Chronic alcoholism can also affect gonadal function and lead to testicular atrophy, gynaecomastia (enlargement of male breasts) and sterility. It is not known what the exact mechanism for these changes is, but it is thought to be a result of reduced liver function. This reduced liver function decreases the rate of metabolism of female sex hormones, thereby leading to an increased level of circulating oestrogens. A second mechanism is thought to be that alcohol reduces synthesis of testosterone (18). Testosterone synthesis involves many steps and some of the intermediates may be dependent on the NAD + /NADH concentration ratio which, as has already been discussed, is affected by alcohol consumption.
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