, Volume 12, Issue 3, pp 405–416 | Cite as

Sex steroids and sex hormone-binding globulin in postmenopausal women with nonalcoholic fatty liver disease

  • Stergios A. PolyzosEmail author
  • Jannis Kountouras
  • Agathocles Tsatsoulis
  • Efthimia Zafeiriadou
  • Evangelia Katsiki
  • Kalliopi Patsiaoura
  • Christos Zavos
  • Vasiliki V. Anastasiadou
  • Aristidis Slavakis
Research paper



The evaluation of serum sex steroids and sex hormone-binding globulin (SHBG) levels in postmenopausal women with nonalcoholic fatty liver disease (NAFLD) and their association to the disease severity.


Twenty-two postmenopausal women with biopsy-proven NAFLD and 18 matched controls were recruited. Blood samples for serum SHBG, total testosterone, estradiol levels and standard biochemical tests were obtained after overnight fasting. Free androgen index (FAI), calculated free (cFT) and bioavailable testosterone were estimated by standard formulas.


The NAFLD group had lower serum SHBG levels and higher values of cFT, bioavailable testosterone and FAI, despite exhibiting similar to controls levels of serum total testosterone and estradiol. Serum SHBG levels (adjusted odds ratio [aOR] =0.912; 95% CI 0.854–0.973), bioavailable testosterone (aOr=1.254; 95% CI 1.0101.556) and FAI (aOr=2.567; 95% CI 1.153–5.716), but not cFT, were associated with NAFLD independently of age, body mass index (BMI) and waist circumference. Serum estradiol levels were associated with the presence of nonalcoholic steatohepatitis (NASH) independently of age, BMI and waist circumference (aOR=0.727; 95% CI 0.537–0.985).


Low SHBG levels and high metabolically active testosterone fractions were independently associated with NAFLD. Among NAFLD patients, serum estradiol levels were independently associated with NASH. However, these results need further validation from large-scale studies.

Key words

Estradiol Free androgen index Insulin resistance Metabolic syndrome Nonalcoholic fatty liver disease Nonalcoholic steatohepatitis Sex hormone-binding globulin Testosterone 


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Copyright information

© Hellenic Endocrine Society 2013

Authors and Affiliations

  • Stergios A. Polyzos
    • 1
    Email author
  • Jannis Kountouras
    • 1
  • Agathocles Tsatsoulis
    • 2
  • Efthimia Zafeiriadou
    • 3
  • Evangelia Katsiki
    • 4
  • Kalliopi Patsiaoura
    • 4
  • Christos Zavos
    • 1
  • Vasiliki V. Anastasiadou
    • 5
  • Aristidis Slavakis
    • 6
  1. 1.Department of Medicine, Second Medical ClinicAristotle University of Thessaloniki, Ippokration HospitalThessalonikiGreece
  2. 2.Department of EndocrinologyUniversity of IoanninaIoanninaGreece
  3. 3.Department of RadiologyIppokration HospitalThessalonikiGreece
  4. 4.Department of PathologyIppokration HospitalThessalonikiGreece
  5. 5.Department of Gynecology and ObstetricsMaternity Hospital “Mitera”AthensGreece
  6. 6.Department of BiochemistryIppokration HospitalThessalonikiGreece

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