Yassin Aksam A, Alwani Mustafa, Talib Riadh, Almehmadi Yousef, Nettleship Joanne E, Alrumaihi Khalid, Albaba Bassam, Kelly Daniel M, Saad Farid
Department of Surgery, Division of Urology/Andrology & Men's Health, Hamad Medical Corporation, Doha, Qatar.
Weill Cornell Medical School (WCM-Q), Doha, Qatar.
Aging Male. 2020 Dec;23(5):1553-1563. doi: 10.1080/13685538.2020.1867094. Epub 2021 Jan 13.
Non-alcoholic fatty liver disease (NAFLD) is associated with cardiovascular disease (CVD) and both are prevalent in men with testosterone deficiency. Long-term effects of testosterone therapy (TTh) on NAFLD are not well studied. This observational, prospective, cumulative registry study assesses long-term effects of testosterone undecanoate (TU) on hepatic physiology and function in 505 hypogonadal men (T levels ≤350 ng/dL). Three hundred and twenty one men received TU 1000 mg/12 weeks for up to 12 years following an initial 6-week interval (T-group), while 184 who opted against TTh served as controls (C-group). T-group patients exhibited decreased fatty liver index (FLI, calculated according to Mayo Clinic guidelines) (83.6 ± 12.08 to 66.91 ± 19.38), γ-GT (39.31 ± 11.62 to 28.95 ± 7.57 U/L), bilirubin (1.64 ± 4.13 to 1.21 ± 1.89 mg/dL) and triglycerides (252.35 ± 90.99 to 213 ± 65.91 mg/dL) over 12 years. Waist circumference and body mass index were also reduced in the T-group (107.17 ± 9.64 to 100.34 ± 9.03 cm and 31.51 ± 4.32 to 29.03 ± 3.77 kg/m). There were 25 deaths (7.8%) in the T-group of which 11 (44%) were cardiovascular related. In contrast, 28 patients (15.2%) died in C-group, and all deaths (100%) were attributed to CVD. These data suggest that long-term TTh improves hepatic steatosis and liver function in hypogonadal men. Improvements in liver function may have contributed to reduced CVD-related mortality.
非酒精性脂肪性肝病（NAFLD）与心血管疾病（CVD）相关，且在睾酮缺乏的男性中均很常见。睾酮治疗（TTh）对NAFLD的长期影响尚未得到充分研究。这项观察性、前瞻性、累积登记研究评估了十一酸睾酮（TU）对505名性腺功能减退男性（睾酮水平≤350 ng/dL）肝脏生理和功能的长期影响。321名男性在最初6周的间隔期后接受1000 mg/12周的TU治疗，最长可达12年（T组），而184名选择不接受TTh的男性作为对照组（C组）。T组患者在12年期间脂肪肝指数（根据梅奥诊所指南计算）降低（从83.6±12.08降至66.91±19.38），γ-谷氨酰转移酶（从39.31±11.62降至28.95±7.57 U/L），胆红素（从1.64±4.13降至1.21±1.89 mg/dL）和甘油三酯（从252.35±90.99降至213±65.91 mg/dL）。T组的腰围和体重指数也有所降低（从107.17±9.64降至100.34±9.03 cm，从31.51±4.32降至29.03±3.77 kg/m）。T组有25人死亡（7.8%），其中11人（44%）与心血管疾病相关。相比之下，C组有28名患者（15.2%）死亡，所有死亡（100%）均归因于CVD。这些数据表明，长期TTh可改善性腺功能减退男性的肝脏脂肪变性和肝功能。肝功能的改善可能有助于降低与CVD相关的死亡率。
