pee symptoms, erection problems or visible blood in the pee, and myeloma blood tests at 60 and over with persistent bone pain.
Sources 33, 34, 35, 36, 7, 37, 38, 11, 39, 40, 41, 8, 42, 43, 44, 45, 46, 47
When a scan or test helpsStrong evidence
Usually not at first: NHS inform says new hip pain should begin to settle within 6 weeks, and NICE diagnoses osteoarthritis from the symptoms. X-rays come first; an MRI scan answers specific questions, such as a labral tear, an early stress fracture or avascular necrosis, for which Arthritis UK asks for an urgent MRI. For impingement, a scan confirms the diagnosis rather than making it. A broken hip is checked with X-rays in hospital, a hernia is diagnosed by examination, and NICE suggests a PSA test for pee or erection symptoms and a fracture risk assessment after a broken bone at 50 or over.
Sources 33, 21, 20, 23, 18, 48, 7, 47, 32
How it usually goesEmerging evidence
New hip pain often settles within 6 weeks. With impingement, people improve with exercise or surgery: in an Australian trial (PhysioFIRST), hip quality of life rose about 20 points out of 100 over 6 months with strengthening or stretching; in the UK FASHIoN trial, 24% of the physiotherapy group chose surgery within 3 years; and after keyhole surgery, 79.6% returned to the same or a higher level of sport, at an average of 14.3 months, in studies of 4,103 people, 68% of them men. Arthritis changes slowly over years, and exercise eases the pain a little while it's kept up. Avascular necrosis usually progresses, and treatment without surgery hasn't been shown to stop it. Men tend to recover less well after a broken hip, so falls and bone checks matter. No one can promise a timescale.
Sources 33, 49, 50, 51, 52, 25, 12
