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**Gynecomastia in men**: In CLD, there is defective metabolism of androstenedione, thereby shunting the estrogen precursors and increasing plasma level of estradiol. Additionaly, Spironolactone may be used in CLD, which is a testosterone inhibitor.

**Breast atrophy in women:** Serum hormone binding globulin (SHBG) is decreased in liver cirrhosis leading to increased bioavailable androgens in females. This can lead to hirsuitism and defeminization. Breast atrophy is one of the early manifestations in female due to this reason.

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