Liver function

The testosterone preparations proposed for testosterone replacement do not have negative side-effects on liver function (e.g. Gooren 1994). Nevertheless, many physicians believe that testosterone may disturb liver function. This impression derives from 17a-methyltestosterone and other 17a-alkylated anabolic steroids which are indeed liver toxic and which should no longer be used in the clinic (see Chapter 14). However, there maybe ethnic differences since the weekly application of200 mg testosterone enanthate, i.e. double the dose used for substitution, for several months led to a slight increase of liver transaminases in Chinese men while this effect was not seen in non-Chinese men (Wu et al. 1996). Under more physiologic testosterone doses this phenomenon was not observed (Wang etal. 1991).

Monitoring liver function is of special interest in hypogonadal patients with concomitant diseases that affect liver function, or in patients whose hypogonadism is induced by general diseases. In such cases additional medication is necessary that may influence liver function and thus influence testosterone metabolism, e.g. by increasing SHBG production. We determine liver enzymes once per year routinely.

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