madman
Super Moderator
One of the first cases of hypogonadism successfully treated with testosterone (T) published in 1937
This report of a single case is deemed worthwhile because of 1) the lack of reports of similarly treated cases, 2) the very limited amount of synthetic male hormone that was available for this investigation, 3) the extensive study made of this individual before and after treatment, and 4) the wide bearing of these findings upon endocrine treatment of hypogenitalism, cryptorchidism, impotence, migraine, acne, and menopausal symptoms.
Treatment
The patient was given a total of 550 mg. of testosterone acetate3 in 14 injections, 3 injections per week, for a period of 1 month. Peanut oil was selected as the vehicle since the type and amount of oil is significant (2). Injections were subcutaneous and intramuscular, in arm or in buttock. At the end of these injections, the patient received oil which, unknown to him, did not contain the potent male hormone substance he had been receiving. When he became thoroughly aware of the absence of response, all injections were stopped for 1.5 months. Injections were begun again 2 times a week, with a smaller dosage of 5 mg. of testosterone propionate in peanut oil, since the propionate compound has been shown to be absorbed more slowly than the acetate (2). After 10 injections of 5 mg. each, the dosage was increased to 20 mg. of testosterone propionate given twice weekly.
First Period of Treatment
The effect of the hormone administration was seen within 60 hours after the first injection when the patient experienced pronounced penile erections. After 6 days erections occurred repeatedly and continued throughout the month, at times reaching a state of priapism. Despite the small size of the penis, the patient felt conspicuous because of the erectile condition. The left side of the scrotum contained a mass in which testis and epididymis were not distinguished. The scrotum appeared to be somewhat thicker and of a darker color, the glans penis pinker.
Within 2 weeks the scrotum became much larger, rugose, pendulous, and more pigmented. The mass on the left side of the scrotum enlarged until a wellformed epididymis could be differentiated from a tiny atrophic testis. The penis increased in both length and diameter. The larynx was congested; the thyroid was felt to be larger.
After 3 weeks the areolar tissue became more darkly pigmented, somewhat rugose, and tender to deep pressure. The nipple was more prominent and beneath it appeared a rather firm area. On rectal examination, the prostate was felt to' be heart-shaped and of moderate thickness. Both testes and epididymides were palpable in the scrotum. Figures 1, C, and D show the increased length and diameter of the penis and the pendulousness of the scrotum. The urethral opening was also enlarged.
The hot flushes disappeared entirely throughout the period of treatment. One moderately severe migraine attack occurred. The patient was more energetic than usual, self-assured, and in higher spirits. There was some question as to a lowering of the pitch of the voice. Small hairs appeared on the chest and in a masculine distribution above the pubis. Periods between the shaving of the upper lip were shortened to 2 weeks. The dark circles beneath the eyes became lighter in color.
Period of Withdrawal
Five days following the last injection a series of 4 hot flushes were experienced and the erections became infrequent. By 11 days there was a moderately severe attack of migraine, repeated hot flushes, lassitude, some loss of self-assurance, and some huskiness of the voice. By 16 days an acneform eruption was seen on the back and chest, which progressed to include the face and neck. Hot flushes and migraines occurred as before treatment. There was some decrease in prostatic, epididymal, and scrotal size, but less regression of penile growth. Mammary tenderness persisted and a specimen that was taken for biopsy seemed to resemble a female mammary structure in gross characteristics, but in the histological examination was seen to contain lactiferous ducts without alveolar tissue.
The acne gradually disappeared as the period of hormone withdrawal lengthened to iy2 months. The dark circles returned beneath the eyes.
Second Period of Treatment
A smaller dosage of 5 mg. of testosterone propionate was employed twice weekly. The phenomena observed in the first period of treatment were again encountered but to a lesser degree. Erections reappeared, hot flushes disappeared; migraine attacks became less severe. Genital growth was resumed. The acne returned at the onset of the injections but disappeared as the treatment continued. After 10 injections, the dosage was increased to 20 mg. administered twice weekly. Growth became more rapid. The patient reported more energy and self-assurance.
The data concerning the response of this patient is relevant to several clinical conditions which, theoretically at least, can be treated either by anterior pituitary-like substances (gonadotropic material extracted from pregnancy urine, such as antuitrin-S or follutein), or by gonadal substances, which in the male can be testicular extracts or synthetic material. Without a lengthy discussion of the relative merits of gonadotropic and gonadal substances (3), this patient will serve as an example of the results being obtained with synthetic male hormone (gonadal) substances in several of the following conditions, until our cases under study at present can be compared with those treated by pregnancy urine extracts.
SUMMARY
Synthetic male hormone substances were administered to a 27-year old hypogonadal male, 'physiologically castrate' from birth, who provided an excellent subject for evaluation of the effect of these materials. The hypogonadism, cryptorchidism, impotence, hot flushes, migraine, and mental attitude were treated with some degree of success. A brief discussion is given of the relation of these results in this clear-cut case to the subject of male hormone treatment, with especial reference to cryptorchidism, hypogonadism, impotence, menopausal symptoms, migraine, and acne. The possible influence of made hormone upon the pitch of the voice, the area of pigmented skin under the eye, and the mental attitude are mentioned.
This report of a single case is deemed worthwhile because of 1) the lack of reports of similarly treated cases, 2) the very limited amount of synthetic male hormone that was available for this investigation, 3) the extensive study made of this individual before and after treatment, and 4) the wide bearing of these findings upon endocrine treatment of hypogenitalism, cryptorchidism, impotence, migraine, acne, and menopausal symptoms.
Treatment
The patient was given a total of 550 mg. of testosterone acetate3 in 14 injections, 3 injections per week, for a period of 1 month. Peanut oil was selected as the vehicle since the type and amount of oil is significant (2). Injections were subcutaneous and intramuscular, in arm or in buttock. At the end of these injections, the patient received oil which, unknown to him, did not contain the potent male hormone substance he had been receiving. When he became thoroughly aware of the absence of response, all injections were stopped for 1.5 months. Injections were begun again 2 times a week, with a smaller dosage of 5 mg. of testosterone propionate in peanut oil, since the propionate compound has been shown to be absorbed more slowly than the acetate (2). After 10 injections of 5 mg. each, the dosage was increased to 20 mg. of testosterone propionate given twice weekly.
First Period of Treatment
The effect of the hormone administration was seen within 60 hours after the first injection when the patient experienced pronounced penile erections. After 6 days erections occurred repeatedly and continued throughout the month, at times reaching a state of priapism. Despite the small size of the penis, the patient felt conspicuous because of the erectile condition. The left side of the scrotum contained a mass in which testis and epididymis were not distinguished. The scrotum appeared to be somewhat thicker and of a darker color, the glans penis pinker.
Within 2 weeks the scrotum became much larger, rugose, pendulous, and more pigmented. The mass on the left side of the scrotum enlarged until a wellformed epididymis could be differentiated from a tiny atrophic testis. The penis increased in both length and diameter. The larynx was congested; the thyroid was felt to be larger.
After 3 weeks the areolar tissue became more darkly pigmented, somewhat rugose, and tender to deep pressure. The nipple was more prominent and beneath it appeared a rather firm area. On rectal examination, the prostate was felt to' be heart-shaped and of moderate thickness. Both testes and epididymides were palpable in the scrotum. Figures 1, C, and D show the increased length and diameter of the penis and the pendulousness of the scrotum. The urethral opening was also enlarged.
The hot flushes disappeared entirely throughout the period of treatment. One moderately severe migraine attack occurred. The patient was more energetic than usual, self-assured, and in higher spirits. There was some question as to a lowering of the pitch of the voice. Small hairs appeared on the chest and in a masculine distribution above the pubis. Periods between the shaving of the upper lip were shortened to 2 weeks. The dark circles beneath the eyes became lighter in color.
Period of Withdrawal
Five days following the last injection a series of 4 hot flushes were experienced and the erections became infrequent. By 11 days there was a moderately severe attack of migraine, repeated hot flushes, lassitude, some loss of self-assurance, and some huskiness of the voice. By 16 days an acneform eruption was seen on the back and chest, which progressed to include the face and neck. Hot flushes and migraines occurred as before treatment. There was some decrease in prostatic, epididymal, and scrotal size, but less regression of penile growth. Mammary tenderness persisted and a specimen that was taken for biopsy seemed to resemble a female mammary structure in gross characteristics, but in the histological examination was seen to contain lactiferous ducts without alveolar tissue.
The acne gradually disappeared as the period of hormone withdrawal lengthened to iy2 months. The dark circles returned beneath the eyes.
Second Period of Treatment
A smaller dosage of 5 mg. of testosterone propionate was employed twice weekly. The phenomena observed in the first period of treatment were again encountered but to a lesser degree. Erections reappeared, hot flushes disappeared; migraine attacks became less severe. Genital growth was resumed. The acne returned at the onset of the injections but disappeared as the treatment continued. After 10 injections, the dosage was increased to 20 mg. administered twice weekly. Growth became more rapid. The patient reported more energy and self-assurance.
The data concerning the response of this patient is relevant to several clinical conditions which, theoretically at least, can be treated either by anterior pituitary-like substances (gonadotropic material extracted from pregnancy urine, such as antuitrin-S or follutein), or by gonadal substances, which in the male can be testicular extracts or synthetic material. Without a lengthy discussion of the relative merits of gonadotropic and gonadal substances (3), this patient will serve as an example of the results being obtained with synthetic male hormone (gonadal) substances in several of the following conditions, until our cases under study at present can be compared with those treated by pregnancy urine extracts.
SUMMARY
Synthetic male hormone substances were administered to a 27-year old hypogonadal male, 'physiologically castrate' from birth, who provided an excellent subject for evaluation of the effect of these materials. The hypogonadism, cryptorchidism, impotence, hot flushes, migraine, and mental attitude were treated with some degree of success. A brief discussion is given of the relation of these results in this clear-cut case to the subject of male hormone treatment, with especial reference to cryptorchidism, hypogonadism, impotence, menopausal symptoms, migraine, and acne. The possible influence of made hormone upon the pitch of the voice, the area of pigmented skin under the eye, and the mental attitude are mentioned.
