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The Effect of Testosterone Replacement Therapy on Nonalcoholic Fatty Liver Disease in Older Hypogonadal Men
Hae Seung Lee1, Sang Hun Han1, Ronald Swerdloff1
1Division of Endocrinology, Department of Medicine, The Lundquist Institute and Harbor-UCLA Medical Center, Torrance, CA 90502, USA.
Context:
Male hypogonadism is associated with visceral obesity and the metabolic syndrome: factors important for the development of nonalcoholic fatty liver disease (NAFLD). The Testosterone Trials (The T Trials) showed testosterone (T) treatment compared with placebo in older hypogonadal men was associated with decreases in cholesterol and insulin levels suggesting that T treatment may improve NAFLD.
Objective:
Compare effects of T vs placebo treatment on NAFLD scores and liver scans in elderly hypogonadal men.
Methods:
Secondary data analyses from 479 older hypogonadal men with total T < 275 ng/dL from The T Trials were performed. Three clinical liver fat scores-lipid accumulation product index, hepatic steatosis index, nonalcoholic fatty liver disease-metabolic syndrome score-and liver computed tomography (CT) Hounsfield units and liver to spleen ratio were evaluated at baseline and 12 months after treatment.
Results:
There were no statistically significant differences of change in lipid accumulation product index (P = .98), hepatic steatosis index (P = .67), and nonalcoholic fatty liver disease-metabolic syndrome (P = .52) in 246 men treated with T compared with 233 treated with placebo for 12 months. Liver CT showed no statistically significant difference of change in Hounsfield units (P = .24; n = 71 for T, n = 69 for placebo) and liver to spleen ratio (P = .74; n = 55 for T, n = 62 for placebo) between the 2 groups.
Conclusions:
Our study did not show improvement of NAFLD in older hypogonadal men after 12 months of T vs placebo treatment, as assessed by 3 clinical scores and liver CT for hepatic steatosis. Future studies with longer treatment duration and additional NAFLD diagnostic modalities as primary outcome are warranted.
Insights
Testosterone treatment did not improve nonalcoholic fatty liver disease (NAFLD) in older hypogonadal men over 12 months. Further research with longer durations and advanced imaging is needed to assess NAFLD treatment efficacy.
Area of Science:
- Endocrinology
- Hepatology
- Metabolic Syndrome
Background:
- Male hypogonadism is linked to obesity, metabolic syndrome, and nonalcoholic fatty liver disease (NAFLD).
- Previous studies suggested testosterone (T) treatment might improve NAFLD markers in hypogonadal men.
Purpose of the Study:
- To compare the effects of testosterone versus placebo on NAFLD scores and liver scans in elderly hypogonadal men.
Main Methods:
- Secondary analysis of 479 older hypogonadal men from The T Trials.
- Evaluated three clinical liver fat scores and liver CT parameters at baseline and 12 months.
Main Results:
- No significant differences in NAFLD scores (Lipid Accumulation Product, Hepatic Steatosis Index, NAFLD-Metabolic Syndrome Score) between T and placebo groups.
- Liver CT scans showed no significant differences in Hounsfield units or liver-to-spleen ratio between groups after 12 months.
Conclusions:
- Twelve months of testosterone treatment did not improve NAFLD in older hypogonadal men.
- Longer studies with advanced NAFLD diagnostic tools are recommended.
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