The testicular atrophy is due to disorder of hormonal metabolism or direct toxic effect on testis. In cirrhosis of liver a combined testicular and pituitary abnormality leads to decreased testosterone production. The decreased testosterone (i.e. androgen insufficiency) production most likely result from inhibition of L H secretion by estrogens in patients with chronic liver disease. The increased estrogen production result from impaired hepatic extraction of adrenal androstenedione and subsequent increased extraglandular conversion to estrone and estradiol. The hyperestrogenemia cause hypogonadism and gynecomastia.