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High testosterone increases risk for fatty liver in postmenopausal women

Researchers found that postmenopausal women with high levels of bioavailable testosterone are at greater risk for developing fatty liver compared with women with low testosterone, according to published findings.

“To our knowledge, this is the largest study to date showing the association of circulating multiple sex hormone levels with liver fat, as measured using [computed tomography] scan, in a population-based multi-ethnic sample of both men and women,” the researchers wrote.

Using data from the Multiethnic Study of Atherosclerosis, researchers conducted a cross-sectional analysis of 2,835 postmenopausal women and 2,899 men from six clinical centers in the U.S. Each patient underwent testing to measure any association of bioavailable testosterone, estradiol (E₂), dehydroepiandrosterone and sex hormone binding globulin (SHBG) with liver fat.

“Reports of studies in small samples suggest that lower levels of SHBG are associated with increased [nonalcoholic fatty liver disease] in men and menopausal women,” the researchers wrote. “Another study reported an association between low levels of dehydroepiandrosterone and NAFLD. However, no associations with estradiol or testosterone have been reported in U.S., multiracial, population-based studies.”

Analyses showed that women in the highest tertile of bioavailable testosterone were more likely to have fatty liver compared with women in the lowest tertile (OR = 1.77; 95% CI, 1.07-2.92). After adjusting for multiple factors, including age, race/ethnicity, and waist-to-hip ratio, the researchers found an increased difference between the two groups of women for level of E₂ (OR = 2.49; 95% CI, 1.41-4.39).

Men in the highest tertile of E₂ level were more likely to have fatty liver compared with men in the lowest tertile (OR = 2.1; 95% CI, 1.29-3.4). However, the men in the highest tertile of SHBG were less likely to have fatty liver compared with men in the lowest tertile of SHBG (OR = 0.46; 95% CI, 0.27-0.77).

“We have shown that there is a strong association of fatty liver with high E₂ levels in men and women and low SHBG levels in men independent of demographic, anthropometric and cardiometabolic risk factors,” the researchers wrote. “Higher androgenic milieu is associated with fatty liver in women only.”

The researchers concluded: “Future studies with measurement of liver inflammation and fibrosis are necessary to determine whether these associations may give rise to clinically significant liver-related morbidity.” – by Melinda Stevens

Disclosures: Lazo reports no relevant financial disclosures. Please see the study for a full list of all other authors’ relevant financial disclosures.