Endocrine Abstracts

Background and aims

Low levels of testosterone and non-alcoholic fatty liver disease (NAFLD) in obese men are both linked to the metabolic syndrome, but the independent association between testosterone and NAFLD needs to be elucidated. In this cross-sectional analysis the association between total testosterone (total T) and calculated free testosterone (cFT) on the one hand and NAFLD, non-alcoholic steatohepatitis (NASH) and fibrosis on the other hand was investigated in obese men.

Methods

Data of 134 men of 18 years or older and a body mass index of at least 25 kg/m² who underwent a liver biopsy after visiting the obesity clinic were collected. Liver biopsy was performed if there was suspicion of NAFLD. Individuals were classified into 4 categories: no NAFLD, NAFL, NASH (no fibrosis (F0) or F1) or NASH with advanced fibrosis (F2-F4). Because of an unequal distribution of fibrosis, the 5 stages were regrouped into F0–1 and F2–4.

Results

Mean age was 45 ± 12, median BMI was 39.6 kg/m² (range 25.0–64.9). Only 5.2% of the individuals had no NAFLD. Of the individuals with NAFLD, 15.7% had NAFL, 56.7% had NASH F0-F1 and 22.4% had NASH F2-F4. Fibrosis stage 0 to 4 were present in respectively 47.8, 26.9, 17.2, 7.5 and 0.7%. cFT and total T were below the limit of normal in respectively 63% and 23% of individuals. One-way ANOVA showed a tendency toward a difference in the level of cFT between the grades of NAFLD (P = 0.053) that did not persist after controlling for confounding variables. No significant difference was seen for total T. Ordinal regression analysis showed a decreasing level of cFT was associated with an increase in the grade of NAFLD (P = 0.005) that did not persist after controlling for confounding variables. No significant effect of total T on the grade of NAFLD was seen. When performing the same analyses for fibrosis and after controlling for confounding variables, no difference in the level of cFT or total T were seen between F0-F1 and F2-F4 and no effect of cFT or total T was seen on the stage of fibrosis.

Conclusion

To the best of our knowledge, this is until now the largest study investigating the association between sex steroid levels and biopsy-proven NAFLD. After controlling for confounding variables no association was found between the level of total T and cFT on the one hand and NAFLD, NASH or fibrosis on the other hand.