鄉下的妹子太便宜，一次四個都要了[12P]

stcar

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dadiaoguang

谢谢

wyp5888

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wudaode

11

xxp13136

大家好心情

weihai

果您要查看本帖隱藏內容請

q2367975099

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金正恩

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zidantiao

真的很不错

kaifka

RESPONSE OF MICROPENIS TO TOPICAL TESTOSTERONE AND
GONADOTROPIN
9 p- F3 M' `, e) `/ I6 CRICHARD C. KLUGO* AND JOSEPH C. CERNY
From the Division of Urology, Henry Ford Hospital, Detroit, Michigan
ABSTRACT
* g; t* P/ G; |Five patients were treated with gonadotropin and topical testosterone for micropenis associated
: G# [# t) u; Q1 m! [9 d" v& x  Qwith hypothalamic hypogonadotropic hypogonadism. All patients received 1,000 units of gonado-
3 u% B; j# C) l: s& w4 ]tropin weekly for 3 weeks, with a 6-week interval followed by 10 per cent topical testosterone
cream twice daily for 3 weeks. Serum testosterone levels were measured and remained equivalent
& t7 K/ j. A' s. e8 Vfor both modes of therapy. Average penile growth response with gonadotropin was 14.3 per cent
7 L/ q4 V! i$ d/ Fincrease in length and 5.0 per cent increase of girth. Topical testosterone produced an average
increase of 60 per cent in penile length and 52. 9 per cent in girth. The greatest growth response
  L+ z) R9 G7 J- ooccurred in prepuberal male subjects with a minimal response in postpuberal male subjects. This
study suggests that 10 per cent topical testosterone cream twice daily will produce effective penile
$ _& p6 a) c0 G8 U& t! mgrowth. The response appears to be greater in younger children, which is consistent with previ-
ously published studies of age-related 5 reductase activity.
/ _1 M. ^# x$ f' M8 D9 h1 X; |5 kChildren with microphallus regardless of its etiology will
& v, I- r/ z" q' u# Wrequire augmentation or consideration for alteration of exter-
nal genitalia. In many instances urethroplasty for hypo-
spadias is easier with previous stimulation of phallic growth.
The use of testosterone administered parenterally or topically
( S: N9 x# B% `; L* Ohas produced effective phallic growth. 1- 3 The mechanism of
9 E% V* A3 ?8 U" v) Z$ cresponse has been considered as local or systemic. With this
in mind we studied 5 children with microphallus for response
to gonadotropin and to topical testosterone independently.
MATERIALS AND METHODS
( X0 B( d+ M+ Q& l, UFive 46 XY male subjects between 3 and 17 years old were
, ?# {6 l- [* v5 v+ _6 u. C% Qevaluated for serum testosterone levels and hypothalamic
, N7 h4 m: q6 ?( p1 mfunction. Of these 5 boys 2 were considered to have Kallmann's
syndrome, 1 Prader-Willi syndrome and 2 idiopathic hypotha-
lamic deficiency. After evaluation of response to luteinizing
hormone-releasing hormone these patients were treated with
1,000 units of gonadotropin weekly for 3 weeks. Six weeks
2 r, s) w0 h/ k) J* V# Zafter completion of gonadotropin therapy 10 per cent topical
testosterone was applied to the phallus twice daily for 3 weeks.
6 \. \& z& I( J4 _  y6 ySerum testosterone, luteinizing hormone and follicle-stimulat-
ing hormone were monitored before, during and after comple-
! j' m7 v1 I" D, t: k2 Wtion of each phase of therapy. Penile stretch length was
5 {- [, a2 l3 m# [obtained by measuring from the symphysis pubis to the tip of
the glans. Penile circumferential (girth) measurements were
$ e! t: r; {  g" Yobtained using an orthopedic digital measuring device (see
* I6 P4 d6 c. \* D. Q5 A% ?) j! ~figure).
RESULTS
Serum testosterone increased moderately to levels between
0 Q' o$ o% s8 g  E50 and 86 ng./dl. with gonadotropin stimulation. Serum testos-
3 h5 R9 C; n$ u9 Cterone levels with topical testosterone remained near pre-
- m# t) m& H# ]: k' `& S$ C0 Mtreatment levels (35 ng./dl.) or were elevated to similar levels
6 `( Q2 F1 N& r6 c, ?developed after gonadotropin therapy (96 ng./dl.). Higher
serum levels were noted in older patients (12 and 17 years old),
while lower levels persisted in younger patients (4, 8, and 10
, b1 H& _. R4 r2 @years old) (see table). Despite absence of profound alterations
of serum testosterone the topical therapy provided a greater
Accepted for publication July 1, 1977. ·
Read at annual meeting of American Urological Association,
Chicago, Illinois, April 24-28, 1977.
* Requests for reprints: Division of Urology, Henry Ford Hospital,
2 T3 a, u! M. ~) }9 W2799 W. Grand Blvd., Detroit, Michigan 48202.
improvement in phallic growth compared to gonadotropin.
' j, Q* o/ E9 u3 Q0 Y9 mAverage phallic growth with gonadotropin was 14.3 per cent
8 T# M" v5 h! Y6 Q8 }increase in length and 5.0 per cent increase of girth. Topical
( @. i# Q# y& [8 l: a, h& c' ^testosterone produced a 60.0 per cent increase of phallic length
and 52.9 per cent increase of girth (circumference). The
response to topical testosterone was greatest in children be-
tween 4 and 8 years old, with a gradual decrease to age 17
years (see table).
DISCUSSION
8 R1 v9 P- B' \; k3 o" t" b  GTopical testosterone has been used effectively by other
clinicians but its mode of action remains controversial. Im-
mergut and associates reported an excellent growth response
to topical testosterone with low levels of serum testosterone,
( N  A" A3 \  gsuggesting a local effect.1 Others have obtained growth re-
sponse with high. levels of serum testosterone after topical
7 d$ \- h* _; Q- G, Iadministration, suggesting a systemic response. 3 The use of
gonadotropin to obtain levels of serum testosterone compara-
7 b6 U% E% y9 k/ R/ J, }' p# J) Jble to levels obtained with topical testosterone would seem to
provide a means to compare the relative effectiveness of
$ e0 ~8 r1 u6 q2 E, [topical testosterone to systemic testosterone effect. It cer-
tainly has been established that gonadotropin as well as par-
enteral testosterone administration will produce genital
2 ~' U$ x- S9 N) Lgrowth. Our report shows that the growth of the phallus was
significantly greater with topical applications than with go-
* s2 v; z1 R% g; Wnadotropin, particularly in children less than 10 years old.
. K0 K$ i* v" n: eThe levels of serum testosterone remained similar or lower
than with gonadotropin during therapy, suggesting that topi-
! W5 i. b/ z- S2 ^0 K1 `  acal application produces genital growth by its local effect as
# z( K! h# O* Rwell as its systemic effect.
Review of our patients and their growth response related to
age shows a greater growth response at an earlier age. This is
consistent with the findings of Wilson and Walker, who
* R  [; M& I$ t' s. X" U/ e0 xreported an increased conversion of testosterone to dihydrotes-
& Q# H( l( }. A+ U; ptosterone in the foreskin of neonates and infants.4 This activ-
ity gradually decreases with age until puberty when it ap-
proaches the same level of activity as peripheral skin. It may
+ d4 P' m! Q# |- p( I5 b: }' `well be that absorption of testosterone is less when applied at
# U0 N- ]1 K' n) w' N! z3 ]" z* qan earlier age as suggested by lower serum levels in children
2 y8 {( W! c' o! V# fless than 10 years old. This fact may be explained by the
greater ability of phallic skin to convert testosterone to dihy-
$ F( v' j/ ^* Z1 g( Jdrotestosterone at this age. Conversely, serum levels in older
patients were higher, possibly because of decreased local
- f. ]- O5 |8 w" ]: K& i667
668 KLUGO AND CERNY
Pt. Age
( k0 D5 c) _8 z" ^1 O(yrs.)
Serum Testosterone Phallus (cm.) Change Length
(ng./dl.) Girth x Length (%)
, G) C/ O" S/ t, L/ @4
8
$ Y: \" m- O1 G! `9 y: O10
12
17
Gonadotropin
71.6 2.0 X 3 16.6
50.4 4.0 X 5.0 20.0
22.0 4.5 X 4.0 25.0
84.6 4.0 X 4.5 11.1
; _2 V2 |: i7 N: K* s6 Z% {85.9 4.5 X 5.5 9.0
Av. 14.3
4
8
10
; C" \' E8 l+ x  g) T) U% l12
17
Topical testosterone
' H9 F; w2 r1 g* _34.6 4.5 X 6.5 85
38.8 6.0 X 8.5 70
40.0 6.0 X 6.5 62.5
0 V# x- N, {! a  I93.6 6.0 X 7.0 55.5
9 l. p/ t" ?' `95.0 6.5 X 7.0 27.2
: h3 a5 u' Y. z3 }; Z, S0 a& ZAv. 60.0
available testosterone. Again, emphasis should be placed on
early therapy when lower levels of testosterone appear to
& D, P- B1 d! t' c! V2 q& i& ~  eprovide the best responses. The earlier therapy is instituted
2 Q; i1 u; Z! L: F: L2 G+ X7 Z  _the more likely there will be an excellent response with low
serum levels. Response occurs throughout adolescence as
( O3 E$ g. J- w9 j  Cnoted in nomograms of phallic growth. 7 The actual response
to a given serum level of testosterone is much greater at birth
and gradually decreases as boys reach puberty. This is most
+ e# c) T4 A- D* z4 [2 flikely related to the conversion of testosterone to dihydrotes-
tosterone and correlates well with the studies of testosterone
# U  q, b* c- _/ O2 yconversion in foreskin at various ages.
The question arises regarding early treatment as to whether
one might sacrifice ultimate potential growth as with acceler-
6 m+ ^6 l0 d( `3 Qated bone growth. The situation appears quite the reverse
with phallic response. If the early growth period is not used
when 5a reductase activity is greatest then potential growth
may be lost. We have not observed any regression of growth
attained with topical or gonadotropin therapy. It may well
be that some patients will show little or no response to any
form of therapy. This would suggest a defect in the ability to
2 G+ q; P, _4 J, H# M5 p, ]# W, Bconvert testosterone to dihydrotestosterone and indicate that
phallic and peripheral skin, and subcutaneous tissue should
be compared for 5a reductase activity.
( F. Q5 z: d" z) KA, loop enlarges to measure penile girth in millimeters. B,
, {7 O& E, ~1 c9 W; M- ]' ^7 W8 Xexample of penile girth computed easily and accurately.
conversion of testosterone to dihydrotestosterone. It is in this
older group that others have noted high levels of serum
  P# W, Q$ r5 o0 ~- Itestosterone with topical application. It would also appear
that phallic response during puberty is related directly to the
serum testosterone level. There also is other evidence of local
4 E2 ?$ d% i% tresponse to testosterone with hair growth and with spermato-
genesis. 5• 6
6 A2 E/ ]0 U9 X+ r. ^4 j  ZAdministration of larger doses of gonadotropin or systemic
0 E  Q. {2 K% f) g) p9 i6 D& Ntestosterone, as well as topical applications that produce
higher levels of serum testosterone (150 to 900 ng./dl.), will
also produce phallic growth but risks accelerated skeletal
( P+ D% _% I- _  ^$ vmaturation even after stopping treatment. It would appear
that this may be avoided by topical applications of testosterone
' d6 C- i. P0 [and monitoring of serum testosterone. Even with this control
the duration of our therapy did not exceed 3 weeks at any
" \/ F$ `- f- q% V6 i- Y6 F( v7 k* Ytime. It is apparent that the prepuberal male subject may
0 m, ?4 p7 |, M2 T2 q; Wsuffer accelerated bone growth with testosterone levels near
200 ng./dl. When skeletal maturation is complete the level of
* g! p. \  k/ i; Y* E1 Nserum testosterone can be maintained in the 700 to 1,300 ng./
. h- X7 W6 X$ ldl. range to stimulate phallic growth and secondary sexual
) a- a5 V% B) q6 Uchanges. Therefore, after skeletal maturation parenteral tes-
6 }1 e: C$ l: X' A. L  l* w! c# gtosterone may be used to advantage. Before skeletal matura-
tion care must be taken to avoid maintaining levels of serum
+ O" r' @) O4 Ltestosterone more than 100 ng./dl. Low-dose gonadotropin
depends upon intrinsic testicular activity and may require
- E9 S9 l9 H1 T8 W+ a; ?( W+ aprolonged administration for any response.
& ~+ F/ x, f2 d5 ~Alternately, topical testosterone does not depend upon tes-
9 M. Z! l2 u6 m: r3 bticular function and may provide a more constant level of
REFERENCES
3 a% R- U7 q7 c7 U2 P# Y1. Immergut, M., Boldus, R., Yannone, E., Bunge, R. and Flocks,
R.: The local application of testosterone cream to the prepub-
+ T; q0 k/ x+ V* V& M& tertal phallus. J. Urol., 105: 905, 1971.
2. Guthrie, R. D., Smith, D. W. and Graham, C. B.: Testosterone
treatment for micropenis during early childhood. J. Pediat.,
: U. x; z" v3 y8 \" ]! d83: 247, 1973.
3. Jacobs, S. C., Kaplan, G. W. and Gittes, R. F.: Topical testoster-
' |; D3 |$ H6 `, K& C0 A9 ?6 ~one therapy for penile growth. Urology, 6: 708, 1975.
4. Wilson, J. D. and Walker, J. D.: The conversion of testosterone
to 5 alpha-androstan-17 beta-01-3-one (dihydrotestosterone) by
" }/ f; S9 {  s- X" {/ p8 Mskin slices of man. J. Clin. Invest., 48: 371, 1969.
5. Papa, C. M. and Klingman, A. M.: Stimulation of hair growth
by topical application of androgens. J.A.M.A., 191: 521, 1965.
6. Gittes, R. F., Smith, G., Conn, C. A. and Smith, F.: Local
androgenic effect of interstitial cell tumor of the testis. J.
Urol., 104: 774, 1970.
7. Schonfeld, W. A. and Beebe, G. W.: Normal growth and varia-
tion in the male genitalia from birth to maturity. J. Urol., 48: