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 to 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 versus 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 (LAP) index, hepatic steatosis index (his), nonalcoholic fatty liver disease-metabolic syndrome (NAFLD-MS) score, and liver computed tomography (CT) Hounsfield unit (HU) and liver to spleen ratio (LSR) were evaluated at baseline and 12 months after treatment.

Results

There were no statistically significant differences of change in LAP index (p=0.98), HSI (p=0.67), and NAFLD-MS (p=0.52) in 246 men treated with T compared to 233 treated with placebo for 12 months. Liver CT showed no statistically significant difference of change in HU (p=0.24; n=71 for T, n=69 for placebo) and LSR (p=0.74; n=55 for T, n=62 for placebo) between the two groups.

Conclusions

Our study did not show improvement of NAFLD in older hypogonadal men after 12 months of T versus placebo treatment, as assessed by three clinical scores and liver CT for hepatic steatosis. Future studies with longer treatment duration and additional NAFLD diagnostic modalities as primary outcome are warranted.