If You're on a GLP-1 Medication in Australia, Here's What the Guidelines Say About Your Liver

The MJA consensus statement — published 1 September 2025, doi: 10.5694/mja2.70008 — contains the following primary recommendation:

Adults with type 2 diabetes, obesity or two or more other metabolic risk factors should be tested for MAFLD.

It then specifies the testing pathway:

The risk of advanced liver fibrosis requires assessment using the Fibrosis-4 (FIB-4) Index. People with an indeterminate FIB-4 score (between 1.3 and 2.7) should undergo second-line assessment with liver elastography.

This is the official Australian clinical standard. Not a suggestion from a supplement company or a health blog. A peer-reviewed, evidence-based consensus statement from Australia's most authoritative medical journal, co-authored by Professor Jacob George from the Storr Liver Centre at Westmead Hospital — one of the world's leading MASH researchers.

What metabolic risk factors does it list?

Type 2 diabetes. Obesity (BMI above 30). Overweight (BMI 25–30) with any one of the following: high blood pressure, high triglycerides, low HDL cholesterol, pre-diabetes, or metabolic syndrome.

If you are on a GLP-1 medication, you were prescribed it because you meet at least one of these criteria. In most cases, several. The guidelines apply to you.

The population prescribed GLP-1 medications in Australia overlaps almost entirely with the population the MJA guidelines identify as needing liver assessment. This is not a coincidence — it reflects the same underlying metabolic picture.

Type 2 diabetes and obesity are both primary indications for GLP-1 prescription. They are also the two highest-risk conditions for developing MASLD. Approximately 65–75% of people with type 2 diabetes have fatty liver disease. Approximately 60–80% of people with obesity have it.

Most of them do not know.

MASLD is almost entirely asymptomatic in its early stages. A person can have significant liver fat accumulation, early inflammation, and even developing fibrosis and feel completely normal. The only way to know is to test.

The GLP-1 medications themselves do not cause this problem — in fact, the clinical evidence is clear that semaglutide and tirzepatide actively improve liver health in most patients. But the monitoring matters because:

One — you may have had undiagnosed MASLD before you started. The GLP-1 is improving it, but without a baseline measurement you cannot know where you started or whether the improvement is adequate.

Two — if you have significant liver fibrosis (stages F2–F3), you now qualify for Wegovy under Australia's April 2026 TGA provisional approval specifically for MASH treatment — but only if your liver has been assessed.

Three — the FIB-4 → elastography pathway is quick, non-invasive, and inexpensive relative to the clinical information it provides. There is no good reason not to know.

This is important context, not a criticism of any specific service.

The major Australian GLP-1 telehealth platforms — the services most Australians use to access Ozempic, Wegovy, and Mounjaro — operate a fast, digital prescription model. Their patient communications focus on medication administration, managing GI side effects, dose escalation schedules, and lifestyle support. Blood tests are offered as optional add-ons in some cases.

The liver monitoring pathway recommended in the September 2025 MJA consensus statement is not routinely communicated to patients by these platforms. It is a relatively new clinical standard — the consensus statement was published less than a year ago — and it has not yet been incorporated into standard patient onboarding by GLP-1 prescribing services.

Your GP may also not have raised it. The MJA consensus is addressed to primary care — GPs are the intended audience — but implementation takes time and the guidelines are recent.

This is why patients are searching. "Does Ozempic affect my liver?" "Does Mounjaro cause liver damage?" "Do I need a liver scan on Wegovy?" These are Breakout search queries in Australia — growing rapidly because patients are concerned and searching for information they were not given at the point of prescription.

You are not alone in not knowing. And now you do.

The pathway has two steps. Both are straightforward.

Step 1 — FIB-4 Score (at your GP)

The FIB-4 score is a calculation using four values from a standard blood test: your age, and your ALT, AST, and platelet count. If you have had a blood panel recently — which most GLP-1 patients have — your GP can calculate the score immediately from existing results.

What the score means:

• Below 1.3: Low risk of significant liver fibrosis. Reassuring. Repeat in 3 years.
• Between 1.3 and 2.67: Indeterminate — proceed to liver elastography.
• Above 2.67: High risk — GP referral to hepatologist recommended.

Most GLP-1 patients with metabolic risk factors will have a FIB-4 in the indeterminate range. This is not alarming — it is expected. The indeterminate range exists precisely because FIB-4 alone cannot rule fibrosis in or out for this group. That is why the next step exists.

Step 2 — Liver Elastography (if FIB-4 is indeterminate)

Liver elastography — performed with a device like FibroScan or guided elastography — measures liver stiffness (kPa) and liver fat content (CAP score) in a single 10–15 minute scan. No radiation. No injection. No hospitalisation. Results available immediately.

What the result means:

• Below 8 kPa: No significant fibrosis — reassuring.
• 8–10 kPa: Moderate fibrosis — warrants monitoring and specialist discussion.
• 10–13 kPa: Significant fibrosis — specialist review recommended.
• Above 13 kPa: Cirrhosis range — urgent specialist referral.

If your result is reassuring — below 8 kPa — you know your liver is in good shape and you have a baseline to compare future scans against as your GLP-1 treatment continues.

If your result shows significant fibrosis, you now have actionable information that changes your clinical management — including potential eligibility for Wegovy under Australia's new MASH treatment indication.

FIB-4 score guide for GLP-1 patients →

Not always. Several Australian clinics accept self-referred patients for liver elastography — no GP letter required.

However, starting with your GP is recommended. A GP conversation ensures your FIB-4 is calculated first (ruling out the need for a scan entirely if the score is low), and ensures your scan result is interpreted in the full context of your medical history and current medications.

If you want to proceed directly to a scan, use the directory below to find a clinic near you and check their referral requirements when booking.

Elastography Australia is the national directory of liver elastography clinics and specialists across Australia. Search by suburb, city, or state.

Find a clinic near you →

If you are not sure how to start the conversation, this is all you need:

I'm on [Ozempic / Wegovy / Mounjaro] and I've read that the 2025 Australian guidelines recommend liver assessment for patients with metabolic risk factors. Can you calculate my FIB-4 score from my blood tests and refer me for elastography if it's indeterminate?

That is the entire conversation. Any GP familiar with the September 2025 MJA consensus statement will know exactly what you are asking for.