5 reasons men are more at risk of liver disease – and what you can do about it

Our annual health analysis of over 30,000 customers’ data showed a quarter of men who tested in 2024 had abnormal levels of alanine aminotransferase (ALT). That’s one in four men vs. one in ten women.

ALT (along with ALP, bilirubin, and GGT), is a key liver biomarker, that can indicate how healthy your liver is. 

While high ALT levels don’t guarantee severe liver issues, these results echo public health data, which shows twice as many men die from liver disease than women [1].

Why is there such a large difference? 

It comes down to several factors.

1. Diet and lifestyle
2. Metabolic syndrome
3. Hormones
4. Genetics
5. Age
    

1. Diet and lifestyle

Obesity

Non-alcoholic fatty liver disease (NAFLD, also known as metabolic dysfunction-associated steatotic liver disease (MASLD), is a type of chronic liver disease associated with the build-up of fat in the liver. It’s usually seen in people who are overweight or obese. 

And in the UK, men are more likely to be obese than women [2]. 

Obesity and NAFLD are closely interlinked [3] and affect the liver by:

• Fat storage in the liver – when you eat more calories than you use, the body stores them as fat. When the liver receives fat faster than it can process, fatty deposits form in the liver. This is known as hepatic steatosis.

• Insulin resistance – visceral fat (fat stored around the organs) leads to insulin resistance, where your cells don’t respond properly to insulin. If your insulin levels get too high this promotes fat storage in the liver.

• Inflammation – when fat collects in liver cells it causes inflammation. Your body sees inflammation as something it needs to fix, and triggers an immune response, damaging the liver.

Alcohol consumption 

Men are more likely to drink alcohol, both more frequently and in larger amounts, than women [4]. Excessive alcohol use can lead to alcohol-related liver disease (ARLD).

The advised maximum units of alcohol is 14 units a week, ideally spread out over the week. But a quarter of the UK regularly drinks more than this recommendation [5].

While it can be fun, alcohol is technically a poison, and your liver works overtime processing it and removing the toxins from your body. Each time your liver processes alcohol, some of your liver cells die.

Your liver produces new cells, but drinking regularly reduces its efficiency, and can cause permanent damage.

ARLD doesn’t usually cause symptoms until an advanced stage of liver damage. If you regularly drink alcohol, a Liver Function Blood Test could tell you if you need to reach out to your GP. 

2. Metabolic syndrome

If you are obese, eat a high-saturated-fat diet, and drink a lot of alcohol you are more susceptible to metabolic syndrome, a term for a group of factors including:

• Elevated blood glucose levels

• Raised cholesterol levels

• Excess body fat around the waist

Since men are more prone to the behaviours mentioned above, they are also more at risk of metabolic syndrome. Metabolic syndrome increases your chances of having NAFLD which can lead to more severe liver problems. 

Metabolic syndrome is also linked to other health problems such as type 2 diabetes, cardiovascular disease, and some cancers. 

3. Hormones

Testosterone

We’ve all heard of testosterone, but did you know your testosterone levels could affect your risk of liver disease?

Traditionally thought of as a male sex hormone, it’s present in men and women and has effects on liver health.

In men, low levels of testosterone are associated with an increased risk of NAFLD and severity of liver cirrhosis. Testosterone replacement therapy in men has shown an improvement in metabolic factors such as insulin resistance. 

Conversely, high levels of testosterone in men who are using performance-enhancing drugs for sports can cause liver damage [6].

Oestrogen

Oestrogen, one of the main female sex hormones, has been shown to have a protective effect on the liver [7]. By regulating bile production and reducing inflammation, it can offer protection against liver disease. 

Since men typically have lower levels of oestrogen than women, this leaves them more exposed to the effects of liver problems. Additionally, women become more vulnerable once they reach the menopause, as their oestrogen levels drop. 

If you’re worried about how your hormones may be affecting your liver, you can easily check with our Testosterone Blood Test, or, for a more in-depth look at your health, the Advanced Well Man Blood Test.

4. Genetics

In men and women, genetics can play an important role in liver health. However, these can manifest in different ways and can result in men being diagnosed sooner, or experiencing worse symptoms.

Haemochromatosis

Some people are genetically predisposed to a faulty HFE gene that affects the way iron is absorbed in the body. You have to inherit this gene from both parents.

The gene mutation causes you to absorb too much iron, which then starts to build up in your organs, including the liver. 

Haemochromatosis is often diagnosed in men earlier than women, as women lose iron due to menstruation and pregnancy. 

Alpha-1 Antitrypsin Deficiency (AATD)

Alpha-1-antitrypsin is a protein produced by the liver, involved in the protection of the lungs. People who have AATD produce lower levels of the protein, a deficiency which can lead to liver damage and cirrhosis. Some studies believe men metabolise the protein differently and are more prone to AATD.

Wilson’s disease

While haemochromatosis causes a build-up of iron, Wilson’s disease causes copper accumulation in the liver. 

The result of mutations in the ATP7B gene, it affects men and women equally. But men are more likely to experience liver damage as a result of the disease.

 

5. Age

Our insights showed men aged 18-40 were particularly at risk of liver injuries due to raised ALT levels. 

For the most part, this is believed to be due to lifestyle habits. A study in Bristol following thousands of people born in the early 90s found that as young as 17 had evidence of liver damage [8]. Sadly, childhood obesity and alcohol-related harm are the primary causes.

The tricky thing about liver disease is it can develop with no symptoms from a very young age. The symptoms occur after the damage is done. 

How can I lower my risk of liver disease?

 

According to the British Liver Trust, nine out of ten cases of liver disease could be prevented. 

The most important way you can lower your risk is by monitoring your liver health. By taking regular blood tests and monitoring your ALT levels, you can take action early and potentially reverse adverse effects. 

7 ways to prevent liver injuries

1. Reduce your alcohol intake
2. Ensure a healthy BMI
3. Lower your body fat percentage
4. Stick to the recommended dosage of medications
5. Reduce or quit smoking
6. Reduce your risk of viral hepatitis
7. Check your iron levels

For an in-depth approach to these 7 ways to keep your liver healthy, take a look at our insightful blog.

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References

1. Liver disease in numbers – key facts and statistics. In: British Liver Trust [Internet]. [cited 7 Jan 2025]. Available: https://britishlivertrust.org.uk/information-and-support/statistics/
2. Male Obesity - Health Action Campaign. [cited 8 Jan 2025]. Available: https://www.healthactionresearch.org.uk/obesity/male-obesity/
3. Fabbrini E, Sullivan S, Klein S. Obesity and Nonalcoholic Fatty Liver Disease: Biochemical, Metabolic and Clinical Implications. Hepatology. 2010;51: 679–689. doi:10.1002/hep.23280
4. How does alcohol affect men? | Drinkaware. [cited 7 Jan 2025]. Available: https://www.drinkaware.co.uk/facts/health-effects-of-alcohol/general-health-effects/alcohol-and-men
5. Alcohol statistics. In: Alcohol Change UK [Internet]. [cited 7 Jan 2025]. Available: https://alcoholchange.org.uk/alcohol-facts/fact-sheets/alcohol-statistics
6. Petrovic A, Vukadin S, Sikora R, Bojanic K, Smolic R, Plavec D, et al. Anabolic androgenic steroid-induced liver injury: An update. World J Gastroenterol. 2022;28: 3071–3080. doi:10.3748/wjg.v28.i26.3071
7. Cooper KM, Delk M, Devuni D, Sarkar M. Sex differences in chronic liver disease and benign liver lesions. JHEPReport. 2023;5. doi:10.1016/j.jhepr.2023.100870
8. Fatty liver disease affecting one in five young adults, Bristol study shows. BBC News. 17 Apr 2024. Available: https://www.bbc.com/news/uk-england-bristol-68724726. Accessed 8 Jan 2025.