(034) Identifying Undiagnosed Hypogonadism: The Role of Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD) Screening

Introduction Metabolic dysfunction–associated fatty liver disease (MAFLD) is increasingly recognized as a sentinel condition linking hepatic and cardiometabolic risk. However, the potential endocrine interplay, specifically the link between MAFLD and hypogonadism (testosterone deficiency, TD), has not been thoroughly investigated in aging male cohorts. Objective To examine the relationship between MAFLD and TD, with particular focus on men who exhibit MAFLD in the absence of metabolic syndrome (MetS) Methods This investigation utilized data from a comprehensive, community-based health examination in Kaohsiung, Taiwan, enrolling men aged 40 years and older. Data collection involved standardized physical assessments, detailed questionnaires on medical history and hypogonadal symptoms, and the analysis of plasma samples (20-mL venipuncture) for hormonal, adipocytokine, and general biochemical profiling. Hepatic steatosis risk was estimated using the Fatty Liver Index (FLI). MAFLD diagnosis adhered to consensus criteria: evidence of fatty liver co-occurring with obesity/overweight, type 2 diabetes mellitus, or at least two features of metabolic dysregulation. Results The cohort comprised 631 adult men (median age: 55 years; interquartile range:52-58). Men diagnosed with MAFLD demonstrated a significantly elevated incidence of both hypogonadism and MetS relative to non-MAFLD controls (p<0.001 for both comparisons). Furthermore, MAFLD status exhibited a strong statistical relationship with circulating levels of insulin-sensitizing adipokines, including leptin, adiponectin, and RBP-4 (p<0.001 for all three). Crucially, within the subgroup of participants not meeting MetS criteria, MAFLD was independently associated with a relative risk increase of approximately four-fold for biochemical TD (Total Testosterone <300 ng/dL) (Adjusted Odds Ratio: 3.89) and a nearly five-fold increase for clinical TD (Adjusted Odds Ratio: 4.74). Conclusions MAFLD is a strong independent correlate of hypogonadism in aging men, even in the absence of MetS. These findings suggest MAFLD may serve as an early clinical marker for identifying men at risk of undiagnosed TD, supporting targeted screening strategies. Longitudinal studies are needed to clarify underlying mechanisms and validate its predictive utility. Disclosure No