Jou,rnal of Hepatology 1994; 20:426~130 Printed in Denmark. All rights reserved Munksgaard. Copenhagen Copyright © Journalof Hepatology 1994 Journal of Hepatology ISSN 0168-8278 Effect of liver transplantation on sex-hormone disorders in male patients with alcohol-induced or post-viral hepatitis advanced liver disease J6r6me Gu6chot, Olivier Chazouill6res, Alain Loria, Laurent Hannoun, Pierre Balladur, Rolland Parc, Jacqueline Giboudeau and Raoul Poupon Hdpital Saint-Antoine, Paris, France (Received 5 January 1993) The effects of liver transplantation on the pituitary-gonadal axis and sex-hormone metabolism were evaluated by studying hormonal status (androgens, oestrogens, and gonadotropins) and sex-hormone-binding globulin levels in men with ad- vanced liver disease of both alcoholic and viral origins. Comparison of the results prior to and 6 months after liver transplantation showed that successful liver transplantation in men induced significant differences in sex-hormone levels and in pituitary-gonadal function in both alcoholic and post-hepatitis patients. Plasma testosterone and dihydrotestoster- one levels increased, oestrogen (oestrone and oestradiol) and androstenedione levels fell while gonadotropin (FSH and LH) levels increased. There was also a fall in plasma prolactin levels. Sex-hormone binding globulin plasma levels were elevated prior to transplantation and decreased thereafter. These data show that male patients with advanced liver disease have biological hypogonadism and feminization, irrespective of the aetiology, and that these abnormalities rapidly im- prove after successful liver transplantation. Therefore in men with advanced liver disease the biochemical signs of sex hormone disturbance are reversible and may be largely related to the liver disease. © Journal of Hepatology. Key words: Androgens; Estrogens; Gonadotropins; Liver transplantation; Sex hormones Men with advanced liver disease show clinical and bio- chemical signs of hypogonadism and feminization. Tes- ticular atrophy, lack of libido, impotence, oligospermia, loss of body hair, reduced prostate size, gynaecomastia, arterial spiders, female fat distribution and palmar ery- thema are frequent (1,2). The associated biochemical bases of these phenomena are well documented: the plas- ma testosterone is slightly lower than in normal subjects (1,3) which masks a marked fall in the non-protein-bound (biologically active) fraction of the hormone due to a large increase in the sex-hormone-binding globulin (SHBG) (4) which binds testosterone with a high affinity. Plasma gonadotropins (FSH and LH) are inappropriately low, given the androgenic failure (5,6). Hyperoestrogenae- mia is well documented and is probably due to an increase in the peripheral conversion of androgens into oestrogens (7) and to a decrease in hepatic extraction of oestrone and oestradiol (8). These changes frequently occur in patients with alcoholic cirrhosis (1), but are also found in patients with non-alcoholic liver diseases (9,10). There have only been a few reports on the effects of liver transplantation on hypothalamic-pituitary-gonadal function in men (11) or women (12). In men with advanced alcohol-induced liver disease, Van Thiel et al. (11) recently showed that liver transplantation induced an improvement in both gonadotropin and testosterone blood levels. The aim of the present study was to evaluate the effects of liver transplantation on the pituitary-gonadal axis and sex-hormone metabolism by studying hormonal status (an- drogens, oestrogens, and gonadotropins) and sex-hor- mone-binding globulin levels in male patients with ad- vanced liver disease of specifically alcoholic or viral origin. Patients and Methods Patients Sixteen patients (49.2_+7.9 years old) were investigated. All had undergone successful orthotopic liver transplan- Correspondence to: J6r6me Gu6chot, Laboratoire de Biochimie-Hormonologie, Hopital Saint-Antoine, 75571 Paris Cedex 12, France.