Serum total testosterone and the prognosis of patients with advanced liver disease: a systemic review and meta-analysis

Background: Advanced liver disease (ALD) is associated with significant morbidity and mortality worldwide. Emerging evidence suggests that sex hormonal imbalances, particularly low serum total testosterone (TT) levels, may influence the prognosis of patients with ALD. This meta-analysis aimed to evaluate the association between serum TT levels and the prognosis of patients with ALD. Methods: Comprehensive searches of PubMed, Embase, and Web of Science were performed from the inception of the searched databases up to November 13, 2025, to identify observational studies assessing the association between serum TT levels and the risk of all-cause mortality or liver transplant (LT) among patients with ALD. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model to account for the potential influence of heterogeneity. This systematic review was registered in PROSPERO (CRD42024578870). Results: for subgroup difference, all > 0.05). Conclusion: Lower serum TT levels are significantly associated with a higher risk of all-cause death or LT in patients with ALD, indicating their potential utility as prognostic biomarkers.