ALCOHOLIC HYPOGONADISM - HORMONAL RESPONSE TO CLOMIPHENE

To investigate the androgen, weak androgen, estrogen, and gonadotrophi n response to clomiphene in alcoholics, we determined in 63 male patie nts (25 with and 38 without liver cirrhosis) serum testosterone, sexua l hormone binding protein (SHBG), dehidroepiandrosterone, androstenedi one, LH, FSH, prolactin, and estradiol levels, on the first and the si xth day after admission, and after a course of 8 days of clomiphene 20 0 mg/day. The same test was performed on 15 healthy volunteers. Cirrho tic patients showed decreased basal testosterone levels and a loss of the circadian rhythm with recovery after clomiphene. Although basal te stosterone levels in noncirrhotic alcoholics did not differ from those of the controls, there was a significant improvement after withdrawal . SHBG levels were higher in both groups of alcoholics than in control s, pointing to a worse degree of hypogonadism, because only the free h ormone is active. Before the clomiphene test, serum LH and FSH levels were nonsignificantly higher in both groups of alcoholics than in the control group. After clomiphene both LH and FSH increased. Androstened ione and estradiol showed a (parallelism) similar behavior in alcoholi c and in cirrhotic groups, showing in both cases higher levels than in the control group, and an increase after clomiphene, perhaps reflecti ng peripheral conversion of androgens to estrogens. Because clomiphene has no effect on the adrenal cortex, the increase of androstenedione after clomiphene points to its testicular origin (directly or after te stosterone conversion) and not to an adrenal one. The highest serum es tradiol levels were observed in cirrhotics with ascites or gynecomasti a. We have not found any relation between serum hormone levels and alc ohol intake nor with nutritional status.