MALE hypogonadism is associated with visceral obesity and metabolic syndrome. These factors are in turn associated with the development of non-alcoholic fatty liver disease (NAFLD). The present study aims to compare the effects of testosterone treatment with a placebo in treating NAFLD in older males who are hypogonadal.
Secondary analysis was conducted on data from 479 participants aged 65 years and older, with serum testosterone levels of 275 ng/dL or lower, who were included in the ‘T Trials’. Of the included population, 246 were randomly assigned to testosterone gel treatment, while 233 were randomly assigned to a placebo for 1 year. Medical history was collected at baseline, while total and free testosterone levels, aspartate transaminase, alanine transaminase, total high-density lipoprotein and low-density lipoprotein cholesterol, haemoglobin A1c, and insulin resistance were assessed during baseline and during 12-month laboratory testing. NAFLD was assessed at baseline and 12 months using three measures: lipid accumulation product (LAP) index, NAFLD in metabolic syndrome patients scoring system, and hepatic steatosis index (HSI).
Overall, no difference was identified in the prevalence of NAFLD between the two test groups when considering all three scoring systems. Serum total and free testosterone also did not differ between those with and without NAFLD at baseline. However, at 12 months, males receiving testosterone gel had a greater increase in total testosterone (mean increase: 285.5 ng/dL) and free testosterone (mean increase: 107.9 pg/dL) than placebo. Finally, there was no difference in the prevalence of NAFLD in both groups at 12 months, and this was consistent across all scoring systems.
Overall, 12 months of testosterone replacement therapy did not improve metabolic dysfunction associated steatotic liver disease. The research team concluded that this was not surprising as a previous secondary analysis of participants of the T Trials also identified minimal improvement in the same metabolic biomarkers. First author Christina Wang, The Lundquist Institute at Harbor-UCLA Medical Center, Los Angeles, California, USA, suggested future studies would benefit from “a larger study in younger men who have [NAFLD] and hypogonadism as defined by The Endocrine Society.”
