Testosterone in Men with Advanced Liver Disease: Abnormalities and Implications

Abstract Serum testosterone is reduced in up to 90% of men with cirrhosis, with levels falling as liver disease advances. Testosterone is an important anabolic hormone, with effects on muscle, bone, and haematopoiesis. Many of the features of advanced liver disease are similar to those seen in hypogonadal men, including sarcopenia, osteoporosis, gynecomastia and low libido. However the relative contribution of testosterone deficiency to the symptomatology of advanced liver disease has not been well established. More recently it has been demonstrated that low testosterone in men with cirrhosis is associated with increased mortality, independent of the classically recognised prognostic factors such as MELD score. Only several small clinical trials have examined the role of testosterone therapy in men with cirrhosis, none of which have resolved the issue of whether or not testosterone is beneficial. However, in men with organic hypogonadism due to structural hypothalamic‐pituitary‐testicular axis disease, testosterone therapy has been shown to improve muscle mass, bone mineral density, increase haemoglobin and reduce insulin resistance. Despite initial concerns linking testosterone with hepatocellular carcinoma, more recent data suggests that this risk has been overstated. There is therefore now a strong rationale to assess the efficacy and safety of testosterone therapy in cirrhosis in well‐designed randomised controlled trials.
Source: Journal of Gastroenterology and Hepatology - Category: Gastroenterology Authors: Tags: Review Article Source Type: research