Hypogonadism and non-alcoholic fatty liver disease

Mintziori, Gesthimani; Poulakos, Pavlos; Tsametis, Christos; Goulis, Dimitrios G.

doi:10.23736/s0391-1977.16.02570-0

Cited by 64 publications

(12 citation statements)

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“…Previous research has shown an association of NAFLD with hypogonadism [14,22]. However, studies have been conflicting regarding whether these associations are due solely to the confounding factor of obesity, or if there may be an underlying role of liver fat and inflammation on testosterone levels independent of the effects of obesity [14,22]. While several studies have attempted to answer this question, they have relied on lower sensitivity techniques for NAFLD diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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Severity of non-alcoholic steatohepatitis is not linked to testosterone concentration in patients with type 2 diabetes

et al. 2021

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Background Hypogonadism is reported to occur in non-alcoholic fatty liver disease (NAFLD), but earlier studies used low-sensitivity diagnostic techniques (CT, ultrasound), for NAFLD diagnosis. We hypothesized that if hypogonadism was due to NAFLD, and not solely attributable to underlying obesity/diabetes, it would be more severe in the presence of steatohepatitis (NASH). To examine the influence of liver disease on testosterone in males with type 2 diabetes mellitus (T2DM), we used gold-standard liver imaging with MR-spectroscopy (1H-MRS), and performed liver biopsies to grade/stage the NAFLD. Methods In this cross-sectional study, we measured in 175 males with T2DM total and free testosterone, markers of insulin resistance, and intrahepatic triglyceride content (IHTG) by 1H-MRS. Those with NAFLD on imaging underwent a liver biopsy. Results Total testosterone was higher in the group without NAFLD (“No-NAFLD”; n = 48) compared to isolated steatosis (IS; n = 62) or NASH (n = 65) (385 ± 116 vs. 339 ± 143 vs. 335 ± 127 ng/ml, ptrend 0.03). Testosterone was also lower in obese vs. non-obese subjects in both the No-NAFLD and IS groups (p = 0.06 and p = 0.11, respectively), but not in obese vs. non-obese patients with NASH (p = 0.81). IHTG was independently associated with total testosterone (ß = -4.8, p = 0.004). None of the liver histology characteristics were associated with lower testosterone. Conclusions NAFLD is linked to lower total testosterone in patients with T2DM, but likely given a common soil of insulin resistance/obesity and not from the severity of liver necroinflammation or fibrosis. Nevertheless, clinicians should consider screening patients with T2DM and NAFLD for hypogonadism.

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Section: Discussionmentioning

confidence: 99%

“…Nonalcoholic fatty liver disease has been strongly associated with obesity, T2DM and the metabolic syndrome [7]. The impact of having NAFLD, or even more severe liver disease, such as NASH, in terms of risk for hypogonadism remains uncertain [14]. This is important as it has significant clinical management implications.…”

Section: Introductionmentioning

confidence: 99%

Severity of non-alcoholic steatohepatitis is not linked to testosterone concentration in patients with type 2 diabetes

et al. 2021

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“…In the presence of hypothyroidism, the prevalence of NAFLD increases by 1.6 times [ 61 ], and in the presence of polycystic ovary syndrome, the incidence increases by about 2.2 times [ 62 ]. In addition, obstructive sleep apnea [ 63 ], hypopituitarism [ 64 ], hypogonadism [ 65 ], pancreatoduodenal resection [ 66 ], and psoriasis [ 67 ] increase the prevalence of NAFLD.…”

Section: Epidemiologymentioning

confidence: 99%

KASL clinical practice guidelines: Management of nonalcoholic fatty liver disease

Kang

Lee

Yoo³

et al. 2021

Clin Mol Hepatol

179

206

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“… 16 In recent years, many studies have reported the relationship between NAFLD and sex hormones (especially levels of TT and SHBG). 17 , 18 A meta-analysis reported that lower TT levels were associated with NAFLD in men, whereas higher SHBG levels were associated with lower NAFLD odds in both men and women. 19 However, the relationship between sex hormones and the severity and prognosis of NAFLD remains uncertain.…”

Section: Introductionmentioning

confidence: 99%

Relationship between total testosterone, sex hormone–binding globulin levels and the severity of non-alcoholic fatty liver disease in males: a meta-analysis

Huang

Yang

et al. 2022

Therapeutic Advances in Endocrinology

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Background: In recent years, many studies have reported the relationship between non-alcoholic fatty liver disease (NAFLD) and sex hormones, especially total testosterone (TT) and sex hormone–binding globulin (SHBG). However, the relationship between sex hormones and the severity of NAFLD is still unclear. Methods: PubMed, Embase, Cochrane Library, Web of Science, WanFang, China National Knowledge Infrastructure and VIP databases were searched for relevant studies from inception to 31 August 2021. Values of weighted mean differences (WMDs) and odds ratios (ORs) with their 95% confidence intervals (CIs) were combined by Stata 12.0 software to evaluate the relationship between TT, SHBG and the severity of NAFLD in males. Results: A total of 2995 patients with NAFLD from 10 published cross-sectional studies were included for further analysis. The meta-analysis indicated that the moderate-severe group had a lower TT than the mild group in males with NAFLD (WMD: −0.35 ng/ml, 95% CI = −0.50 to −0.20). TT and SHBG were important risk factors of moderate-severe NAFLD in males (ORTT = 0.79, 95% CI = 0.73 to 0.86; ORSHBG = 0.22, 95% CI = 0.12 to 0.39; p < 0.001). Moreover, when the analysis was limited to men older than age 50, SHBG levels were lower in those with moderate-severe disease (WMD: −11.32 nmol/l, 95% CI = −14.23 to −8.40); while for men with body mass index (BMI) >27 kg/m2, moderate-severe NAFLD had higher SHBG levels than those with mild disease (WMD: 1.20 nmol/l, 95% CI = −2.01 to 4.42). Conclusion: The present meta-analysis shows that lower TT is associated with the severity of NAFLD in males, while the relationship between SHBG and severity of NAFLD is still to be further verified.

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Hypogonadism and non-alcoholic fatty liver disease

Cited by 64 publications

References 0 publications

Severity of non-alcoholic steatohepatitis is not linked to testosterone concentration in patients with type 2 diabetes

Severity of non-alcoholic steatohepatitis is not linked to testosterone concentration in patients with type 2 diabetes

KASL clinical practice guidelines: Management of nonalcoholic fatty liver disease

Relationship between total testosterone, sex hormone–binding globulin levels and the severity of non-alcoholic fatty liver disease in males: a meta-analysis

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