Fatty Liver Questions

[Deebs1234]

I'm a 37 year old male.  5'10, 210 pounds (40 lbs overweight).  I do not smoke or do drugs.  I very rarely drink alcohol (maybe one beer a month).  My doctors tell me that my blood pressure is fine.  He also says that my cholestoral is also a little on the high side, though he says it's not too high to be concerned with yet.



Over the past few years, my doctor has noticed a steadily increasing case of "fatty liver," that is, elevated ALT levels.  I don't know exactly what the levels were, but they were high enough that my doctor has been growing more and more concerned the past couple of years.



Additionally (and I mention this because I think it might relate to the fatty liver), I suffer from male pattern baldness.  About 8 years ago, I began taking 1 mg per day of Propecia to keep my hair from falling out.  But then about six years ago, I stopped taking Propecia and instead began taking 2.5 mg a day of Proscar.  I did this to enhance the hair-growing effects since Proscar contains a higher concentration of the active ingredient (and I am taking it in a higher dose, 2.5 mg as opposed to 1mg).



As far as the fatty liver goes, my doctor's opinion is that I first and foremost need to lose weight and eat healthier.  (I am currently on a diet and am slowly losing weight).  I've asked him if my consumption of Proscar in 2.5 MG daily doses might also be contributing to the problem.  He doesn't think so, but is ordering tests for me to be sure (bloodwork and abdominal ultrasound)  He's also suggested that, to be safe, I switch back to daily 1mg doses of Propecia instead of the 2.5 daily mg of Proscar.



My questions are:  how concerned should I be about this fatty liver?  (I wish I knew what my levels were, but I don't)  Is it likely that the Proscar has been contributing to my liver problems?  I don't want to further damage my liver, but I would also like to keep my hair from falling out, if possible (and yes, I know that liver damage is much more important than vanity over baldness).  Will switching back to Propecia instead of Proscar help?  Do I need to quit taking Propecia or Proscar altogether?  Any info would be greatly appreciated.  Thank you!

[Kevin Pho, MD]

Fatty liver is not uncommon.  It seems like your physician is suspecting NASH (non-alcoholic steatohepatitis) - normally associated with obesity and elevated cholesterol and triglyceride levels.  Lifestyle changes normally are the treatment for this.  



Although possible, it is less likely that the Proscar is associated with the liver problems.  



I would consider further evaluation with a hepatologist if the symptoms continue.



Followup with your personal physician is essential.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Kevin, M.D.

kevinmd_

[Deebs1234]

Thank you for the response.



After I posted this message, I received a call from the nurse at my doctor's office.  It seems that my ALT levels have gone WAY down since I stopped taking the Proscar.



She told me that normal ALT levels are between 5-35.  One month ago, my ALT level was up to 258.  But last week (after not taking any Proscar for 2 weeks), my ALT dropped down to 40.



So it appears that the Proscar was the problem in my case.  With my doctor's permission, I am going to try taking Propecia for 2 weeks to see if that causes my ALT levels to rise.  If so, then I will simply stop taking Propecia altogether, and (sigh) go bald.  But if the Propecia does not have any adverse affect on my AT levels, then I will continue to take that drug, keep my hair, and still have normal ALT levels.



Again thank you for your response.