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類宦官症 및 性交不能症에 對한 內分泌療法의 治驗

The Effect of Gonadotropin (Puberogen) and Androgen (Testosterone propionate) on Eunuchoidism and Impotence

최신의학 1965년 8권 9호 p.39 ~ 53
이희영,
소속 상세정보
이희영 (  ) - 서울대학교 의과대학 비뇨기과학교실

Abstract


The writer reports the clinical experiences in the treatment of eunuchoidism and impotence with intramuscular injections of human chorionic gonadotropins alone or in combination with androgens and also describes a review of the literatures on the newer concepts of hypogonadism, eunuchoidism, impotence, gonadotropins and androgens.
Subjects and Methods
The history of five cases of eunuchoidisms and six cases. of impotences were shown in tables 1 and 2, respectively.
The eunuchoidism group was injected intramuscularly by 1,000 to 1,500 I.U. of human chorionic gonadotropin (Puberogen, Tomoda Pham. MFG. Co. Ltd.), twice a week for three to six months combined with- 25 to 50 mg.of Testosterone propionate (Samil Pham. MFG. Co. Ltd.), twice a week for three to six months. (Table 3).
The impotence group was also injected intramuscularly by 1.000 LU. of puberogen (H.C.G.) alone or com tined with 50 mg. of testosterone propionate twice a week for three to six months. (Table 4).
Results
The results were obtained in each group are found to be satisfactory.
The_eunuchoid group: The patients were noted to have a subjective response of increased phallic sensitivity, vocal´ changes, enlargement of prostate, and appreciable increase in the pubic hair two months after ginning the therapy. (Table 3 and figures 1 and 2).
The impotence group: They were all noted to have improved sexual activities after the treatment. Remark-We increase in an erection, an ejaculation, and an orgasm were observed during the course of several weeks. Some of them were successfully treated with this therapy. (Table 4).
Discussion
Hormonal Treatment for an Eunuchoidism:
In general there are two possible physiologic approaches to the problem: 1) the administration of the roducts which will stimulate the patients own cells to produce androgens and, 2) the administration of ndrogens themselves.
The former is possible only, of course, in those cases where the androgen deficit lies not in the Leydig We of response, is unquest~o ed is uence*upon testrcular.:,androgenesis´´
rru \ ation or enlargement of genital growtli* orb ?ody ature is. neccessary. Average 4 sugle.
tinged between 1,000 to 2,000 I´U..´intrarnuscularly two or sometimes three times, a~ week >enods _f at least three months.
r he latter is possible in those cases where the androgen deficit liesY in the Leyding cells in the testicles
~"hypergonadotropic eunuchoidism). For this purpose androgens might be given for supplement. Of the steroids r %with: androgenic !properties now available by far the most potent and clinically useful are the components of
testosterone. Testosterone propionate in sesame oil has proved very satisfactory and is now the standard
`androgen, for intramuscular injection. The preparation is being used 25 to 50 mg. twice a week. Substitution
therapy will be´ required permanently. The preparations´ which when given by intramuscular injections are very ´ slowly, absorbed are now available. Such depot injections need to be administered only once in 7 to 10 days
because optimal effects might be maintained for only 10 days. Methyltestosterone, 50 mg. per day orally has
seemed adequate for the average patients.
Usually patients noted a subjective response of increased phallic sensitivity from 1 to 2 weeks after beginn ing androgen therapy, vocal changes were noted from 2 to 3 weeks, definite enlargement of the prostate and -seminal vasicles could be palpated in 2 months, and eruption of pubic hair appeared from 1 to 2 weeks after beginning the treatment.
Hormonal Treatment for an Impotence:
Majority cases of impotence are failure of ejaculation, loss of libido, and a general deteriolation of the sense of well-being. They should be treated according to their causes, but in many instances the underlying causes are uncertain.
Principles of hormonal treatment for impotence is to administer the human chorionic gonadotropin which stimulates Leydig cells to produce androgen or androgen itself to improve sexual activities.
The testosterone treatment is effective in those cases of impotence due to testicular deficiencies. In the schedule of two injections per week of 25 mg. ´of testosterone propionate there is - often effective to these regressive phenomena. Three injections of 25 mg. or even more seemed to provide a smoother course. The .rj writer has tried it out only on the most obstinate cases of impotence which had resistered to all other methods of treatment. The writer´s best results were with the large doses of 50 mg.. of testosterone propionate given twice´a´week. To the depressed elderly males with vasomotor instability who manifested no objective criteria
t of ´male hormone deficiency, a therapeutic trial with androgens may be given.
~- The gonadotropic hormone offers a useful field in the treatment of impotence group, but whenever the testes are responsive to gonadotropic stimulation, the theraphy with human chorioic gonadotropins is preferable to Ahiect.replacement therapy with androgens. Testosterone preparations are usually applied for this, but also by the continuous applications of puberogen (H.C.G.) the thorough recovery of testicular function will be expectedt, Injections of 1,000 to 2,000 LU. of puberogen twice a week for at least three months might be given for the impotence.
Hypogonadism.:
Male hypogonadism may be divided into a hypergonadotropic or secondary and a hypogonadotropic or. primary hypogonadism groups. In the hypergonadotropic group are those cases in which the underlying causes´ lies outside of testis, usually in or near the pituitary gland. In the hypogonadotropic group, the basic fault lies primary in the testis itself.
If to this simple grouping the writer adds the time factor or age at which the disturbances occurs, be subdivided each group could into prepuberal, prior to sexual maturation, and postpuberal, after sexual mature,: tion group, and if he also adds the damaged testicular cells whether the disturbances occurs in germinal,
i
s...6v uavaaa, a +
r~r
onadotropin excretion is high and tlu
dism:
, Vp us c. of ASS ivmg hypergona otro is o
able 5; 6 and 7). ~.~ ~V* r..M1 ´.
r;
01
unuchoidism is also divided into a hypergonadotropic and hypogonadotropic groups. ´(Table 9)j
ypergonadotropic .eunuchoidism where underlying pathology is within the testes proper, urinary gonado-
pic substance is high and thereby serves as an aid in differential diagnosis. Such individuals have a tall jUti~ents,.gynecomastia nchoid type of skeleton with impaired growth and faulty development of penis and testes even long after
tim
e of ex ected ubert .Pubic hair distribution is scanty and if present is of the female t
p p y ype. In some is present but this is not a consistent finding.
`Hypogonadotropic eunuchoidism is actually an indefinite postponement of puberty and majority of eunucho idisms are belonging to this group. In this form of eunuchoidism, there is failure of hormonal and gametogenic function. The testes remain small and firm and resemble the size and. consistency of testes seen in infants. These patients suffer from faulty masculine development characterized by a high-pitched voice and little or no hair on the face, body and extremities. The epiphyseal closure is delayed ana growth is characterized by ;.all stature, long arms and legs.
These clinical findings produce a characteristic habitus so that persons with eunuchoidism resemble each ither clinically although the underlying disturbance may by entirely different. As a rule such patients have disproportionate anthropometric measurements, span being greater than the height and the distance from ymphysis pubis to floor being greater than one half the height. Of singular interest is that, clinically
t is difficult, if not entirely impossible, to distinguish between hypergonadotropic and, hypogonadotropio unuchoidism. The testicular biopsy does not permit this differential. It can only be determined by me-consuming hormonal analysis. However the biopsy does give valuable information as to the status of ie tubules.
Impotence is a highly individual problem often of great complexity. The condition is that in which the man }finable to perform the sexual act. It may be either complete or partial and transient or permanent. The uzbance may affect libido, erection, cohabitation, ejacualtion and orgasm and it may be purely symptomatic ,fray occur as a leading personality difficulty. There may be present organic urologic disease interference th the nerve pathways or functional, psychologic factors and hormonal deficiencies, either independently or combination. (Table 9).
r ;deal adequetely with the problem, the status in all four of these fields must be determined and evaluat-By far the greatest number of patients seeking medical advice for impotence are found to have no nonstrable organic disease but to have psychologic problems.
t is my experience that unless hormonal deficiency exists there is little likelihood that any stimulation in sexual sphere will result from hormonal therapy, at least in doses which produce such effects dramatically androgenic patients.
Hormone:
4 Pituitary anterior gonadotropin: The follicle stimulating hormone acts on´ the seminal tubules and
A ,
iulates spermatogenesis. The luteinizing hormone or the interstitial cell stimulating hormone acts on the Leydig
s stimulating them to secrete androgens. The luteotropic hormone tends to be nullified by the simultaneous iinistration. of androgen or follicle stimulating hormone but it is believed that prostate might be stimulated this hormone with androgen in men. (Table 10).
B´ ~nman~ tp;pmc gonadotropms (H C G) The; gonadotropin, is a choriomc gonadotropin `obta ed`from -
wine ofpregnant women and. is a hormone produced´by the, chorionic tissue of the placenta´. The gona= Qotropic action of H.C.G. more resembles that of I.C.S.H. or L.H. secreted by the pituitary gland. It stimulates ´ the interstitial cells, increasing the production of androgens , and- accerates the growth of male accessory sex organs by secreting male hormone from the .testicles.
.Pregnant mare serum gonadotropin (P.M.S.):The gonadotropin is produced by serum of pregnant mares and its actiop more resembles that of F.S.H. than that of L.H. although there is same effect of each. Thus
r P.M.S. -acts on seminal tubular cells and stimulates spermatogenesis directly. In contrast to pituitary gonado tropin and human chorionic gonadotropin it is essentially as effective in. single dose as in frequent multiple -doses, it disappears from serum much more slowly than the other gonodotropins.
Androgenic Hormone:
An androgen is the steroid hormone elaborated by the testis, presumably by the interstitial cell of Leydig. An androgen is found also i4 the adrenal cortex.
Physiological effects of the androgens are as follows :
1) The androgen has definite effects on the secondary sex organs, that is. the hormone induces enlargement of the prostate and seminal vesicles and promote secretory activity of these structures.
2) It enhances the libido and stimulates the erection.
3) It has property of stimulating the development and maintenance of musculine sex characteristics such as enlargement of genitalia, deepening of the voice and promotion of growth of the beard and hair about the genitalia as well as in the axillae and on the chest.
4) It acts to stimulate the formation of spermatozoa.
5) It has -protein anabolizing effects.
6) It has renotropic activities.
7) It acts to prevent atrophy of liver and heart.
Summary
Administration to five cases of the eunuchoidism and six cases of impotence of 1,000 I.U. of puberogen (human chorionic gonadotropins) alone or in combination with 50 mg. of testosterone twice a week for three "to six -months was found to be very effective for these problems.

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