Ethanol: Its Adverse Effects Upon the Hypothalamic-pituitary-gonadal Axis

Considerable evidence has accrued over the last decade to establish that ethanol is a gonadal toxin. Such toxicity is both direct, being expressed at the level of the testes, and indirect, being expressed at the level of the hypothalamus and/or pituitary. As a result of studies performed both in man and in animals, it has been shown that ethanol abuse per se, and not the associated disease that occurs with alcohol abuse, is responsible for the impotence, loss of libido, and testicular atrophy which are seen commonly in chronic alcoholic men. With prolonged alcohol abstinence, recent studies have suggested that spontaneous recovery of normal sexual function is possible in some chronic alcoholics if testicular atrophy has not yet occurred and if their responses to clomiphene and/or luteinizing hormone--releasing factor stimulation are normal. In contrast, abstinent alcoholic men with either overt testicular atrophy or inadequate responses to such pharmacologic challenges fail to recover spontaneously despite continued alcohol abstinence and will require either a penile prosthesis or long-term oral androgen therapy to achieve "acceptable" sexual functioning.