A Study to Assess the Efficacy, Safety, and Tolerability of Oral LPCN 1148 in Male Subjects With Cirrhosis of the Liver and Sarcopenia

Open to males ages 18 years and up

1. Male ≥ 18 years old
2. Currently listed, on the liver transplant waitlist for cirrhosis secondary to Hepatitis B or C infection, Alcoholic Liver Disease (ALD), Non-Alcoholic Steatohepatitis (NASH), Primary Biliary Cholangitis (PBC), or Primary Sclerosing Cholangitis (PSC)
3. Evidence of sarcopenia with appropriate cutoff recommended by clinical guidance

1. Suspected or proven hepatocellular carcinoma (HCC)
2. History of current or suspected prostate or breast cancer
3. History of malignancies other than prostate, breast, or HCC, unless successfully treated with curative intent and believed to be cured (defined as complete remission lasting at least 5 years)
4. History of uncontrolled or recurrent portal hypertensive bleeding, including uncontrolled or recurrent bleeding from varices, gastropathy, colopathy, or hemorrhoidal bleeding in the past 6 months.
5. History or current thrombosis (including portal vein thrombosis), thromboembolism, or treatment for portal vein thrombosis
6. History of hemochromatosis
7. History of hypercoagulable state (e.g. Factor V Leiden deficiency, protein C deficiency, protein S deficiency, anti-thrombin III deficiency, or the presence of lupus anticoagulant)
8. Prior history of complications of ascites in the past 6 months including:
   1. Spontaneous bacterial peritonitis
   2. Hepatic hydrothorax

9. MELD score > 25

   10. Abnormal lab value in serum chemistry, hematology, or urinalysis that the PI considers

   clinically significant, including but not limited to:

   1. PSA > 4 ng/mL
   2. Polycythemia (Hematocrit > ULN) or history of polycythemia
   3. ALT or AST > 5x ULN
   4. ALP > 2x ULN; subjects with PBC or PSC are excluded if ALP is > 10x ULN
   5. Platelet count < 30,000/mL
   6. EGFR < 30 mL/min/1.73 m2 for subjects not undergoing routine, scheduled dialysis
   7. Serum albumin < 2.0 g/dL
   8. INR > 2.3
      1. Subjects with PSA between 2.5 ng/mL and 4 ng/mL are excluded only if any of the below criteria are met at baseline:
   9. Hematocrit > 48%
   10. I-PSS > 19
   11. Any irregularity found on digital rectal examination of the prostate
       1. Subjects with PSA > 3 ng/mL are excluded only if any of the below criteria are met at baseline:
   12. Subject is African American
   13. Subject has a first-degree relative who has a history of prostate cancer
   14. Hematocrit > 48%
   15. I-PSS > 19
   16. Any irregularity found on digital rectal examination of the prostate
       1. Clinically significant abnormal prostate digital rectal examination (DRE) in the opinion of the PI, with DRE screening initiated at International Prostate Symptom Score (I-PSS) > 19
          1. History of bariatric surgery
          2. History of stroke or myocardial infarction within the past 5 years
          3. History of TIPS within the past 6 months, or TIPS procedure expected within 6 months of Day 1
          4. Known positivity for Human Immunodeficiency Virus (HIV) infection
          5. Acute liver failure as the indication for addition to the liver transplant waitlist
          6. Estimated life expectancy less than 3 months or expected to undergo liver transplant within 3 months
          7. Known heart failure of New York Heart Association class III or IV
          8. Evidence of severe encephalopathy at screening encephalopathy that is not controlled despite adequate medical therapy
          9. History of prior organ transplant
          10. History of Fontan physiology
          11. History of pulmonary embolus
          12. Porto-pulmonary hypertension
          13. Hepatopulmonary syndrome requiring standing home supplemental oxygen therapy, or MELD exception points for hepatopulmonary syndrome
          14. Uncontrolled epilepsy or migraine
          15. Active substance abuse or dependency extending to within the previous 3 months
          16. History of significant sensitivity or allergy to testosterone, or product excipients.
          17. Use of known strong inhibitors (e.g., ketoconazole) or inducers (e.g., dexamethasone, phenytoin, rifampin, carbamazepine) of cytochrome P450 3A (CYP3A) within 30 days prior to study drug administration and through the end of the study
          18. Subjects who are currently receiving any androgens (testosterone or other androgens or androgen-containing supplements) and are unwilling to washout prior to screening

   17. Washout: 12 weeks following long-acting intramuscular androgen injections; 4 weeks following topical or buccal androgens; 3 weeks following oral androgens

       32. Uncontrolled hypertension (>160/90 mmHg despite treatment) 33. Uncontrolled obstructive sleep apnea 34. Use of any investigational drug within 5 half-lives of the last dose or in the past 6

       months prior to Study Day -2 without medical monitor and/or Sponsor approval

       35. Subject who is not willing to use adequate contraception for the duration of the study 36. Any other condition, which in the opinion of the investigator would impede compliance

       to the study protocol (including diet, exercise, and alcohol abstinence) or hinder completion of the study

       37. Failure to give informed consent