Male hypogonadism in cirrhosis and after liver transplantation

Abstract

Liver is deeply involved in the metabolism of proteins, hormones, enzymes, cytokines, as well as in sex hormones catabolism. Gonadal function requires a normal liver function, and it is well known that clinical signs of hypogonadism are common in patients with liver cirrhosis. Few studies have focused on hypothalamic- pituitary-gonadal alterations in male cirrhotic patients or after orthotopic liver transplantation (OLT). The pathogenesis of hypogonadism in cirrhotic patients is complex and not well explained. It involves both a gonadal and a hypothalamic- pituitary dysfunction. After OLT the hypothalamic-pituitary-gonadal function partially improves, showing that the hepatic dysfunction before OLT is deeply involved in its pathogenesis. After OLT some alterations persist in some patients, both because of pre-existing gonadal alterations (toxic-metabolic damage) and immunosuppressive pharmacological side effects. Further studies will explain the relationship between hypogonadism and OLT outcome, and the role of androgen therapy in hypogonadism after OLT, in the early months and in the long term.

Testicular immunohistochemical and Ultrastructural changes associated with chronic cholestasis in rats: Effect of ursodeoxycholic acid

“…Chronic liver diseases are usually associated with high prevalence of hypogonadism and testicular atrophy in patients [2][3][4], and experimental animals [5,6]. Since the pathogenesis of testicular atrophy associated with chronic cholestasis is still not clear, the current study aimed to evaluate the immunohistochemical changes and ultrastrusctural events of this complication.…”

Ursodeoxycholic acid alleviates cholestasis-induced histophysiological alterations in the male reproductive system of bile duct-ligated rats

“…Cholestasis also adversely affects other organs and causes serious clinical complications. High incidence of hypogonadism has been reported in patients with chronic cholestasis [2].…”

Prediagnostic plasma testosterone, sex hormone‐binding globulin, IGF‐I and hepatocellular carcinoma: Etiological factors or risk markers?

“…Furthermore, valid characterization of the association of circulating testosterone with HCC requires a concurrent investigation of sex hormone‐binding globulin (SHBG), testosterone's major protein carrier in the circulation . Determination of SHBG is essential because it is exclusively of liver origin, its synthesis may increase with liver damage and lead to reduced clearance of the SHBG‐bound hormone . Free testosterone is of interest, because it represents the bioavailable fraction of the hormone that can readily reach target tissues and its positive association with risk will substantiate an etiological role of testosterone in HCC.…”