Testosterone therapy may reduce NAFLD risk in obese men with diabetes, and hypogonadism

NAFLD is emerging as a public health issue worldwide. It is estimated that prevalent cases will increase 21% by 2030, from 83.1 million to 100.9 million. NAFLD is more commonly found in people with type-2 diabetes and is linked to obesity, insulin resistance, and atherogenic dyslipidemia. NAFLD refers to excess fat accumulation in the liver, in the absence of excessive alcohol consumption. Alcohol consumption of less than 30 g (3.75 units) per day for men is used as the cut-off to diagnose NAFLD. As an increasing global health issue, this study and its findings may be a promising area for further research.

The researchers carried out a large study on the effects of testosterone therapy on glycemic control, metabolic parameters, vascular function, and morphology in obese men with hypogonadism and type-2 diabetes mellitus. They presented a part of this study at e-ECE 2021 in which they evaluated the effects of testosterone therapy on morphology and grade of NAFLD in this population. The two-year clinical trial saw 55 males with functional hypogonadism and type-2 diabetes participate. The first year focused on a double-blind, placebo-controlled study and the following year was used for follow-up.

During the study, the participants were randomized into two groups. The first group received testosterone undecanoate during both years of the study, while the second group received a placebo in the first year and testosterone therapy in the second year. A range of tests including testosterone levels, prostate-specific antigen, and routine blood tests were assessed at the beginning of the trial, 12 and 24 months. Liver ultrasounds for NAFLD grade assessments were performed at the beginning and after two years, which showed an improvement in NAFLD grades after two years of the trial.

Dr. Kristina Groti Antonic shared that, "improvement of NAFLD grade was a result of improved insulin resistance, reduction in body mass index and body weight, along with changes in body composition. As we know, testosterone increases lean body mass at the expense of fat mass, either alone or in combination with behavioral and lifestyle modifications. Testosterone with its anti-inflammatory effects also reduced the chronic inflammatory state in the liver. Our study shows that testosterone therapy could be used as a suitable therapy for obese men living with non-alcoholic fatty liver disease, and therefore the findings can be used to tackle this growing pandemic."

This knowledge could help obese men living with functional hypogonadism and type-2 diabetes experience normalized testosterone levels and reduced prevalence of the non-alcoholic fatty liver disease.