鄉下的妹子太便宜，一次四個都要了[12P]

stcar

good good support

dadiaoguang

谢谢

wyp5888

好图，谢谢分享。

wudaode

11

xxp13136

大家好心情

weihai

果您要查看本帖隱藏內容請

q2367975099

看看再说

金正恩

将计就计

zidantiao

真的很不错

kaifka

RESPONSE OF MICROPENIS TO TOPICAL TESTOSTERONE AND
GONADOTROPIN
' ]( y$ x1 Z; h. n+ v5 o3 zRICHARD C. KLUGO* AND JOSEPH C. CERNY
From the Division of Urology, Henry Ford Hospital, Detroit, Michigan
: ~; ~' r, x7 N2 b2 RABSTRACT
Five patients were treated with gonadotropin and topical testosterone for micropenis associated
; M" W0 L  f% B* ?with hypothalamic hypogonadotropic hypogonadism. All patients received 1,000 units of gonado-
( m1 P& ~4 P! `% F4 Dtropin weekly for 3 weeks, with a 6-week interval followed by 10 per cent topical testosterone
6 \& z( G) x3 Y$ |! kcream twice daily for 3 weeks. Serum testosterone levels were measured and remained equivalent
# ]  F, {3 p2 e6 a! efor both modes of therapy. Average penile growth response with gonadotropin was 14.3 per cent
increase in length and 5.0 per cent increase of girth. Topical testosterone produced an average
# s+ }9 l7 B( I; qincrease of 60 per cent in penile length and 52. 9 per cent in girth. The greatest growth response
  r5 H- L% t, @occurred 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
9 a* D( J& l$ `4 M  dgrowth. The response appears to be greater in younger children, which is consistent with previ-
/ E6 b$ ~" i. A- }. D& y6 Dously published studies of age-related 5 reductase activity.
6 T! v: r# C. a0 Y9 XChildren with microphallus regardless of its etiology will
require augmentation or consideration for alteration of exter-
nal genitalia. In many instances urethroplasty for hypo-
) a+ r, ~) X# j/ m4 S* Q+ ~2 j! M( k# H! Nspadias is easier with previous stimulation of phallic growth.
, V  F' v3 l4 a( x( x) FThe use of testosterone administered parenterally or topically
has produced effective phallic growth. 1- 3 The mechanism of
response has been considered as local or systemic. With this
in mind we studied 5 children with microphallus for response
3 S) J% Z/ j# B, x( L( zto gonadotropin and to topical testosterone independently.
MATERIALS AND METHODS
$ I0 Y, b# K6 L3 [' P' u( \Five 46 XY male subjects between 3 and 17 years old were
4 W) b" `) Z2 C' e2 N  m- W* a7 Wevaluated for serum testosterone levels and hypothalamic
" \0 M- }1 |) t  \function. 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
* j8 X/ ?* x) c( w% ?hormone-releasing hormone these patients were treated with
1,000 units of gonadotropin weekly for 3 weeks. Six weeks
after completion of gonadotropin therapy 10 per cent topical
testosterone was applied to the phallus twice daily for 3 weeks.
. e) z/ A- Y. z3 mSerum testosterone, luteinizing hormone and follicle-stimulat-
ing hormone were monitored before, during and after comple-
: g) M8 ]  D4 gtion of each phase of therapy. Penile stretch length was
8 Q+ c4 _& S/ V( B3 Sobtained by measuring from the symphysis pubis to the tip of
( l: r( ?! Y- |) {% V: u! vthe glans. Penile circumferential (girth) measurements were
. l; }6 L  C6 }) H; ^obtained using an orthopedic digital measuring device (see
4 y! r6 D# n1 L. d/ [figure).
1 [# C# x. j6 X& L" S: ?RESULTS
Serum testosterone increased moderately to levels between
; V$ P  j3 M7 Y6 C3 p50 and 86 ng./dl. with gonadotropin stimulation. Serum testos-
terone levels with topical testosterone remained near pre-
treatment levels (35 ng./dl.) or were elevated to similar levels
1 U  N6 Y4 _* z" \2 o! w; _developed after gonadotropin therapy (96 ng./dl.). Higher
. A5 H# e  \. U5 tserum levels were noted in older patients (12 and 17 years old),
6 I2 Z1 @, O3 b! x* k/ v* n$ T7 k2 Vwhile lower levels persisted in younger patients (4, 8, and 10
+ l3 v7 F% X: p* K, wyears old) (see table). Despite absence of profound alterations
* ^& e! G. m9 p. b- v: ^of serum testosterone the topical therapy provided a greater
Accepted for publication July 1, 1977. ·
Read at annual meeting of American Urological Association,
! `- L7 i, H6 [Chicago, Illinois, April 24-28, 1977.
* Requests for reprints: Division of Urology, Henry Ford Hospital,
2 W+ d- ?' R6 x# m. `& ~2799 W. Grand Blvd., Detroit, Michigan 48202.
improvement in phallic growth compared to gonadotropin.
Average phallic growth with gonadotropin was 14.3 per cent
) l1 }. ?8 h5 p+ p7 {& K3 Z6 C' y& [increase in length and 5.0 per cent increase of girth. Topical
1 G7 ?: [' K' z  |* ]# K1 _testosterone produced a 60.0 per cent increase of phallic length
: a* n4 I! I# ]& B; @7 j5 L+ U; h" Qand 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
! U" X( F; H% F# V7 Vyears (see table).
DISCUSSION
Topical testosterone has been used effectively by other
% Q) p6 C$ [) w& h, e6 k+ oclinicians but its mode of action remains controversial. Im-
* C9 ^- e/ c, i+ e; b9 R) ]. F% t  f7 Cmergut and associates reported an excellent growth response
2 g: V& ]5 t" f% z* _; \! H1 F1 zto topical testosterone with low levels of serum testosterone,
suggesting a local effect.1 Others have obtained growth re-
sponse with high. levels of serum testosterone after topical
administration, suggesting a systemic response. 3 The use of
+ ?2 e0 r6 r4 @  [gonadotropin to obtain levels of serum testosterone compara-
ble to levels obtained with topical testosterone would seem to
provide a means to compare the relative effectiveness of
8 R8 {3 ~5 e, e) H; Htopical testosterone to systemic testosterone effect. It cer-
tainly has been established that gonadotropin as well as par-
enteral testosterone administration will produce genital
growth. Our report shows that the growth of the phallus was
significantly greater with topical applications than with go-
nadotropin, particularly in children less than 10 years old.
The levels of serum testosterone remained similar or lower
6 |0 F9 N+ U* Z& x% m9 v  Dthan with gonadotropin during therapy, suggesting that topi-
cal application produces genital growth by its local effect as
well as its systemic effect.
: }. `% Q& _$ N/ q  a" u) {- N3 aReview of our patients and their growth response related to
* N; D) N1 y( c3 U  T; Tage shows a greater growth response at an earlier age. This is
consistent with the findings of Wilson and Walker, who
reported an increased conversion of testosterone to dihydrotes-
tosterone in the foreskin of neonates and infants.4 This activ-
ity gradually decreases with age until puberty when it ap-
! ]( L! N0 O" ?0 g9 Q5 D: i4 bproaches the same level of activity as peripheral skin. It may
* A4 ~0 z" \; A* Swell be that absorption of testosterone is less when applied at
an earlier age as suggested by lower serum levels in children
less than 10 years old. This fact may be explained by the
greater ability of phallic skin to convert testosterone to dihy-
drotestosterone at this age. Conversely, serum levels in older
patients were higher, possibly because of decreased local
& ^; l  b* h/ p% k! W! ]667
$ R3 f- b1 \( ^1 U" D# w7 n* t- w668 KLUGO AND CERNY
. t2 C. D! _) f$ D8 }2 zPt. Age
(yrs.)
$ q/ E$ h4 \: U# L/ JSerum Testosterone Phallus (cm.) Change Length
(ng./dl.) Girth x Length (%)
4
4 c. B$ r, L6 j: D  ?8
10
12
: B, v' g3 e) W8 P7 |+ Y' ^17
Gonadotropin
! A  ~+ v( ~* s! n71.6 2.0 X 3 16.6
9 i9 Z2 y2 q2 |% Z6 A50.4 4.0 X 5.0 20.0
22.0 4.5 X 4.0 25.0
4 `! d7 R! `9 `$ t3 j8 }84.6 4.0 X 4.5 11.1
: a9 }. _- {7 M8 r6 P5 l85.9 4.5 X 5.5 9.0
Av. 14.3
: u3 W% f$ k+ _( n4
8
10
12
' O( U5 @+ y8 N2 n4 u17
" `$ b% }0 O* }: g& G" ATopical testosterone
34.6 4.5 X 6.5 85
6 r" w& @9 @" l- r* O# W; e( D38.8 6.0 X 8.5 70
7 c' B) J- x% @2 R+ q+ |40.0 6.0 X 6.5 62.5
" V5 K; R  ~7 e; R4 c0 R93.6 6.0 X 7.0 55.5
95.0 6.5 X 7.0 27.2
' q: a5 ?0 V9 `/ J& q# o' G' g4 \Av. 60.0
available testosterone. Again, emphasis should be placed on
3 a! Q3 x' O  o1 V- C$ I! }: {6 aearly therapy when lower levels of testosterone appear to
provide the best responses. The earlier therapy is instituted
( S& j  t- h0 rthe more likely there will be an excellent response with low
serum levels. Response occurs throughout adolescence as
noted in nomograms of phallic growth. 7 The actual response
, Z9 \: Z3 Q0 F. R& X) Ato a given serum level of testosterone is much greater at birth
and gradually decreases as boys reach puberty. This is most
likely related to the conversion of testosterone to dihydrotes-
tosterone and correlates well with the studies of testosterone
conversion in foreskin at various ages.
The question arises regarding early treatment as to whether
/ @8 ]" ~# c& z! p" v$ K( d4 done might sacrifice ultimate potential growth as with acceler-
ated 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
  Q, g+ p, R" r6 u2 P+ Wmay be lost. We have not observed any regression of growth
8 B! w7 T6 g, fattained with topical or gonadotropin therapy. It may well
* |$ D8 T. b" q7 ~% Wbe that some patients will show little or no response to any
form of therapy. This would suggest a defect in the ability to
convert testosterone to dihydrotestosterone and indicate that
phallic and peripheral skin, and subcutaneous tissue should
be compared for 5a reductase activity.
A, loop enlarges to measure penile girth in millimeters. B,
" W/ _$ |9 \' Z0 Texample of penile girth computed easily and accurately.
. C; i: E5 I3 r5 c2 [% iconversion of testosterone to dihydrotestosterone. It is in this
older group that others have noted high levels of serum
testosterone 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
response to testosterone with hair growth and with spermato-
3 K* [5 a6 o) n) Rgenesis. 5• 6
9 E! r8 V2 D! ?1 B* M) }Administration of larger doses of gonadotropin or systemic
& N+ W( t7 R0 {/ P+ T( Vtestosterone, as well as topical applications that produce
- F( Q; Q8 W; }+ S  }7 f1 Ghigher levels of serum testosterone (150 to 900 ng./dl.), will
also produce phallic growth but risks accelerated skeletal
9 }* ?: @# i- `3 R2 B# _; U" gmaturation even after stopping treatment. It would appear
that this may be avoided by topical applications of testosterone
' ]- j4 }+ L8 \- {# I/ Kand monitoring of serum testosterone. Even with this control
* _2 d4 v1 J. Y: A5 G8 t9 pthe duration of our therapy did not exceed 3 weeks at any
& R: _1 x) m9 t" c! jtime. It is apparent that the prepuberal male subject may
suffer accelerated bone growth with testosterone levels near
# \, W- P  ^+ B4 n( n6 W, }200 ng./dl. When skeletal maturation is complete the level of
serum testosterone can be maintained in the 700 to 1,300 ng./
dl. range to stimulate phallic growth and secondary sexual
changes. Therefore, after skeletal maturation parenteral tes-
' K8 g8 A1 n1 Q3 [6 `. \tosterone may be used to advantage. Before skeletal matura-
. s4 b9 ]; \, N/ ]8 F' n' J4 Mtion care must be taken to avoid maintaining levels of serum
; B) X) z/ r8 I0 utestosterone more than 100 ng./dl. Low-dose gonadotropin
8 j+ I1 V$ i  Z' N3 F) U3 G0 g2 }depends upon intrinsic testicular activity and may require
prolonged administration for any response.
Alternately, topical testosterone does not depend upon tes-
ticular function and may provide a more constant level of
7 m7 x7 `- p3 MREFERENCES
1. Immergut, M., Boldus, R., Yannone, E., Bunge, R. and Flocks,
3 S1 {0 ^/ c; t7 f/ YR.: The local application of testosterone cream to the prepub-
ertal phallus. J. Urol., 105: 905, 1971.
0 Y: p2 o! C6 D/ B* E# q9 X2. Guthrie, R. D., Smith, D. W. and Graham, C. B.: Testosterone
/ h) o: v7 Y: Gtreatment for micropenis during early childhood. J. Pediat.,
83: 247, 1973.
2 D0 L# @- W: r* m; C3. Jacobs, S. C., Kaplan, G. W. and Gittes, R. F.: Topical testoster-
one therapy for penile growth. Urology, 6: 708, 1975.
3 p- ]8 M) g  O3 ?1 L/ E. x4. Wilson, J. D. and Walker, J. D.: The conversion of testosterone
to 5 alpha-androstan-17 beta-01-3-one (dihydrotestosterone) by
9 c/ N! Z5 `9 }$ Jskin slices of man. J. Clin. Invest., 48: 371, 1969.
5. Papa, C. M. and Klingman, A. M.: Stimulation of hair growth
8 Y# s, M: q1 ?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.
3 [) T$ ~/ c1 a* QUrol., 104: 774, 1970.
! f* B. k; r5 O& ^) }( p( K0 O1 l7. Schonfeld, W. A. and Beebe, G. W.: Normal growth and varia-
7 V+ s+ t! A& ?7 |  y3 q) u! etion in the male genitalia from birth to maturity. J. Urol., 48: