Endocrine Abstracts

Introduction: Low testosterone levels are associated with cardiovascular morbidity and an increased risk of non-alcoholic steatohepatitis (NASH). NASH is closely associated with insulin resistance and atherosclerosis.

AIM: We studied the effect of long-term testosterone replacement therapy (TRT) on liver function and cardiovascular risk factors in hypogonadal men.

Method: Retrospective audit of 308 hypogonadal men receiving TRT as in normal clinical practice. Changes in diabetes and cholesterol medications were recorded. Cardiovascular risk factors (blood results and clinical parameters) and liver function tests were monitored at 3, 6 and 12 months and yearly thereafter for 5 years (mean 4.6 years). Data from the most recent visits represent the primary endpoint.

Results: There was a significant decrease in AST between baseline and the primary endpoint (29.7 vs 26.2 u/L; P=0.031). ALT was also significantly lowered by TRT (36.7 vs 31.5 u/L; P=0.025). Patients with raised liver transaminases at baseline (>40 u/L) had the greatest response to TRT. In patients with poorly controlled diabetes (HbA1C>7% at baseline; n=151), HbA1C was significantly reduced within 3 months and at all follow-ups until the primary endpoint (8.65% vs 6.74%; P<0.001). Diabetes medication was increased in 33 patients and decreased in 17. TRT reduced total cholesterol levels (over and above the effect of statins) at the primary endpoint (4.45 vs 4.19 mmol/l; P=0.018) and triglycerides were also significantly lowered (2.42 vs 2.12 mmol/L; P=0.033). Haemoglobin was significantly higher at the primary endpoint (14.26 vs 14.89g/dl; P<0.001). TRT had no significant effects on HDL, LDL, BMI, waist circumference or blood pressure.

Conclusion: This is the first study to demonstrate the long-term beneficial effects of TRT on liver function and cardiovascular risk factors after 5 years.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.