Korean J Fam Med Search


Korean J Fam Med > Volume 43(6); 2022 > Article
Lee: Alcohol and Testosterone Deficiency in People Who Experience Facial Flushes
Many Asians, including Koreans, have the inactive form of aldehyde dehydrogenase (ALDH), which inhibits the breakdown of acetaldehyde [1,2]. When these people consume alcohol, acetalde­hyde (a toxic substance) accumulates in the body, leading to a charac­teristic flush [3,4]. Therefore, people who exhibit flushing after alcohol consumption are considered to have lower alcohol metabolism [5,6]. Up to 50% of Asians, have the ALDH 2 gene mutation that causes the facial flushing response [7].
Koh et al. [8] examined the relationship between alcohol consumption and total testosterone deficiency according to facial flushing in Korean men. Most previous studies have assessed the effect of alcohol on testosterone levels based on the amount of alcohol consumed, but few studies have considered personal differences in alcohol metabolism.
In that retrospective study, they revealed that the drinker groups that experienced flushing and consumed more than eight standard drinks per week (112 g of alcohol per week) had a 4.37 times higher risk of testosterone deficiency than the nondrinker group [8].
Facial flushing is caused by acetaldehyde that accumulates within the body, which is enabled by an inactive ALDH2. For this reason, it is possible that the average level of testosterone was low, and the risk of testosterone deficiency increased only in the group that experienced flushing at a relatively low eight standard drinks per week in this study, compared to other studies [8]. Some studies have reported that Koreans who develop a drinking flush have higher risks of hypertension [9], metabolic syndrome [10,11], diabetes mellitus [12,13], and have high rheumatoid factors [14] and intraocular pressure [15] even if they do not drink excessively. The authors recommended that the drinkers who experienced flushing should limit their alcohol intake to eight or less standard drinks per week [8].
Previously, Lee et al. [7] investigated advantages and potential risks associated with drinking alcohol in Koreans based on the alcohol flush reaction. After a sophisticated review, they suggested that individuals with the flushing reaction should maintain an alcohol consumption level of half of that for non-flushers (≤four drinks/wk for men aged ≤65 years and ≤two drinks/week for >65 years old for flushers).
Even though the study had limitations, such as a lower proportion of heavy drinkers and being a retrospective analysis, it implied the importance of individual alcohol metabolism in the analysis of the effects of alcohol consumption.



No potential conflict of interest relevant to this article was reported.


1. Agarwal DP, Harada S, Goedde HW. Racial differences in biological sensitivity to ethanol: the role of alcohol dehydrogenase and aldehyde dehydrogenase isozymes. Alcohol Clin Exp Res 1981;5:12-6.
crossref pmid
2. Mizoi Y, Tatsuno Y, Adachi J, Kogame M, Fukunaga T, Fujiwara S, et al. Alcohol sensitivity related to polymorphism of alcohol-metabolizing enzymes in Japanese. Pharmacol Biochem Behav 1983;18 Suppl 1:127-33.
crossref pmid
3. Crabb DW. Ethanol oxidizing enzymes: roles in alcohol metabolism and alcoholic liver disease. Prog Liver Dis 1995;13:151-72.
4. Mizoi Y, Ijiri I, Tatsuno Y, Kijima T, Fujiwara S, Adachi J, et al. Relationship between facial flushing and blood acetaldehyde levels after alcohol intake. Pharmacol Biochem Behav 1979;10:303-11.
crossref pmid
5. Yokoyama A, Muramatsu T, Ohmori T, Kumagai Y, Higuchi S, Ishii H. Reliability of a flushing questionnaire and the ethanol patch test in screening for inactive aldehyde dehydrogenase-2 and alcohol-related cancer risk. Cancer Epidemiol Biomarkers Prev 1997;6:1105-7.
6. Shin CM, Kim N, Cho SI, Sung J, Lee HJ. Validation of alcohol flushing questionnaires in determining inactive aldehyde dehydrogenase-2 and its clinical implication in alcohol-related diseases. Alcohol Clin Exp Res 2018;42:387-96.
crossref pmid pdf
7. Lee S, Kim JS, Jung JG, Oh MK, Chung TH, Kim J. Korean alcohol guidelines for moderate drinking based on facial flushing. Korean J Fam Med 2019;40:204-11.
crossref pmid pmc pdf
8. Koh K, Kim SS, Kim JS, Jung JG, Yoon SJ, Suh WY, et al. Relationship between alcohol consumption and testosterone deficiency according to facial flushes among middle-aged and older Korean men. Korean J Fam Med 2022;43:381-7.
crossref pmid pmc pdf
9. Jung JG, Kim JS, Kim YS, Oh MK, Yoon SJ. Hypertension associated with alcohol consumption based on the facial flushing reaction to drinking. Alcohol Clin Exp Res 2014;38:1020-5.
crossref pmid pdf
10. Jung JG, Kim JS, Yoon SJ, Oh MK. Relationships among alcohol consumption, facial flushing response, and metabolic syndrome in healthy men. Ann Epidemiol 2012;22:480-6.
crossref pmid
11. Seo YR, Kim JS, Kim SS, Jung JG, Yoon SJ. Association between alcohol consumption and metabolic syndrome determined by facial flushing in Korean women. Korean J Fam Med 2021;42:24-30.
crossref pmid pdf
12. Jung JG, Kim JS, Oh MK. The role of the flushing response in the relationship between alcohol consumption and insulin resistance. Alcohol Clin Exp Res 2010;34:1699-704.
crossref pmid
13. Kim J, Kim JS, Kim SS, Jung JG, Yoon SJ, Seo YR, et al. Influence of facial flushing on pre- or type 2 diabetes risk according to alcohol consumption in Korean male. Korean J Fam Med 2020;41:153-60.
crossref pmid pmc pdf
14. Kim J, Park CK, Kim JS, Lee S. Relationship between alcohol consumption and rheumatoid factor (RF) with alcohol-induced facial flushing response. Alcohol 2020;84:43-8.
crossref pmid
15. Lee S, Kim JS, Kim SS, Jung JG, Yoon SJ, Seo Y, et al. Relationship between alcohol consumption and ocular pressure according to facial flushing in Korean men with obesity. Korean J Fam Med 2019;40:399-405.
crossref pmid pmc pdf


Browse all articles >

Editorial Office
Room 2003, Gwanghwamun Officia, 92 Saemunan-ro, Jongno-gu, Seoul 03186, Korea
Tel: +82-2-3210-1537    Tax: +82-2-3210-1538    E-mail: kjfm@kafm.or.kr                

Copyright © 2024 by Korean Academy of Family Medicine.

Developed in M2PI

Close layer
prev next