{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:37:24Z","timestamp":1787017044236,"version":"build-2736575974"},"reference-count":67,"publisher":"BMJ","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"published-print":{"date-parts":[[1977,10]]},"abstract":"<jats:p>Men with chronic liver disease frequently develop clinical signs of hypogonadism and overt feminisation. Associated with these features, they have been found to have a reduced production of testosterone with low plasma concentrations, but only a minority of cirrhotic men would seem to have a marginal increase in circulating biologically potent oestrogens. Furthermore, this latter finding does not correlate with the presence of clinical feminisation. The original hypothesis to explain these changes now seems less likely to be true and no other single hypothesis has, on its own, been found to provide an adequate explanation for all the clinical and biochemical features found in cirrhotic men. It may be that the pathogenesis of endocrine changes in cirrhotic men is multifactorial--for instance, a combination of decreased hepatic clearance of some oestrogenic compounds, an autoimmune mediated primary testicular defect, and a specific potentiation effect by alcohol. Alternatively, it may be that none of these suggested mechanisms is of importance and that the endocrine changes are mediated instead by other mechanisms which remain, as yet, undiscovered or unconsidered. The fascination which this problem has held for clinicians and biochemists for many years seems likely to persist for some time to come.<\/jats:p>","DOI":"10.1136\/gut.18.10.843","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:41:31Z","timestamp":1190137291000},"page":"843-853","source":"Crossref","is-referenced-by-count":41,"title":["Mechanism of hypogonadism in cirrhotic males."],"prefix":"10.1136","volume":"18","author":[{"given":"G R","family":"Green","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1977,10,1]]},"reference":[{"key":"ref_1","article-title":"Gynecomastia associated","author":"Edmondson, H.A.; Glass, S.J.; Soll, S.N.","year":"1939","unstructured":"Edmondson, H. A., Glass, S. J., and Soll, S. N. (1939). Gynecomastia associated with cirrhosis"},{"key":"ref_2","article-title":"La reviviscenza mammaria nell 'uomo affeto da cirrosi del Laennec","author":"Silvestrini, R.","year":"1926","unstructured":"Silvestrini, R. (1926). La reviviscenza mammaria nell 'uomo affeto da cirrosi del Laennec."},{"key":"ref_3","first-page":"1067","article-title":"Sulla c.d. reviviscenza della mammella maschile nella cirrosi epatica","volume":"5","author":"Corda, L.","year":"1925","unstructured":"Corda, L. (1925). Sulla c.d. reviviscenza della mammella maschile nella cirrosi epatica. Minerva Medica, 5, 1067-1069.","journal-title":"Minerva Medica"},{"key":"ref_4","first-page":"315","article-title":"Endocrine changes associated with Laennec's cirrhosis of the liver","volume":"4","author":"Lloyd, C.W.; Williams, R.H.","year":"1948","unstructured":"Lloyd, C. W., and Williams, R. H. (1948). Endocrine changes associated with Laennec's cirrhosis of the liver. American Journal ofMedicine, 4, 315-330.","journal-title":"American Journal ofMedicine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"941","DOI":"10.5694\/j.1326-5377.1971.tb87962.x","article-title":"Cirrhosis of the liver-a comparative study of the four major aetiological groups","volume":"1","year":"1971","unstructured":"Powell, L. W., Mortimer, R., and Harris, 0. D. (1971). Cirrhosis of the liver-a comparative study of the four major aetiological groups. Medical Journal ofAustralia, 1, 941-950.","journal-title":"Medical Journal ofAustralia"},{"key":"ref_6","first-page":"145","article-title":"A study of the endocrine manifestations of hepatic cirrhosis","volume":"45","author":"Baker, H.W.G.; Burger, H.G.; de Kretser, D.M.; Dulmanis, A.; Hudson, B.; O'Connor, S.; Paulsen, C.A.; Purcell, N.; Rennie, G.C.; Seah, C.S.; Taft, H.P.; Wang, C.","year":"1976","unstructured":"Baker, H. W. G., Burger, H. G., de Kretser, D. M., Dulmanis, A., Hudson, B., O'Connor, S., Paulsen, C. A., Purcell, N., Rennie, G. C., Seah, C. S., Taft, H. P., and Wang, C. (1976). A study of the endocrine manifestations of hepatic cirrhosis. Quarterly Journal of Medicine, 45, 145-178.","journal-title":"Quarterly Journal of Medicine"},{"key":"ref_7","first-page":"385","article-title":"Les glandes a s6cr6tion interne dans la cirrhose hepatique","volume":"9","author":"Barrelet, J.","year":"1932","unstructured":"Barrelet, J. (1932). Les glandes a s6cr6tion interne dans la cirrhose hepatique. Annales de Anatomie Pathologique, 9, 385-389.","journal-title":"Annales de Anatomie Pathologique"},{"key":"ref_8","first-page":"39","article-title":"Effect of estrogens on the testis in hepatic insufficiency","volume":"37","author":"Morrione, T.G.","year":"1944","unstructured":"Morrione, T. G. (1944). Effect of estrogens on the testis in hepatic insufficiency. Archives of Pathology, 37, 39-48.","journal-title":"Archives of Pathology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1093\/ajcp\/20.9.814","article-title":"The testis, breast and prostate of men who die of cirrhosis of the liver","volume":"20","author":"Bennett, H.S.; Baggenstoss, A.H.; Butt, H.R.","year":"1950","unstructured":"Bennett, H. S., Baggenstoss, A. H., and Butt, H. R. (1950). The testis, breast and prostate of men who die of cirrhosis of the liver. American Journal of Clinical Pathology, 20, 814-828.","journal-title":"American Journal of Clinical Pathology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1016\/S0016-5085(19)32705-2","article-title":"Hypogonadism in alcoholic liver disease; evidence for a double defect","volume":"67","author":"Van Thiel, D.H.; Lester, R.; Sherins, R.J.","year":"1974","unstructured":"Van Thiel, D. H., Lester, R., and Sherins, R. J. (1974). Hypogonadism in alcoholic liver disease; evidence for a double defect. Gastroenterology, 67, 1188-1199.","journal-title":"Gastroenterology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1136\/gut.17.5.345","article-title":"Hypothalamic-pituitary-gonadal function in men with cirrhosis of the liver","volume":"17","author":"Mowat, N.A.G.; Edwards, C.R.W.; Fisher, R.; McNeilly, A.S.; Green, J.R.B.; Dawson, A.M.","year":"1976","unstructured":"Mowat, N. A. G., Edwards, C. R. W., Fisher, R., McNeilly, A. S., Green, J. R. B., and Dawson, A. M. (1976). Hypothalamic-pituitary-gonadal function in men with cirrhosis of the liver. Gut, 17, 345-350.","journal-title":"Gut"},{"key":"ref_12","first-page":"1572","article-title":"Cited in: The Vienna Convention: diseases of metabolism and of the digestive tract","volume":"85","author":"Eppinger","year":"1925","unstructured":"Eppinger (1925). Cited in: The Vienna Convention: diseases of metabolism and of the digestive tract. (Letter.) Journal of the American Medical Association, 85, 1572-1574.","journal-title":"(Letter.) Journal of the American Medical Association"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1056\/NEJM196001072620101","article-title":"Cirrhosis of the liver: a study of alcoholic and non-alcoholic patients in Boston and London","volume":"262","author":"Summerskill, W.H.J.; Davidson, C.S.; Dible, J.H.; Mallory, G.K.; Sherlock, S.; Turner, M.D.; Wolfe, S.J.","year":"1960","unstructured":"Summerskill, W. H. J., Davidson, C. S., Dible, J. H., Mallory, G. K., Sherlock, S., Turner, M. D., and Wolfe, S. J. (1960). Cirrhosis of the liver: a study of alcoholic and non-alcoholic patients in Boston and London. New England Journal of Medicine, 262, 1-9.","journal-title":"New England Journal of Medicine"},{"key":"ref_14","first-page":"173","article-title":"Biologically active androgens and oestradiol in men with chronic liver disease","volume":"1","author":"Galvao-Teles, A.; Anderson, D.C.; Burke, C.W.; Marshall, J.C.; Corker, C.S.; Bown, R.L.; Clark, M.L.","year":"1973","unstructured":"Galvao-Teles, A., Anderson, D. C., Burke, C. W., Marshall, J. C., Corker, C. S., Bown, R. L., and Clark, M. L. (1973). Biologically active androgens and oestradiol in men with chronic liver disease. Lancet, 1, 173-177.","journal-title":"Lancet"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/S0016-5085(76)80212-0","article-title":"Alcoholism: its effect on hypothalamic-pituitary-gonadal function","volume":"71","author":"Van Thiel, D.H.; Lester, R.","year":"1976","unstructured":"Van Thiel, D. H., and Lester, R. (1976). Alcoholism: its effect on hypothalamic-pituitary-gonadal function. Gastroenterology, 71, 318-327.","journal-title":"Gastroenterology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1097\/00000441-194208000-00012","article-title":"A note on the development of cutaneous arterial 'spiders' and palmar erythema in persons with liver disease and their development following the administration of estrogens","volume":"204","author":"Bean, W.B.","year":"1942","unstructured":"Bean, W. B. (1942). A note on the development of cutaneous arterial 'spiders' and palmar erythema in persons with liver disease and their development following the administration of estrogens. American Journal of the Medical Sciences, 204, 251-253.","journal-title":"American Journal of the Medical Sciences"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1056\/NEJM196510212731704","article-title":"Testosterone in human plasma","volume":"273","author":"Coppage, W.S.; Cooner, A.E.","year":"1965","unstructured":"Coppage, W. S., and Cooner, A. E. (1965). Testosterone in human plasma. New England Journal ofMedicine, 273, 902-907.","journal-title":"New England Journal ofMedicine"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"198","DOI":"10.7326\/0003-4819-79-2-198","article-title":"Estrogen-androgen imbalance in hepatic cirrhosis","volume":"79","author":"Chopra, I.J.; Tulchinsky, D.; Greenway, F.L.","year":"1973","unstructured":"Chopra, I. J., Tulchinsky, D., and Greenway, F. L. (1973). Estrogen-androgen imbalance in hepatic cirrhosis. Annals of Internal Medicine, 79, 198-203.","journal-title":"Annals of Internal Medicine"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/S0016-5085(73)80098-8","article-title":"Plasma testosterone, estradiol and gonadotrophins in hepatic insufficiency","volume":"64","author":"Kent, J.R.; Scaramuzzi, R.J.; Lauwers, W.; Parlow, A.F.; Hill, M.; Penardi, R.; Hilliard, J.","year":"1973","unstructured":"Kent, J. R., Scaramuzzi, R. J., Lauwers, W., Parlow, A. F., Hill, M., Penardi, R., and Hilliard, J. (1973). Plasma testosterone, estradiol and gonadotrophins in hepatic insufficiency. Gastroenterology, 64, 111-115.","journal-title":"Gastroenterology"},{"key":"ref_20","author":"Kley, H.K.; Nieschlag, E.; Wiegelmann, W.; Solbach, H.G.; Kruskemper, H.L.","year":"1975","unstructured":"Kley, H. K., Nieschlag, E., Wiegelmann, W., Solbach, H. G., and Kruskemper, H. L. (1975)."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1210\/jcem-26-12-1399","article-title":"Electrophoretic evidence for the presence of an estrogen-binding,-globulin in human plasma","volume":"26","author":"Rosenbaum, W.; Christy, N.P.; Kelly, W.G.","year":"1966","unstructured":"Rosenbaum, W., Christy, N. P., and Kelly, W. G. (1966). Electrophoretic evidence for the presence of an estrogen-binding,-globulin in human plasma. Journal of Clinical Endocrinology and Metabolism, 26, 1399-1403.","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1470","DOI":"10.1210\/jcem-29-11-1470","article-title":"Capacity of the testosterone-binding globulin in human plasma and influence of specific binding of testosterone on its metabolic clearance rate","volume":"29","author":"Vermeulen, A.; Verdonck, L.; Van der Straeten, M.; Orie, N.","year":"1969","unstructured":"Vermeulen, A., Verdonck, L., Van der Straeten, M., and Orie, N. (1969). Capacity of the testosterone-binding globulin in human plasma and influence of specific binding of testosterone on its metabolic clearance rate. Journal of Clinical Endocrinology and Metabolism, 29, 1470-1480.","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1210\/jcem-34-6-983","article-title":"A simplified method for the quantitative determination of testosteroneestradiol-binding globulin activity in human plasma","volume":"34","author":"Rosner, W.","year":"1972","unstructured":"Rosner, W. (1972). A simplified method for the quantitative determination of testosteroneestradiol-binding globulin activity in human plasma. Journal of Clinical Endocrinology and Metabolism, 34, 983-988.","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1111\/j.1365-2265.1974.tb03298.x","article-title":"Sex-hormone-binding globulin","volume":"3","author":"Anderson, D.C.","year":"1974","unstructured":"Anderson, D. C. (1974). Sex-hormone-binding globulin. Clinical Endocrinology, 3, 69-96.","journal-title":"Clinical Endocrinology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1172\/JCI105344","article-title":"Androstenedione production and interconversion rates measured in peripheral blood and studies on the possible site of its conversion to testosterone","volume":"45","author":"Horton, R.; Tait, J.F.","year":"1966","unstructured":"Horton, R., and Tait, J. F. (1966). Androstenedione production and interconversion rates measured in peripheral blood and studies on the possible site of its conversion to testosterone. Journal of Clinical Investigation, 45, 301-313.","journal-title":"Journal of Clinical Investigation"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1210\/jcem-40-6-1018","article-title":"Conversion of androgens to estrogens in cirrhosis of the liver","volume":"40","author":"Gordon, G.G.; Olivo, J.; Rafii, F.; Southren, A.L.","year":"1975","unstructured":"Gordon, G. G., Olivo, J., Rafii, F., and Southren, A. L. (1975). Conversion of androgens to estrogens in cirrhosis of the liver. Journal of Clinical Endocrinology and Metabolism, 40, 1018-1026.","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"ref_27","author":"Kelch, R.P.; Jenner, M.R.; Weinstein, R.; Kaplan, S.L.; Grumbach, M.M.","year":"1972","unstructured":"Kelch, R. P., Jenner, M. R., Weinstein, R., Kaplan, S. L., and Grumbach, M. M. (1972)."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1172\/JCI106877","article-title":"Estradiol and testosterone secretion by human, simian and canine testes, in males with hypogonadism and in male pseudohermaphrodites with the feminizing testes syndrome","volume":"51","unstructured":"Estradiol and testosterone secretion by human, simian and canine testes, in males with hypogonadism and in male pseudohermaphrodites with the feminizing testes syndrome. Journal of Clinical Investigation, 51, 824-830.","journal-title":"Journal of Clinical Investigation"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1677\/joe.0.0450135","article-title":"Adrenal secretion of androgens and oestrogens","volume":"45","author":"Baird, D.T.; Uno, A.; Melby, J.C.","year":"1969","unstructured":"\"Baird, D. T., Uno, A., and Melby, J. C. (1969). Adrenal secretion of androgens and oestrogens. Journal ofEndocrinology, 45, 135-136.","journal-title":"Journal ofEndocrinology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2191","DOI":"10.1172\/JCI106185","article-title":"Conversion of blood androgens to estrogens in normal adult men and women","volume":"48","author":"Longcope, C.L.; Kato, T.; Horton, R.","year":"1969","unstructured":"'Longcope, C. L., Kato, T., and Horton, R. (1969). Conversion of blood androgens to estrogens in normal adult men and women. Journal of Clinical lnvestigation, 48, 2191-2201.","journal-title":"Journal of Clinical lnvestigation"},{"key":"ref_31","series-title":"Endocrinology","first-page":"749","article-title":"Sex hormone changes associated with liver disease","volume":"27","author":"Fisher, R.A.; Anderson, D.C.","year":"1976","unstructured":"\"Fisher, R. A., and Anderson, D. C. (1976). Personal communication. 33Glass, S. J., Edmondson, H. A., and Soll, S. N. (1940). Sex hormone changes associated with liver disease. Endocrinology, 27, 749-752."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1210\/jcem-4-2-54","article-title":"Excretion of estrogen after the injection of estradiol and estrone into men with cirrhosis of the liver","volume":"4","author":"Glass, S.J.; Edmondson, H.A.; Soll, S.N.","year":"1944","unstructured":"Glass, S. J., Edmondson, H. A., and Soll, S. N. (1944). Excretion of estrogen after the injection of estradiol and estrone into men with cirrhosis of the liver. Journal of Clinical Endocrinology, 4, 54-57.","journal-title":"Journal of Clinical Endocrinology"},{"key":"ref_33","first-page":"\"688","article-title":"Hormone excretion in liver disease and in gynecomastia","volume":"11","author":"Rupp, J.; Cantarow, A.; Rakoff, A.E.; Paschkis, K.E.","year":"1951","unstructured":"Rupp, J., Cantarow, A., Rakoff, A. E., and Paschkis, K. E. (1951). Hormone excretion in liver disease and in gynecomastia. Journal of Clinical Endocrinology, 11, 688-699. \"Pincus, 1. J., Rakoff, A. E., Cohn, E. M., and Tumen, H. J. (1951). Hormonal studies in patients with chronic liver disease. Gastroenterology, 19, 735-754.","journal-title":"Journal of Clinical Endocrinology; Hormonal studies in patients with chronic liver disease"},{"key":"ref_34","first-page":"277","article-title":"II turbato metabolismo degli estrogeni nelle malattie del fegato, con riferimento al deternismo della ginecomastia","volume":"17","author":"Gregoris, L.","year":"1957","unstructured":"Gregoris, L. (1957). II turbato metabolismo degli estrogeni nelle malattie del fegato, con riferimento al deternismo della ginecomastia. Acta Medica Patavina (Parma), 17, 277-294.","journal-title":"Acta Medica Patavina (Parma)"},{"key":"ref_35","first-page":"28","article-title":"Uber die Phenolsteroidausscheidung bei der Lebercirrhose des Mannes","volume":"(Kbh.),","author":"Muller, J.","year":"1958","unstructured":"\"Muller, J. (1958). Uber die Phenolsteroidausscheidung bei der Lebercirrhose des Mannes. Acta Endocrinologica (Kbh.), 28,205-212.","journal-title":"Acta Endocrinologica"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1136\/gut.5.1.56","article-title":"Oestrogen metabolism and excretion in liver disease","volume":"5","author":"Brown, J.B.; Crean, G.P.; Ginsburg, J.","year":"1964","unstructured":"Brown, J. B., Crean, G. P., and Ginsburg, J. (1964). Oestrogen metabolism and excretion in liver disease. Gut, 5, 56-59.","journal-title":"Gut"},{"key":"ref_37","doi-asserted-by":"crossref","DOI":"10.1530\/acta.0.080S142","article-title":"Studies on the pituitary-testicular axis in patients with chronic hepatic failure","author":"Geisthovel, W.; zur Muhlen, Von","year":"1975","unstructured":"\"Geisthovel, W., and Von zur Muhlen (1975). Studies on the pituitary-testicular axis in patients with chronic hepatic failure. (Abstract.) Acta Endocrinologica (Kbh,), suppl. 199, 256.","journal-title":"(Abstract.) Acta Endocrinologica (Kbh,)"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1136\/gut.17.6.426","article-title":"Plasma oestrogens in men with chronic liver disease","volume":"17","author":"Green, J.R.B.; Mowat, N.A.G.; Fisher, R.A.; Anderson, D.C.","year":"1976","unstructured":"Green, J. R. B., Mowat, N. A. G., Fisher, R. A., and Anderson, D. C. (1976). Plasma oestrogens in men with chronic liver disease. Gut, 17, 426-430.","journal-title":"Gut"},{"key":"ref_39","article-title":"Estradiol in human plasma: demonstration of elevated levels in gynecomastia and in cirrhosis","author":"Korenman, S.G.; Perrin, L.E.; McCallum, T.","year":"1969","unstructured":"Korenman, S. G., Perrin, L. E., and McCallum, T. (1969). Estradiol in human plasma: demonstration of elevated levels in gynecomastia and in cirrhosis. (Abstract.) Journal of Clinical","journal-title":"(Abstract.) Journal of Clinical"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/S0016-5085(19)32631-9","article-title":"Plasma levels and excretion of estrogens in urine in chronic liver disease","volume":"69","year":"1975","unstructured":"Investigation, 48, 45a. 43Pentikfiinen, P. J., Pentikainen, L. A., Azarnoff, D. L.,and Dujovne, C. A. (1975). Plasma levels and excretion of estrogens in urine in chronic liver disease. Gastroenterology, 69, 20-27.","journal-title":"Gastroenterology"},{"key":"ref_41","first-page":"453","article-title":"Les oestrog6nes plasmatiques dans les gyn6comasties et les h6patopathies","volume":"31","author":"Cedard, L.; Mosse, A.; Klotz, H.P.","year":"1970","unstructured":"Cedard, L., Mosse, A., and Klotz, H. P. (1970). Les oestrog6nes plasmatiques dans les gyn6comasties et les h6patopathies. Annales d'Endocrinologie, 31, 453-458.","journal-title":"Annales d'Endocrinologie"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/0039-128X(75)90005-7","article-title":"Estrogen metabolism in hyperthyroidism and cirrhosis of the liver","volume":"26","author":"Olivo, J.; Gordon, G.G.; Rafli, F.; Southren, A.L.","year":"1975","unstructured":"Olivo, J., Gordon, G. G., Rafli, F., and Southren, A. L. (1975). Estrogen metabolism in hyperthyroidism and cirrhosis of the liver. Steroids, 26, 47-56.","journal-title":"Steroids"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1016\/0039-128X(74)90074-9","article-title":"Simultaneous measurement of unbound testosterone and estradiol fractions in undiluted plasma at 37'C by steady-state gel filtration","volume":"24","author":"Fisher, R.A.; Anderson, D.C.; Burke, C.W.","year":"1974","unstructured":"\"Fisher, R. A., Anderson, D. C., and Burke, C. W. (1974). Simultaneous measurement of unbound testosterone and estradiol fractions in undiluted plasma at 37'C by steady-state gel filtration. Steroids, 24, 809-824.","journal-title":"Steroids"},{"key":"ref_44","first-page":"\"276","article-title":"Comparative effectiveness of estrogens on fluid imbibition and growth of the rat's uterus","volume":"64","author":"Hisaw, F.L.","year":"1959","unstructured":"Hisaw, F. L. (1959). Comparative effectiveness of estrogens on fluid imbibition and growth of the rat's uterus. Endocrinology, 64, 276-289. 48Van Thiel, D. H., Gavaler, J. S., Lester, R., Loriaux, D. L., and Braunstein, G. D. (1975). Plasma estrone, prolactin, neurophysin, and sex steroid-binding globulin in chronic alcoholic men. Metabolism, 24, 1015-1019.","journal-title":"Endocrinology; Plasma estrone, prolactin, neurophysin, and sex steroid-binding globulin in chronic alcoholic men"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1530\/acta.0.067S116","article-title":"Androstenedione and testosterone production and interconversion rates measured in peripheral blood in male patients with cirrhosis of the liver","volume":"155","author":"Thijssen, J.H.H.; Lourens, J.; Donker, G.H.","year":"1971","unstructured":"\"Thijssen, J. H. H., Lourens, J., and Donker, G. H. (1971). Androstenedione and testosterone production and interconversion rates measured in peripheral blood in male patients with cirrhosis of the liver. (Abstract.) Acta Endocrinologica (Kbh.), suppl. 155, 116.","journal-title":"(Abstract.) Acta Endocrinologica (Kbh.)"},{"key":"ref_46","first-page":"\"A","article-title":"Extraglandular production of estrogen in subjects with liver disease","volume":"69","author":"Edman, C.D.; MacDonald, P.C.; Combes, B.","year":"1975","unstructured":"Edman, C. D., MacDonald, P. C., and Combes, B. (1975). Extraglandular production of estrogen in subjects with liver disease. Gastroenterology, 69, A-19\/819. \"1Vermeulen, A., Mussche, M., and Verdonck, L. (1972). Testosterone and estradiol production rates and interconversion in normal males and male cirrhotics. Proceedings of the 4th International Congress on Endocrinology. Abstract 305, p. 123. Excerpta Medica: Amsterdam. 62Thijssen, J. H. H., Lourens, J., Donker, G. H., and Schwarz, F. (1975). The role of the liver in the biogenesis of oestrogens in cirrhosis of the liver. (Abstract.) Acta Endocrinologica (Kbh.), suppl. 199, 234.","journal-title":"Gastroenterology; Testosterone and estradiol production rates and interconversion in normal males and male cirrhotics"},{"key":"ref_47","article-title":"Increased oestrogen production by peripheral conversion of androgens in male patients with cirrhosis of the liver","author":"Thijssen, J.H.H.; Lourens, J.; Donker, G.H.","year":"1973","unstructured":"'Thijssen, J. H. H., Lourens, J., and Donker, G. H. (1973). Increased oestrogen production by peripheral conversion of androgens in male patients with cirrhosis of the liver. (Abstract.)"},{"key":"ref_48","first-page":"XLIX.","volume":"57","author":"of Endocrinology, Journal","unstructured":"Journal of Endocrinology, 57, XLIX."},{"key":"ref_49","first-page":"\"S.\" # \"652","article-title":"Unpublished observations.) \"5Yen","volume":"53","author":"C., S.; Ehara, Y.; Siler, T.M.","year":"1974","unstructured":"(Unpublished observations.) \"5Yen, S. S. C., Ehara, Y., and Siler, T. M. (1974). Augmentation of prolactin secretion by estrogen in hypogonadal women. Journal of Clinical Investigation, 53, 652-655.","journal-title":"Journal of Clinical Investigation; Augmentation of prolactin secretion by estrogen in hypogonadal women"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1210\/jcem-34-1-62","article-title":"Serum prolactin levels in patients with gynecomastia","volume":"34","author":"ITurkington, . R. W","year":"1972","unstructured":"ITurkington,. R. W. (1972). Serum prolactin levels in patients with gynecomastia. Journal of Clinical Endocrinology and Metabolism, 34, 62-66.","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"ref_51","first-page":"481","article-title":"Hormone excretion in liver disease","volume":"58","author":"Mowat, N.A.G.; Edwards, C.R.W.; Green, J.R.B.; Dawson, A.M.","year":"1952","unstructured":"Mowat, N. A. G., Edwards, C. R. W., Green, J. R. B., and Dawson, A. M. (Unpublished observations.) 58Dohan, F. C., Richardson, E. M., Bluemle, L. W., and Gy6rgy, P. (1952). Hormone excretion in liver disease. Journal of Clinical Investigation, 31, 481-498.","journal-title":"(Unpublished observations.)"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1016\/S0300-595X(75)80049-1","article-title":"Medical aspects of hypogonadism","volume":"4","author":"London, D.R.","year":"1975","unstructured":"London, D. R. (1975). Medical aspects of hypogonadism. Clinics in Endocrinology and Metabolism, 4, 597-618.","journal-title":"Clinics in Endocrinology and Metabolism"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1677\/joe.0.0460129","article-title":"Oestrogen metabolism in liver disease","volume":"46","author":"Adlercreutz, H.","year":"1970","unstructured":"\"Adlercreutz, H. (1970). Oestrogen metabolism in liver disease. Journal of Endocrinology, 46, 129-163.","journal-title":"Journal of Endocrinology"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1056\/NEJM197405092901913","article-title":"Hepatic metabolism of estrogens in health and disease","volume":"290","author":"Adlercreutz, H.","year":"1974","unstructured":"'Adlercreutz, H. (1974). Hepatic metabolism of estrogens in health and disease. New England Journal of Medicine, 290, 1081-1083.","journal-title":"New England Journal of Medicine"},{"key":"ref_55","first-page":"263","article-title":"Halbwertszeit von (4-14C) ostradiol 17, B in vivo sowie stoffwechsel von (4-14C) 6stron und (4-14C) 6striol in vitro bei leber gesunden und bei patienten mit lebercirrhose","volume":"11","author":"Breuer, J.; Breuer, H.","year":"1973","unstructured":"Breuer, J., and Breuer, H. (1973). Halbwertszeit von (4-14C) ostradiol 17,B in vivo sowie stoffwechsel von (4-14C) 6stron und (4-14C) 6striol in vitro bei leber gesunden und bei patienten mit lebercirrhose. Zeitschrift fdr Klinische Chemie and Klinische Biochemie, 11, 263-269.","journal-title":"Zeitschrift fdr Klinische Chemie and Klinische Biochemie"},{"key":"ref_56","first-page":"295","article-title":"Effect of alcohol (ethanol) administration on sex-hormone metabolism in normal men","author":"Gordon, G.G.; Altman, K.; Southren, A.L.; Rubin, E.; Lieber, C.S.","year":"1976","unstructured":"Gordon, G. G., Altman, K., Southren, A. L., Rubin, E., and Lieber, C. S. (1976). Effect of alcohol (ethanol) administration on sex-hormone metabolism in normal men. New England Journal of Medicine, 295,793-797.","journal-title":"New England Journal of Medicine"},{"key":"ref_57","first-page":"\"A","article-title":"Plasma testosterone and sex hormone binding globulin (SBG) in alcoholic subjects","volume":"15","author":"Liegel, J.; Fabre, L.F.; Howard, P.Y.; Farmer, R.W.","year":"1972","unstructured":"\"Liegel, J., Fabre, L. F., Howard, P. Y., and Farmer, R. W. (1972). Plasma testosterone and sex hormone binding globulin (SBG) in alcoholic subjects. (Abstract.) Physiologist, 15, 198. \"6Van Thiel, D. H., Gavaler, J. S., Vaitukaitis, J., and Lester, R. (1976). Evidence for an isolated defect in pituitary secretion of LH in chronic alcoholic men. Gastroenterology, 71, A-40\/933. \"Crepy, O., Dray, F., and Sebaoun, J. (1967). Role des hormones thyroidiennes dans les inter actions entre la testosterone et les proteines seriques. Comptes Rendus Hebdomadaires des Seances de l'Academie des Sciences, 264, 2651-2653.","journal-title":"(Abstract.) Physiologist; Evidence for an isolated defect in pituitary secretion of LH in chronic alcoholic men"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1016\/S0015-0282(16)41896-0","article-title":"Elevated plasma testosterone and gonadotropin levels in infertile males with hyperthyroidism","volume":"27","author":"Clyde, H.R.; Walsh, P.C.; English, R.W.","year":"1976","unstructured":"Clyde, H. R., Walsh, P. C., and English, R. W. (1976). Elevated plasma testosterone and gonadotropin levels in infertile males with hyperthyroidism. Fertility and Sterility, 27, 662-666.","journal-title":"Fertility and Sterility"},{"issue":"2052-2059","key":"ref_59","first-page":"6","article-title":"Liver hypermetabolic state after chronic ethanol consumption","volume":"34","author":"Israel, Y.; Videla, L.; Bernstein, J.","year":"1975","unstructured":"\"Israel, Y., Videla, L., and Bernstein, J. (1975). Liver hypermetabolic state after chronic ethanol consumption. Federation Proceedings, 34, 2052-2059. 6\"Van Thiel, D. H., Gavaler, J., and Lester, R. (1974). Ethanol inhibition of vitamin A metabolism in the testes: possible mechanism for sterility in alcoholics. Science, 186, 941-942.","journal-title":"Federation Proceedings; Ethanol inhibition of vitamin A metabolism in the testes: possible mechanism for sterility in alcoholics"},{"key":"ref_60","first-page":"188","volume":"3","author":"Leathem, J.H.","year":"1971","unstructured":"\"Leathem, J. H. (1971). InThe Testis, vol. 3, pp. 188-190. Edited by A. D. Johnson, W. R. Gomes, and N. L. Vandemark. Academic Press: New York.","journal-title":"InThe Testis"},{"key":"ref_61","first-page":"326","article-title":"Alcohol-induced testicular atrophy-an experimental model for hypogonadism occurring in chronic alcoholic men","volume":"69","author":"Van Thiel, D.H.; Gavaler, J.S.; Lester, R.; Goodman, M.D.","year":"1975","unstructured":"Van Thiel, D. H., Gavaler, J. S., Lester, R., and Goodman, M. D. (1975). Alcohol-induced testicular atrophy-an experimental model for hypogonadism occurring in chronic alcoholic men. Gastroenterology, 69, 326-332.","journal-title":"Gastroenterology"},{"key":"ref_62","first-page":"40","article-title":"Does autoimmunity contribute to the hypogonadism of alcoholic men?","volume":"71","author":"Van Thiel, D.H.; Gavaler, J.S.; Smith, W.I.; Rabin, B.S.","year":"1976","unstructured":"Van Thiel, D. H., Gavaler, J. S., Smith, W. I., and Rabin, B. S. (1976). Does autoimmunity contribute to the hypogonadism of alcoholic men? Gastroenterology, 71, A-40\/933.","journal-title":"Gastroenterology"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1111\/j.1365-2265.1975.tb01547.x","article-title":"Hormonal studies in Klinefelter's syndrome","volume":"4","author":"Wang, C.; Baker, H.W.G.; Burger, H.G.; DeKretser, D.M.; Hudson, B.","year":"1975","unstructured":"Wang, C., Baker, H. W. G., Burger, H. G., DeKretser, D. M., and Hudson, B. (1975). Hormonal studies in Klinefelter's syndrome. Clinical Endocrinology, 4, 399-411.","journal-title":"Clinical Endocrinology"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1111\/j.1365-2265.1972.tb00384.x","article-title":"Stimulation tests of pituitary-Leydig cell function in normal male subjects and hypogonadal men","volume":"1","author":"Anderson, D.C.; Marshall, J.C.; Young, J.L.; Russell Fraser, T.","year":"1972","unstructured":"Anderson, D. C., Marshall, J. C., Young, J. L., and Russell Fraser, T. (1972). Stimulation tests of pituitary-Leydig cell function in normal male subjects and hypogonadal men. Clinical Endocrinology, 1, 127-140.","journal-title":"Clinical Endocrinology"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1210\/jcem-41-1-13","article-title":"Dissociated responses of plasma testosterone and estradiol to human chorionic gonadotropin in adult men","volume":"41","author":"Mahoudeau, J.A.; Valcke, J.-C.; Bricaire, H.","year":"1975","unstructured":"Mahoudeau, J. A., Valcke, J-C., and Bricaire, H. (1975). Dissociated responses of plasma testosterone and estradiol to human chorionic gonadotropin in adult men. Journal of Clinical Endocrinology and Metabolism, 41, 13-20.","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1001\/jama.1965.03090020077026","article-title":"Spironolactone therapy and gynecomastia","volume":"193","author":"Clark, E.","year":"1965","unstructured":"Clark, E. (1965). Spironolactone therapy and gynecomastia. Journal of the Amnerican Medical Association, 193, 163-164.","journal-title":"Journal of the Amnerican Medical Association"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1038\/240038a0","article-title":"Sex hormone binding globulin is an oestrogen amplifier","volume":"240","author":"Burke, C.W.; Anderson, D.C.","year":"1972","unstructured":"Burke, C. W., and Anderson, D. C. (1972). Sex hormone binding globulin is an oestrogen amplifier. Nature, 240, 38-40.","journal-title":"Nature"}],"container-title":["Gut"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/gut.18.10.843","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T18:34:15Z","timestamp":1765650855000},"score":1,"resource":{"primary":{"URL":"https:\/\/gut.bmj.com\/lookup\/doi\/10.1136\/gut.18.10.843"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1977,10]]},"references-count":67,"journal-issue":{"issue":"10","published-online":{"date-parts":[[1977,10,1]]},"published-print":{"date-parts":[[1977,10]]}},"alternative-id":["10.1136\/gut.18.10.843"],"URL":"https:\/\/doi.org\/10.1136\/gut.18.10.843","relation":{},"ISSN":["0017-5749","1468-3288"],"issn-type":[{"value":"0017-5749","type":"print"},{"value":"1468-3288","type":"electronic"}],"subject":[],"published":{"date-parts":[[1977,10]]}}}