Metabolic Syndrome, Hepatic Steatosis, and Testosterone: A Matter of Sex

The review explores the intricate relationship between metabolic syndrome, hepatic steatosis (now termed MASLD), and sex hormones, emphasizing the sex-dimorphic nature of these conditions. Over 30% of the population is affected by MASLD, which is linked to increased cardiovascular and mortality risks. In men, testosterone deficiency exacerbates metabolic issues like visceral adiposity and insulin resistance, while in women, hyperandrogenism, particularly in PCOS, leads to severe metabolic disturbances, including hepatic steatosis. Estrogen deficiency also contributes to central adiposity and metabolic syndrome. The document highlights the importance of understanding hormonal interactions to address metabolic diseases, noting that testosterone replacement therapy can improve liver steatosis in hypogonadal men, and hormone replacement therapy can mitigate increased fat mass and metabolic syndrome risk in postmenopausal women.