Hidden Hormones in Alcoholic Beverages

Abstract

Visualize the reproductive endocrinopathies and the subdysfunctional alterations of reproductive hormone homeostasis associated with abuse and use of alcoholic beverages. Now, mentally disassociate these endocrine effects from an alcohol etiology, and try to imagine an entirely different causal agent. Picture a quintessential alcoholic compensated-cirrhotic male with all extremes of endocrinopathy. He is both hypogonadal and feminized. He has gynecomastia and spider angiomata; he has reduced beard growth and a female escutcheon; his testes are atrophied, and he cannot achieve an erection; his levels of sex-hormone binding globulin are elevated, but his steroid estrogen levels are only minimally increased; his testosterone levels are below the lower limit of normal, but his gonadotropin levels are only mildly increased, rather than being substantially elevated in response to the low testosterone levels. Now reorient: Imagine this man to have a different face; cross out the word “alcohol” every place it appears in the history on the chart; pen a tentative diagnosis of “findings consistent with prolonged and sustained exposure to estrogen.”