Sex-related differences were prospectively studied in patients with the first presentation of alcoholic liver disease. Among 42 patients the diagnosis was cirrhosis in 8 women and 15 men, alcoholic hepatitis in 4 women and 1 man, steatosis in 6 women and 6 men, and no histologic changes were found in the liver biopsy specimens from 2 men (p > 0.1). The median (range) antipyrine clearance was 14.6 (1.0–64) versus 17.2 (3.0–83) ml/min and the clinical score in accordance with the Pugh modification of the Child-Turcotte classification was 8 (5–13) versus 8 (5–11) in the women and men, respectively (p > 0.05). In 5 women and only 1 man the antipyrine clearance was less than 5 ml/min, indicating an almost total loss of functional liver mass (p < 0.05), whereas the Pugh score was above 11 in 6 women, but not in any of the men (p < 0.05). On an average, the men estimated their total lifetime consumption of alcohol to be 2.1 times greater and the number of days they had consumed more than 5 drinks 2.9 times higher than the women (p < 0.05). These ratios are reduced to 1.4 and 1.7, respectively (p > 0.05), if the female alcohol intake is adjusted to the average male volume of distribution. The results support the concept that women may develop similar, and sometimes even more severe, liver disease after consumption of less alcohol than men. The apparent difference in susceptibility to alcohol may be partly explained by differences in volume of distribution.