Testosterone Therapy and Liver Enzyme Elevations

Introduction to Testosterone Therapy

The American College of Physicians and other medical societies recommend that intramuscular testosterone does not cause clinically significant liver enzyme elevations, making routine monitoring with liver function tests unnecessary for men receiving IM testosterone 1, 2

The American Association for the Study of Liver Diseases guidelines state that intramuscular injections and transdermal preparations of testosterone do not appear to be associated with hepatic dysfunction, making routine liver function test monitoring unnecessary for these formulations 1, 2
The American Association for the Study of Liver Diseases acknowledges that testosterone replacement therapy may be associated with transient elevations in liver enzymes that are usually self-limited 3, 4

Oral testosterone preparations are strongly discouraged due to associated hepatotoxicity and risk of hepatic neoplasia 1, 2
The route of administration matters critically, with oral testosterone causing hepatotoxicity and IM and transdermal formulations having fundamentally different hepatic safety profiles 1, 2

Testosterone can be safely used in men with chronic liver disease, including those with cirrhosis, with benefits including increased muscle mass and bone density 3, 4
Female-to-male transgender patients should be screened for liver abnormalities before initiating high-dose androgen therapy 3, 4

The American College of Physicians recommends that patients receiving therapeutic IM testosterone should not be routinely monitored for liver enzymes, but rather for hematocrit, prostate parameters, and cardiovascular risk factors instead 1, 2, 5