OR25-06 The Effect of Testosterone Replacement Therapy on NAFLD in Elderly Hypogonadal Men
Authors: Seung Lee Hae , Hun Han Sang , Swerdloff Ronald S , Pak Youngju , Budoff Matthew J , CL Wang Christina 
Published: October 2023

Abstract
Disclosure: H. Lee: None. S. Han: None. R.S. Swerdloff: None. Y. Pak: None. M.J. Budoff: None. C.C. Wang: None.
The Effect of Testosterone Replacement Therapy on NAFLD in Elderly Hypogonadal Men
Background: Aging increases body weight, visceral fat, insulin resistance and metabolic syndrome, leading to increased prevalence of nonalcoholic fatty liver disease(NAFLD) in elderly. Testosterone deficiency, more prevalent in elderly men, is associated with metabolic syndrome and increased visceral fat. The T Trials evaluated the effect of testosterone treatment on sexual function, physical function, and vitality. A substudy on the effect of testosterone on cardiovascular markers showed decrease in total cholesterol, LDL cholesterol, HDL cholesterol, fasting insulin level and HOMA-IR in testosterone treatment group compared to placebo. We hypothesized that testosterone replacement in elderly male with hypogonadism will improve NAFLD. Methods: Data from the T Trial was used to evaluate prevalence of NAFLD using 3 clinical scores in testosterone treatment group and placebo group; Lipid accumulation product (LAP) index, hepatic steatosis index (HSI) and NAFLD-MS score. A randomized sub-group of the placebo and testosterone treated subjects had cardiac CT (Computed tomography) that includes liver and spleen. Liver Hounsfield unit (HU) and spleen HU were obtained to evaluate NAFLD by CT criteria. Clinical liver fat scores and CT findings were evaluated at baseline and 12 months post treatment. Correlation between each liver fat score (LAP index, HSI and NAFLD-MS score) and liver CT findings were analyzed. Results: 502 male of age 65 and over with total testosterone &lt;275ng/dL were analyzed (testosterone group n= 246, placebo group n=233). Baseline testosterone levels were not different between the two groups at baseline. Testosterone level was increased by 285.5±266.4ng/dL in the treatment group compared to 1.98±73.6ng/dL in the placebo group (p= 0.0001). Prevalence of NAFLD in elderly hypogonadal men by LAP index, HSI and NAFLD-MS were 89.77%, 88.93% and 3.96% respectively. 30% of subjects had liver HU&lt;40, 21.36% had liver-to-spleen HU ratio (LSR)&lt;1. There were no statistically significant changes in liver fat scores and CT findings in each arm at baseline and after 12 months treatment. Subgroup analysis on subjects with NAFLD defined by LAP index, liver HU or LSR did not show improvement of NAFLD after 12 months of testosterone replacement. Among the 3 liver fat scores, only LAP index showed inverse correlation with liver HU. Conclusion: Our study did not show improvement of NAFLD in elderly hypogonadal male after 12 months of testosterone replacement compared to placebo, assessed by lipid accumulation product index, hepatic steatosis index, NAFLD-MS score, liver HU and liver-to-spleen ratio. Future studies with longer treatment duration and additional modalities to define NAFLD as primary outcome may be warranted.
Presentation Date: Saturday, June 17, 2023