title: Effects of testosterone gel treatment in hypogonadal men with liver cirrhosis.
abstract: BACKGROUND
  Hypogonadism characterized by low serum testosterone level, loss of libido, small testes, impotence and gynecomastia is a common clinical situation in male patients with advanced chronic liver disease. The aim of the study was to assess the efficacy and safety of testosterone replacement on muscle strength, bone mineral density (BMD), body composition and gynecomastia in hypogonadal men with liver cirrhosis.
  
  
  METHODS
  Sixteen hypogonadal male cirrhotic patients were included and twelve completed the study. Abdominal USG and/or MRI were performed to exclude hepatocellular cancer. Testogel 50mg/day was administered for 6 months. Liver enzymes, hormone profiles and muscle strength were evaluated monthly. Body composition parameters, BMD and gynecomastia were evaluated before and after 6 months.
  
  
  RESULTS
  Serum free testosterone level was higher (20.13 ± 10.06 pmol/L; 57.26 ± 39.56 pmol/L, P=0.002) after treatment. Testosterone replacement resulted in an increase in muscle strength (34.03 ± 7.24 kg; 39.18 ± 5.99 kg, P<0.001), the subscapular site subcutaneous fat tissue (P=0.012) and the sum of the four regions (P=0.04). Subareolar breast tissue was lower (28.83 ± 17.18 mm; 15.00 ± 6.74 mm, P=0.007) after treatment. No significant adverse effects were detected.
  
  
  CONCLUSIONS
  Testosterone gel 50mg/day raises free testosterone to values below supraphysiological levels in cirrhotic men. Transdermal testosterone replacement improves muscle strength, ameliorates gynecomastia, alters body fat distribution and causes upper body adiposity in hypogonadal men with cirrhosis. Application of testosterone gel, which undergoes no hepatic first-pass metabolism, seems as a safe and well-tolerated agent in liver cirrhosis as compared to other anabolic steroids, which may be associated with various adverse events.
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, Erciyes University Faculty of Medicine, 38039 Kayseri, Turkey. yurci@erciyes.edu.tr
authors.forename: Alper
authors.initials: A
authors.lastname: Yurci
authors.forename: Mehmet
authors.initials: M
authors.lastname: Yucesoy
authors.forename: Kursad
authors.initials: K
authors.lastname: Unluhizarci
authors.forename: Edip
authors.initials: E
authors.lastname: Torun
authors.forename: Sebnem
authors.initials: S
authors.lastname: Gursoy
authors.forename: Mevlut
authors.initials: M
authors.lastname: Baskol
authors.forename: Kadri
authors.initials: K
authors.lastname: Guven
authors.forename: Omer
authors.initials: O
authors.lastname: Ozbakir
mesh_terms: D000287:Administration, Topical; D005782:Gels; D006801:Humans; D007006:Hypogonadism / Q000150:complications / Q000209:etiology*; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013739:Testosterone / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D005782:Gels; D013739:Testosterone