Cirrhosis

In studies dating back to the 1960's, androgen therapy does not alter the natural history of alcoholic cirrhosis. The earliest controlled studies of androgen therapy to ameliorate the natural history of alcoholic cirrhosis claimed a survival benefit in 26 men treated with testosterone propionate (100 mg alternate days for ~4 weeks) compared with 27 placebo-treated men (Wells 1960). This study had defective randomisation and could not be replicated in another study of 17 men treated with either 100 mg of testosterone propionate or methenolone acetate every second day for one month. They had no survival advantage after 6 months compared with 10 placebo-treated controls (Fenster 1966). Neither study was large nor long enough to be definitive. The best evidence is derived from the Copenhagen Study Group for Liver Disease which enrolled 221 men with alcoholic cirrhosis in a 3 year prospective double-blinded, randomised, placebo-controlled study testing oral micronised testosterone (600 mg daily). This study showed convincingly no benefit in mortality (Copenhagen Study Group for Liver Diseases 1986), hepatic histology (Gluud et al. 1987a), liver hemodynamics and biochemical function (Gluud et al. 1987c) or improvement in sexual dysfunction (Gluud et al. 1988b). The negative outcome with sufficient power to exclude a 35% decrease in mortality was at variance with many enthusiastic but poorly controlled previous reports (Kopera 1976). The observation of portal vein thrombosis in three men treated with testosterone may be related to the extreme portal testosterone levels created by oral administration of very high androgen dosage. Characteristic of testosterone pharmacokinetics in chronic liver disease (Gluud et al. 1981; Nieschlag et al. 1977), this regimen produced markedly supraphysiological peripheral blood testosterone concentrations (Gluud etal. 1988a; Gluud etal. 1987b) which suggests even more extreme portal testosterone concentrations.

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Using Exercise To Get Rid Of Man Boobs

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