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Title: Testosterone is lower in men with non-alcoholic fatty liver disease and alcohol-related cirrhosis and is associated with adverse clinical outcomes.
Austin Authors: Apostolov, Ross ;Wong, Darren;Low, Elizabeth S L ;Vaz, Karl;Spurio, Jessica;Worland, Thomas ;Liu, Dorothy ;Chan, Roseanne Kimberley;Gow, Paul J ;Grossmann, Mathis ;Sinclair, Marie 
Affiliation: Victorian Liver Transplant Unit
Gastroenterology and Hepatology
Austin Health
Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
Issue Date: 6-Jun-2023
Date: 2023
Publication information: Scandinavian Journal of Gastroenterology 2023
Abstract: Low serum testosterone is common in cirrhotic men, but the impact of disease aetiology remains uncertain. This study compares serum total testosterone (TT) levels by disease aetiology and assesses its prognostic value. Single-centre retrospective study of cirrhotic men who had TT levels measured between 2002 and 2020. A cut-off of 12 nmol/L was used to define low TT and 230 pmol/L for calculated free testosterone (cFT). Linear and logistic regression used to adjust for variables known to affect testosterone levels and assess for an association between levels and outcomes. Of 766 cirrhotic men, 33.3% had alcohol-related liver disease (ALD) and 11.9% had non-alcoholic fatty liver disease (NAFLD). The median age was 56 years (interquartile range (IQR) 50-61), and the model for end-stage liver disease (MELD) score 14 (IQR 9-20). TT levels were low in 53.3% of patients, (median 11.0 nmol/L; IQR 3.7-19.8) and cFT low in 79.6% (median 122 pmol/L; IQR 48.6-212). Median TT was lower in men with ALD (7.6 nmol/L; IQR 2.1-16.2) and NAFLD (9.8 nmol/L; IQR 2.75-15.6) compared to other aetiologies (11.0 nmol/L; IQR 3.73-19.8) (p < 0.001 for all), which remained true after adjustment for age and MELD score. TT was inversely associated with 12-month mortality or transplant (381 events, p = 0.02) and liver decompensation (345 events, p = 0.004). Low serum testosterone is common in cirrhotic men and is associated with adverse clinical outcomes. TT levels are significantly lower in ALD and NAFLD compared to other disease aetiologies. Further large-scale studies are required to assess the potential benefits of testosterone therapy.
DOI: 10.1080/00365521.2023.2220857
ORCID: 0000-0002-4827-8795
Journal: Scandinavian Journal of Gastroenterology
Start page: 1
End page: 7
PubMed URL: 37282344
ISSN: 1502-7708
Type: Journal Article
Subjects: Testosterone
alcohol-related liver disease
liver transplantation
non-alcoholic fatty liver disease
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