Testosterone Supplementation and Other Pharmacotherapy for Sarcopenia in Cirrhosis: Evaluation, Treatment and Considerations

Sarcopenia is increasingly recognised as a common and debilitating manifestation of cirrhosis, associated with significant morbidity and mortality. The underlying causes of sarcopenia are multifactorial and may differ between genders, disease aetiologies and severity of liver disease. Understanding the driving factors of muscle loss and dysfunction is crucial to the development of effective and individualised management strategies. Addressing the underlying contributing factors of sarcopenia in cirrhosis is paramount. Dietary interventions with focus on high calorie, high protein and reduced periods of fasting has demonstrated improved muscle strength and function. Nutraceuticals, including branched-chain amino acids, however did not show the same positive improvements in sarcopenia. Low testosterone is a common complication of cirrhosis in males. Testosterone supplementation in this patient group has been shown to improve patient outcomes and improve muscle strength and function. This narrative review summarises the evidence base for existing therapies to treat sarcopenia in cirrhosis, focusing on testosterone and other pharmacotherapies with a plausible biological rationale.