Short answer: Fatty liver and testosterone are linked. Men with fatty liver disease (now called MASLD, metabolic dysfunction-associated steatotic liver disease) have, on average, lower total testosterone than men without it, and both problems grow out of the same metabolic soil: excess belly fat, insulin resistance and the rest of metabolic syndrome. The studies are observational, so they show an association, not proof that one causes the other. The main treatment is gradual weight loss under a doctor’s care, and men with liver disease should not start herbal supplements, including male vitality formulas, without their doctor’s approval.
Key Takeaways
- New name: NAFLD is now called MASLD, and NASH is now called MASH (metabolic dysfunction-associated steatohepatitis).[1]
- The link is real but observational: a meta-analysis of 16 studies found that men with NAFLD had lower total testosterone and lower SHBG than men without it.[3]
- Usually silent: many people with MASLD have no symptoms and can even have normal liver tests, so it is often found by chance on imaging.[2]
- Weight loss comes first: losing 3% to 5% of body weight can reduce liver fat, and 7% to 10% may be needed to reduce inflammation and scarring.[1]
- Supplements are not harmless for the liver: NIDDK warns that some herbal remedies can damage the liver, and LiverTox lists tongkat ali and reishi as possible rare causes of liver injury.[1][4][6]
What Is Fatty Liver Disease (MASLD)?
Fatty liver disease means fat has built up inside liver cells. When it happens in people with metabolic risk factors who drink little or no alcohol, doctors now call it MASLD. The older names, nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), have been replaced by MASLD and MASH.[1] You will still see both sets of names in older articles, lab reports and studies, including the testosterone research discussed below.
It is very common. The American College of Gastroenterology (ACG) estimates that up to 30 out of 100 people, or over 100 million American adults, have MASLD.[2] About 20% of people with MASLD have MASH, the inflamed form, and about 20% of those may go on to develop cirrhosis. ACG also notes that heart disease is the number one cause of death among people with MASLD, which tells you this is a whole body metabolic problem, not only a liver problem.[2]
Who is at risk
MASLD is considered part of metabolic syndrome. The main risk factors are:[2]
- Diabetes or prediabetes (insulin resistance)
- Overweight or obesity, especially around the waist
- High triglycerides or high cholesterol
- High blood pressure
Not everyone has all of these, and you do not need to be visibly overweight to have fatty liver.
Fatty liver symptoms in men
Most men feel nothing. ACG states that many people with MASLD and MASH have no symptoms, and liver tests can be normal.[2] Some people notice abdominal discomfort or fatigue. Advanced scarring (cirrhosis) can cause fluid in the legs or abdomen, confusion or bleeding, which needs urgent medical care. Because the early stage is silent, the diagnosis often comes from an ultrasound or CT scan done for another reason.
How Fatty Liver and Testosterone Are Connected
The best summary of the evidence is a systematic review and meta-analysis published in Annals of Hepatology in 2017. It pooled 16 observational studies with 13,721 men and 5,840 women.[3] In men, those with NAFLD had total testosterone about 2.78 nmol/L lower than men without NAFLD, and higher testosterone was linked to lower odds of having fatty liver. SHBG (sex hormone-binding globulin) was lower in people with NAFLD in both sexes. In women the pattern was different: higher testosterone was linked to higher odds of NAFLD.[3]
Two cautions matter. First, the included studies were very different from each other (statistical heterogeneity was very high), so the size of the gap is an estimate, not a fixed number. Second, these are observational studies. They show that low testosterone and fatty liver travel together, but they cannot prove which comes first.
Why the two problems travel together
The most likely explanation is shared drivers. Excess visceral fat, insulin resistance and the other parts of metabolic syndrome are risk factors for MASLD,[2] and the same metabolic picture is commonly seen in men with low testosterone. SHBG is made in the liver and carries testosterone in the blood, so liver fat and insulin resistance can also change how much total and free testosterone shows up on a lab test. If you want the details on that, see our guides to free vs total testosterone and what high or low SHBG means.
In practice, this means a man with fatty liver may benefit from having his hormones checked, and a man with low testosterone may benefit from having his liver and blood sugar checked. A doctor can sort out which problem is driving the other in your case.
| Shared factor | Why it matters for the liver | Why it matters for testosterone testing |
|---|---|---|
| Belly (visceral) fat | Core feature of metabolic syndrome and MASLD risk | Commonly seen with lower testosterone; ask about waist size, not just weight |
| Insulin resistance, prediabetes, diabetes | Listed risk factor for MASLD | Can affect SHBG, which changes total testosterone readings |
| High triglycerides or cholesterol | Part of the metabolic syndrome cluster | Signals that a full metabolic workup is worth doing |
| High blood pressure | Part of the metabolic syndrome cluster | Also relevant before any supplement or hormone decision |
| Alcohol | ACG advises limiting it and avoiding it entirely if possible | Adds stress to an already strained liver |
How Fatty Liver Is Diagnosed
ACG recommends that people with metabolic risk factors have liver tests checked at least once a year.[2] Diagnosis usually follows these steps:
- Rule out other causes: heavy drinking, certain medications and other liver diseases must be excluded first.[2]
- Blood tests: liver enzymes, plus combinations of routine blood tests that estimate the risk of scarring.
- Imaging: ultrasound or CT often finds the fat; elastography (such as FibroScan) or MRI can measure liver fat and stiffness.[2]
- Liver biopsy: still the most accurate way to confirm MASH and scarring, used when other tests suggest significant damage.[2]
If you also have symptoms such as low libido, low energy or loss of muscle, ask your doctor whether a morning testosterone test makes sense. Our article on signs of low testosterone explains what doctors look for.
Treatment: Weight Loss Is the Main Approach
NIDDK states that losing at least 3% to 5% of your body weight can reduce fat in the liver, and that reducing liver inflammation and fibrosis may require losing up to 7% to 10%.[1] ACG gives a similar target, noting that losing a total of 10% of body weight may reduce fat and inflammation.[2] Both stress going slowly: NIDDK warns that rapid weight loss and malnutrition can worsen liver disease, and ACG suggests a gradual pace of 1 to 3 pounds per week.[1][2]
Practical targets from ACG
- Eat about 500 fewer calories per day than you need to maintain your weight.
- Drink water and avoid juice and sugary drinks; limit added sugar, highly processed snacks and fried foods.
- Fill half your plate with fruits and vegetables, aiming for at least 2.5 cups a day.
- Exercise 150 to 300 minutes per week; walking toward 10,000 steps a day is a simple goal.
- Limit alcohol, and avoid it entirely if possible.
- Keep diabetes, blood pressure and cholesterol under control with your doctor.[2]
For a 220 pound man, 5% is 11 pounds and 10% is 22 pounds. That is a realistic goal over several months, and the same habits are the ones most often recommended for men with low testosterone. See our guide on how to support testosterone naturally for the lifestyle side.
What about medications?
Older NIDDK and ACG pages state that no medicine is approved to cure NAFLD or MASH, and ACG notes vitamin E may help some people with MASH but is less suitable for people with diabetes or significant heart disease, so it should only be started with a liver specialist.[1][2] Drug options for MASH have been changing, so ask a hepatologist what currently applies to you. Testosterone therapy is a separate medical decision that belongs with your doctor after proper testing.
Supplements and Your Liver: What Men With MASLD Should Know
NIDDK advises talking with a doctor before using any supplements, vitamins or complementary medicines, because “some herbal remedies can actually damage your liver.”[1] This matters for men with fatty liver who are tempted by testosterone or vitality supplements. Here is what LiverTox (the NIH database on drug-induced liver injury) and NCCIH report for herbs commonly found in male vitality products:
| Herb | What official sources say about the liver |
|---|---|
| Tongkat ali (Eurycoma longifolia) | LiverTox likelihood score D: a possible rare cause of clinically apparent liver injury, based on isolated reports (the detailed case involved possible steroid use, which weakens the evidence).[4] |
| Reishi (lingzhi, Ganoderma) | LiverTox score D: implicated in rare single cases of acute liver injury, usually self-limited; well tolerated in trials.[6] |
| Panax (Asian) ginseng | NCCIH lists liver damage as an uncommon reported side effect; LiverTox (score E) says ginseng alone has not been linked to liver injury but may cause herb-drug interactions that can.[5][7] |
Rare does not mean zero. A man whose liver is already under strain has less margin for error, and many men with MASLD also take medicines for blood sugar, blood pressure or cholesterol, which raises the risk of interactions. NCCIH also notes that Asian ginseng might lower blood sugar, so people with diabetes should consult their provider first.[7] For more on these herbs, read our tongkat ali side effects guide.
A note about Ultra Bann
Ultra Bann, our herbal supplement made by DL Bioproducts, contains tongkat ali (85 mg), reishi (45 mg) and Panax ginseng (110 mg) among its seven botanicals, as listed on the full label on our ingredients page. Because of the liver findings above, we are clear about this: if you have fatty liver disease, MASH, cirrhosis, raised liver enzymes or any other liver condition, do not take Ultra Bann or any other herbal supplement unless your doctor approves it. Ultra Bann is not a liver product and is not a substitute for medical care. Stop any supplement and call your doctor if you notice yellow skin or eyes, dark urine, pale stools, itching, unusual fatigue or pain in the upper right abdomen.
Frequently Asked Questions
Can fatty liver cause low testosterone?
Fatty liver and low testosterone are clearly associated: men with NAFLD have lower total testosterone and lower SHBG on average.[3] The research is observational, though, so it cannot show that fatty liver directly causes low testosterone. Both are strongly tied to belly fat and insulin resistance, which likely drive much of the overlap.
What is the difference between NAFLD and MASLD?
They describe the same condition. MASLD (metabolic dysfunction-associated steatotic liver disease) is the newer name for NAFLD, and MASH replaces NASH for the inflamed form.[1] The new name puts the focus on metabolic risk factors rather than on alcohol.
Is fatty liver reversible in men?
Often, yes, especially at early stages. NIDDK reports that losing 3% to 5% of body weight can reduce liver fat, and 7% to 10% may be needed to reduce inflammation and fibrosis.[1] ACG adds that a 10% loss may even help scar tissue regress.[2] Your doctor will track progress with blood tests and imaging.
Should I get my testosterone checked if I have fatty liver?
It is a reasonable question to ask your doctor, especially if you have symptoms such as low libido, fatigue or loss of muscle. Because SHBG is often low in fatty liver, your doctor may look at free testosterone as well as total testosterone before drawing conclusions.
Are testosterone supplements safe with fatty liver?
Not automatically. NIDDK warns that some herbal remedies can damage the liver,[1] and LiverTox lists tongkat ali and reishi as possible rare causes of liver injury.[4][6] If you have any liver disease, show your doctor the full label of any supplement before taking it.
References
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Treatment for NAFLD and NASH (MASLD and MASH). niddk.nih.gov
- American College of Gastroenterology. Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) Overview. gi.org
- Testosterone, Sex Hormone-Binding Globulin and Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis. Annals of Hepatology, 2017. doaj.org
- LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Tongkat Ali. NCBI Bookshelf, 2024. ncbi.nlm.nih.gov
- LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Ginseng. NCBI Bookshelf. ncbi.nlm.nih.gov
- LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Lingzhi, Reishi. NCBI Bookshelf, 2024. ncbi.nlm.nih.gov
- National Center for Complementary and Integrative Health (NCCIH). Asian Ginseng. nccih.nih.gov
These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease. This article is for information only and is not medical advice.
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