The different ways fatty liver disease affects women vs. men

A few years ago, I took a DNA test to learn more about my heritage and better understand the health risks that might be tucked away in my bloodlines. Since then, I’ve received periodic updates highlighting personality traits and predispositions linked to my genetic makeup. One result barely made me blink. According to my DNA, I’m highly competitive. Off-the-charts competitive.

That tracked.

Growing up in the wilds of Utah, competition was my native language. Sell lightbulbs door to door to raise money for the school drama club? I sold out in a single day. Monopoly night with friends? Hand me the shoe and watch me scoop up every decent property on the board. I delighted in bankrupting my fellow players. But my greatest joy came from beating the boys. Anything they could do, I was determined to do better.

Including metabolic dysfunction-associated steatohepatitis, or MASH.

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February 9, 2026 News by Steve Bryson, PhD

Coalition to push for earlier diagnosis of fatty liver disease MASLD

It turns out sex really does matter when it comes to metabolic dysfunction-associated steatotic liver disease (MASLD), the precursor to MASH. Men are often diagnosed younger, particularly when heavy alcohol use is part of the picture. Women, however, tend to see MASLD appear later in life, often after menopause.

Researchers suspect hormones play a significant role in this difference, but women’s liver health remains under-studied. What we do know is that the drop in estrogen after menopause affects fat distribution, insulin resistance, muscle mass, and inflammation — all factors tied to MASLD progression.

I didn’t need a study to tell me something was changing. After crossing the threshold into menopause, my body felt unfamiliar. I experienced muscle loss that left me noticeably weaker. My bones became more fragile, culminating in a fall and a broken hip three years ago. These weren’t dramatic symptoms. They were quiet ones. The kind that sneak up on you and force a reckoning.

Those changes made me laser-focused on my health.

Entering a new kind of competition

When I was a kid, my summer uniform consisted of bare feet, a notebook and pencil, and a fishing rod slung over my shoulder. I spent long days along the banks of the Strawberry River in northeastern Utah, writing stories, daydreaming, and imagining the future. But the highlight of every summer was the town’s Huckleberry Finn fishing contest.

I was often the only girl who entered, and that suited me just fine. I wasn’t trying to outdo the other girls. I wanted to beat the boys.

I had my favorite fishing holes, but my real secret was strategic. Catch one fish, gut it, and use the remains as bait to draw in more. It worked beautifully. I won three derbies that way and earned a trail of sore losers behind me. I showed no mercy and laughed openly when they protested.

These days, my competition looks different.

Two years ago, I went to my women’s health doctor and asked — begged, really — for hormone therapy. I wasn’t sleeping. My joints ached. My liver inflammation markers were creeping up despite my best efforts. After careful dose adjustments and close monitoring, my menopausal symptoms eased. My blood work improved. Inflammation levels dropped.

That felt like a win. But I wasn’t finished.

My competitive streak now shows up in the exam room, where I joke with my liver doctor that I plan to be the best patient he’s ever had. I track my labs. I follow the science. I stack small, sustainable habits like trophies on a shelf.

I haven’t entered a fishing contest in years, but I’ve collected healthier victories instead. And while I no longer measure success by beating the boys, I do hope the men and women living with MASH alongside me are winning, too.

This isn’t a zero-sum game. There’s room at the finish line for all of us.

Note: Liver Disease News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Liver Disease News or its parent company, Bionews, and are intended to spark discussion about issues pertaining to liver disease.