30 April 2025

From Fatty Liver to Liver Failure – Gay in the CLE

As we age, maintaining our health becomes more critical—especially when it comes to organs we often take for granted, like the liver. Cirrhosis, a progressive liver condition marked by scarring and loss of function, doesn’t happen overnight. It develops in stages, often beginning quietly and worsening over time.

For gay and bisexual men over 40, liver health can be a crucial but overlooked area of wellness. Understanding the stages of cirrhosis can help you catch issues early, take action, and potentially reverse or slow the damage.

Let’s break down each stage—what’s happening in the body, what signs to watch for, and how to stay ahead of the disease. Let’s get into Understanding the Stages of Cirrhosis: From Fatty Liver to Liver Failure.

The Stigma of Cirrhosis

In previous posts, I have mentioned that Cirrhosis wasnt a stranger in my life. My parents helped my Aunt out at her bar, for a few years. We often were with our mother when she stopped by to check on her, deliver items, or other situations. We knew many of the customers on a first name basis and some felt, almost, like parts of the family. We saw how alcohol affected people and what extreme abuse of it looked like. I saw people with jaundice before I was a teenager and even knew that some of the patrons of the bar had died from Cirrhosis. It was a rough thing for a child to see.

But, even with this exposure I was unaware of how complicated this disease can be.

Even today, many people feel that Cirrhosis is a “Drunk’s Disease.” Essentially, the stigma is that Cirrhosis is only something an alcoholic can get. And even more so is the further delineation that those who drink try to put a definition in what is or is not an alcoholic. Meaning, many think that what makes you an alcoholic is more than just frequency of drinking. Make no mistake, Cirrhosis does not care if you drink or not because it is a disease of the liver. Any abuse to your liver can and mostly will cause it, if left unchecked. Make no mistake, abusing your liver in anyway will cause this, whether that is unhealthy eating habits leading to becoming obese, addiction to sugar, drugs, and alcohol, genetic predisposition, and a myriad of environmental factors that may cause it. The outdated ideas we have over what causes this disease is changing as research continues.

Stage 1: Simple Fatty Liver (Steatosis)

Fatty liver disease is more common than you might think—affecting an estimated 1 in 4 adults in the United States. In fact, non-alcoholic fatty liver disease (NAFLD) is the most widespread chronic liver condition in the country. Often silent, this early stage occurs when fat accumulates in the liver without causing inflammation. While it may not seem serious, it’s the first step toward potentially irreversible damage.

Common causes include:

Excess alcohol consumption
Obesity or being overweight
Insulin resistance or type 2 diabetes
High cholesterol and triglyceride levels

Symptoms: Most people don’t experience symptoms during this stage. Fatty liver is often discovered through routine blood work or imaging.

Why it matters: At this stage, the condition is highly reversible with lifestyle changes such as improved diet, regular exercise, and reduced alcohol intake.

Stage 2: Non-alcoholic Steatohepatitis (NASH)

Once fat buildup starts to irritate liver cells, inflammation begins to set in—a condition called non-alcoholic steatohepatitis (NASH). This is where real damage begins. The liver becomes swollen, and liver cells start dying, triggering immune responses and laying the groundwork for scar tissue.

This stage affects millions, including people who don’t drink alcohol, making it a hidden danger for many over 40.

Symptoms may include:

Persistent fatigue
Discomfort in the upper right abdomen
Mild nausea or a feeling of fullness

Why it matters: NASH is a warning sign that your liver is under attack. With early diagnosis and treatment, it’s possible to stop or slow the progression.

Stage 3: Fibrosis

Fibrosis is when scar tissue begins to replace healthy liver tissue, affecting blood flow and filtering processes. At this point, liver function starts to suffer—but the organ still has some ability to repair itself.

It’s estimated that many people with fibrosis are undiagnosed, especially those who have not had imaging or liver biopsies.

Common symptoms:

Increased fatigue
Digestive issues or bloating
Mild abdominal swelling
Subtle changes in appetite

Why it matters: Fibrosis is a critical tipping point. While not yet classified as full-blown cirrhosis, the liver is becoming structurally compromised. Ongoing monitoring and lifestyle changes are essential.

It is important to stress that this is the point that you can either start your progress back to better health or end up going down a road from which there is no return. As with previous stages, this is not something that flashes a warning sigh to you, you may not even notice the symptoms, this is why going to your doctor, often, is very important to catch and correct it, while you still have a chance.

Stage 4: Cirrhosis (Severe Scarring)

Cirrhosis is marked by extensive scarring (fibrosis) that severely limits liver function. At this stage, the liver becomes hardened, nodular, and incapable of filtering toxins efficiently.

Cirrhosis is often diagnosed in people who ignored symptoms for years—or were unaware they had liver disease.

Symptoms may include:

Jaundice (yellowing of skin or eyes)
Swelling in the legs or abdomen (ascites)
Easy bruising or bleeding
Loss of muscle mass and energy
Mental confusion or forgetfulness

Why it matters: Cirrhosis is irreversible, but treatments exist to manage symptoms, prevent complications, and improve quality of life. Early diagnosis and supportive care can make a big difference.

It may seem that when you are diagnoses with Cirrhosis, there isnt any other option, for you, but death. Your life is still limitless with this disease. Sure, it is going to take come serious lifestyle change to give yourself the best possible foundation for what is to come. At the bare minimum, there will need to be changes to your diet, stopping drinking alcohol…period, incorperating exercise into your life, and ensuring you are taking better care of your body, going forward.

Stage 5: End Stage Liver Disease/Liver Failure

At this final and most serious stage, the liver can no longer perform its life-sustaining functions. Toxin buildup, hormone imbalance, and immune system weakness leave the body vulnerable.

Liver failure affects every system in the body and may require a liver transplant to survive.

Possible complications:

Kidney dysfunction
Internal bleeding
Frequent infections
Increased risk of liver cancer
Hepatic encephalopathy (confusion, memory loss)

Why it matters: At this point, liver function is minimal. Transplant evaluation, palliative care, and aggressive symptom management are typically necessary.

This is a point where end of life considerations need to start. Transplant is about the only option to ensure you have a better chance of life, but the lists are long and the criteria is extensive. You have to be sober, there is no choice. If you drink, and it shows in your system, you are not eligible for a transplant. Your overall health is also a factor, so those needed lifestyle changes mentioned earlier need to be implemented and giving your best effort to follow. It is easier to try to change your habits before getting to this stage than waiting until the bad news lands.

Why Gay and Bisexual Men Should Be Proactive About Liver Health

Liver disease doesn’t discriminate—but gay and bisexual men may face increased risk due to higher rates of alcohol use, limited access to affirming healthcare, and stress-related chronic conditions. Regular liver enzyme checks, honest conversations with healthcare providers, and community awareness are vital.

As Gay or Bisexual men, and any Queer person, we face a lot of stress. We are subjected to images and mindsets that tell us how much the world things we are abominations sent to destroy all moral values of mankind. That kind of stress can takes its toll on us. Due to the constant battle to feel accepted, we often turn to more illicit substances to take our minds away from the hate we are buffeted with, on a daily basis. Alcohol and drugs usage is higher in the LGBTQ community, than many other communities. This puts us at a greater risk of developing Cirrhosis.

Don’t wait for symptoms to show up. Early intervention can stop cirrhosis in its tracks—or even reverse some of the damage.

What you can do today

It is never too late to go to the doctor for check ups. Any information you get gives you tools to help you fight any diagnosis you may receive. For Cirrhosis, time is always your biggest enemy. The sooner you get diagnosed the sooner you can start to make the needed changes to have a better quality of life. Here are a few things you can start today:

Get routine blood work that includes liver function tests (LFTs)
Adopt a low-sodium, plant-based diet
Limit or eliminate alcohol
Talk to your doctor about weight management or diabetes risk
Connect with support groups or wellness programs in your area

Cleveland Resources for Liver Health

MetroHealth Liver Center – Expert care for fatty liver, NASH, and cirrhosis
Cleveland Clinic Liver Disease & Transplant Center – Nationally ranked for advanced care
The LGBT Community Center of Greater Cleveland – For health navigation, support groups, and local resource referrals

Information is crucial

It is never too late to start your fight against Cirrhosis, the longer you wait, the harder the battle may be but you are still in the fight. Knowledge is power and to gain this knowledge you need to get out there and get blood work done. Waiting too long to see your doctor would be like entering the ring against Mike Tyson with your hands tied behind your back. You stand a greater chance of winning the match if you have all the knowledge and abilities in front of you. So get to your doctor and have those health checks completed, regularly.

Have you had any diagnosis that drastically changed your life? What was and how did you cope with it? What changes did you have to make to your life? How did it make you feel? Let me know in the comments below.

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