Male hypogonadism and liver disease

Chronic liver disease and cirrhosis are common causes of morbidity and mortality. However, the relationship between sex hormones, most notably testosterone, and liver disease has been examined only in limited studies. Liver disease is generally associated with central hypogonadism, except in the setting of alcoholic liver disease in which ethanol results in testicular damage. There are limited data on the efficacy and safety of treatment of hypogonadism in the setting of liver disease. Data are mixed on improvements in morbidity and mortality with testosterone treatment with improvement in gynecomastia appearing to be the most consistently reported benefit. Although not powered to examine safety outcomes, studies have not demonstrated a clear increase in associated adverse events with testosterone therapy. Liver transplantation is also associated with improvement in testosterone levels in the majority of individuals. However, this finding is not uniform, likely related in part to pre-existing metabolic damage, immunosuppression, graft function, and potentially other comorbidities. Further research is needed on the efficacy and safety of testosterone treatment in liver disease.