{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T13:16:09Z","timestamp":1787836569472,"version":"build-2784847793"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2021,6,2]],"date-time":"2021-06-02T00:00:00Z","timestamp":1622592000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","award":["VA Merit Award 1 I01 CX000167-01"],"award-info":[{"award-number":["VA Merit Award 1 I01 CX000167-01"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000041","name":"American Diabetes Association","doi-asserted-by":"publisher","award":["1-08-CR-08"],"award-info":[{"award-number":["1-08-CR-08"]}],"id":[{"id":"10.13039\/100000041","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>Hypogonadism is reported to occur in non-alcoholic fatty liver disease (NAFLD), but earlier studies used low-sensitivity diagnostic techniques (CT, ultrasound), for NAFLD diagnosis. We hypothesized that if hypogonadism was due to NAFLD, and not solely attributable to underlying obesity\/diabetes, it would be more severe in the presence of steatohepatitis (NASH). To examine the influence of liver disease on testosterone in males with type 2 diabetes mellitus (T2DM), we used gold-standard liver imaging with MR-spectroscopy (<jats:sup>1<\/jats:sup>H-MRS), and performed liver biopsies to grade\/stage the NAFLD.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>In this cross-sectional study, we measured in 175 males with T2DM total and free testosterone, markers of insulin resistance, and intrahepatic triglyceride content (IHTG) by<jats:sup>1<\/jats:sup>H-MRS. Those with NAFLD on imaging underwent a liver biopsy.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>Total testosterone was higher in the group without NAFLD (\u201cNo-NAFLD\u201d; n = 48) compared to isolated steatosis (IS; n = 62) or NASH (n = 65) (385 \u00b1 116 vs. 339 \u00b1 143 vs. 335 \u00b1 127 ng\/ml, p<jats:sub>trend<\/jats:sub>0.03). Testosterone was also lower in obese vs. non-obese subjects in both the No-NAFLD and IS groups (p = 0.06 and p = 0.11, respectively), but not in obese vs. non-obese patients with NASH (p = 0.81). IHTG was independently associated with total testosterone (\u00df = -4.8, p = 0.004). None of the liver histology characteristics were associated with lower testosterone.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusions<\/jats:title><jats:p>NAFLD is linked to lower total testosterone in patients with T2DM, but likely given a common soil of insulin resistance\/obesity and not from the severity of liver necroinflammation or fibrosis. Nevertheless, clinicians should consider screening patients with T2DM and NAFLD for hypogonadism.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0251449","type":"journal-article","created":{"date-parts":[[2021,6,2]],"date-time":"2021-06-02T21:03:38Z","timestamp":1622667818000},"page":"e0251449","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":17,"title":["Severity of non-alcoholic steatohepatitis is not linked to testosterone concentration in patients with type 2 diabetes"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1872-7753","authenticated-orcid":true,"given":"Kristin 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