Sixty chronically alcoholic men who were impotent and known to have abstained from alcohol were followed prospectively to determine (a) the frequency of spontaneous recovery of normal sexual functioning, (b) indicators of spontaneous recovery, and (c) the response of those who did not achieve a spontaneous recovery to agents known to interact with the hypothalamic-pituitary-gonadal axis. Twenty-five percent of the men studied experienced a spontaneous recovery. Indicators of a spontaneous recovery were absence of testicular atrophy and normal gonadotropin responses to luteinizing hormone releasing factor or clomiphene, or both. Interestingly, the severity of the biochemical or histologic liver disease at admission to study did not have value in predicting endocrine responses or recovery of sexual functioning with continued abstinence. Those not recovering spontaneously were treated sequentially with clomiphene, human chorionic gonadotropin, and an oral exogenous androgen, fluoxymesterone. Only the androgen produced acceptable results and then only at unusually high doses, suggesting some degree of androgen insensitivity in such men.