A 45-year-old man with cirrhosis develops gynecomastia. Which explanation is correct?

• A. The liver cells are removing estrogen too quickly
• B. The liver is producing too much estrogen
• C. The liver cells are failing to recycle estrogen into testosterone
• D. The liver cells are failing to remove estrogen properly from the body

Answer: (D)

In cirrhosis, the liver’s ability to metabolize and clear estrogens is reduced. The liver normally conjugates and excretes estrogens, keeping their levels in check relative to androgens. When hepatic function is compromised, estrogen isn’t removed efficiently, so its circulating level rises. This creates a higher estrogen-to-testosterone ratio, stimulating breast tissue growth and causing gynecomastia. So the correct idea is that the liver fails to remove estrogen properly from the body. It’s not primarily about overproducing estrogen, recycling it into testosterone, or removing it too quickly.