这么漂亮的姐姐潮喷的好厉害，哗哗的流[12P]

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fengliu521

感谢分享内容刺激美女多多

kaifka

RESPONSE OF MICROPENIS TO TOPICAL TESTOSTERONE AND
! G  O) F! u  D* {7 H' L' oGONADOTROPIN
RICHARD C. KLUGO* AND JOSEPH C. CERNY
/ }+ n2 m9 E3 G. |3 u7 LFrom the Division of Urology, Henry Ford Hospital, Detroit, Michigan
( B9 b4 L  G) Y# pABSTRACT
Five patients were treated with gonadotropin and topical testosterone for micropenis associated
with hypothalamic hypogonadotropic hypogonadism. All patients received 1,000 units of gonado-
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
for both modes of therapy. Average penile growth response with gonadotropin was 14.3 per cent
7 L( ?& ^3 m* s  H" sincrease in length and 5.0 per cent increase of girth. Topical testosterone produced an average
: k3 R% B4 [/ Yincrease of 60 per cent in penile length and 52. 9 per cent in girth. The greatest growth response
2 ^. S. z; n. ~/ j6 qoccurred in prepuberal male subjects with a minimal response in postpuberal male subjects. This
8 y6 H$ z5 ]  K1 I$ ]study suggests that 10 per cent topical testosterone cream twice daily will produce effective penile
8 }& s. @5 P( L: f2 v! ^! h. O) Kgrowth. The response appears to be greater in younger children, which is consistent with previ-
5 t' \, l6 P1 \0 n. eously published studies of age-related 5 reductase activity.
Children with microphallus regardless of its etiology will
require augmentation or consideration for alteration of exter-
nal genitalia. In many instances urethroplasty for hypo-
" I& e& X, C5 W, B  o3 B+ c. Espadias is easier with previous stimulation of phallic growth.
4 S6 [" |( o4 K, m# `: \; w. RThe use of testosterone administered parenterally or topically
has produced effective phallic growth. 1- 3 The mechanism of
* W3 l# l8 y" g2 kresponse has been considered as local or systemic. With this
6 ?) u$ o5 @0 _0 Q- Min mind we studied 5 children with microphallus for response
to gonadotropin and to topical testosterone independently.
# m% P: K# @4 D5 z& T5 t1 f% N$ _MATERIALS AND METHODS
3 [# E! O$ A+ }9 v( MFive 46 XY male subjects between 3 and 17 years old were
evaluated for serum testosterone levels and hypothalamic
5 B2 w; ?0 x2 ^1 Bfunction. 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
; q/ t/ A! S" \4 d3 ^- V3 |% k8 V6 m1,000 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.
Serum testosterone, luteinizing hormone and follicle-stimulat-
% U8 V. |/ O% {3 [- t/ j1 o3 uing hormone were monitored before, during and after comple-
2 |7 K! H) J6 k4 _; R0 mtion of each phase of therapy. Penile stretch length was
8 M$ ]& V7 G, m' |. Aobtained by measuring from the symphysis pubis to the tip of
3 ~0 n" b, Z$ K  Rthe glans. Penile circumferential (girth) measurements were
obtained using an orthopedic digital measuring device (see
figure).
0 X( M5 u% Q" jRESULTS
, L0 z/ z$ G+ Z, `Serum testosterone increased moderately to levels between
3 z7 s% M; {* m. a$ q50 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
; S( @" V( U1 ]; D/ F  Udeveloped after gonadotropin therapy (96 ng./dl.). Higher
6 }0 J6 L$ A( N( pserum levels were noted in older patients (12 and 17 years old),
while lower levels persisted in younger patients (4, 8, and 10
years old) (see table). Despite absence of profound alterations
! `5 z; {0 D$ s* gof serum testosterone the topical therapy provided a greater
Accepted for publication July 1, 1977. ·
( H0 K# [9 {& h7 \+ H) m/ P. qRead at annual meeting of American Urological Association,
Chicago, Illinois, April 24-28, 1977.
* Requests for reprints: Division of Urology, Henry Ford Hospital,
2799 W. Grand Blvd., Detroit, Michigan 48202.
improvement in phallic growth compared to gonadotropin.
Average phallic growth with gonadotropin was 14.3 per cent
8 W7 c0 X+ _- p1 Y2 w9 W% S/ b, g) M5 fincrease in length and 5.0 per cent increase of girth. Topical
testosterone produced a 60.0 per cent increase of phallic length
: m& d8 w* L- Wand 52.9 per cent increase of girth (circumference). The
( W2 m8 b) o/ j3 Rresponse to topical testosterone was greatest in children be-
2 N8 h* D, t& @% f; Utween 4 and 8 years old, with a gradual decrease to age 17
years (see table).
DISCUSSION
" m: M# }' V, o. \. cTopical 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,
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
: g3 g4 r. J) z5 `& Q- E" sgonadotropin to obtain levels of serum testosterone compara-
ble to levels obtained with topical testosterone would seem to
# }+ O4 e9 p5 M5 J7 H6 B; q2 mprovide a means to compare the relative effectiveness of
topical 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-
  i  C6 g! J1 b) |3 F% T6 `6 L5 jnadotropin, particularly in children less than 10 years old.
) z& E3 n# i; @! iThe levels of serum testosterone remained similar or lower
) k2 W4 M8 n# q$ I( P; u/ n& h& mthan with gonadotropin during therapy, suggesting that topi-
8 U$ ~3 }" a; ?0 Kcal application produces genital growth by its local effect as
well as its systemic effect.
Review of our patients and their growth response related to
/ I6 _# L" u$ u- j( u9 L; ^age shows a greater growth response at an earlier age. This is
% M+ E' n; H; Hconsistent with the findings of Wilson and Walker, who
reported an increased conversion of testosterone to dihydrotes-
  h2 v9 s5 T- ]% }tosterone in the foreskin of neonates and infants.4 This activ-
ity gradually decreases with age until puberty when it ap-
- c& `% U+ o2 I$ y; \proaches the same level of activity as peripheral skin. It may
well be that absorption of testosterone is less when applied at
$ @3 n, Y) Q3 Y- V0 G% a3 v' can 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
9 A' ?. s. ~/ I( e$ P8 o8 ]* V667
) T0 G4 Z; _& I668 KLUGO AND CERNY
Pt. Age
(yrs.)
Serum Testosterone Phallus (cm.) Change Length
) @. ~; o$ l3 z0 H: j( h3 S" Z) v(ng./dl.) Girth x Length (%)
4
8
10
) Y* Q' M" K, Q( ]12
17
Gonadotropin
$ b* `5 s8 R. e0 i1 _6 \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
# [  d/ U* k; q& \84.6 4.0 X 4.5 11.1
3 |5 j5 V; Q# H9 R& |' y, U7 k85.9 4.5 X 5.5 9.0
Av. 14.3
/ ~4 V7 z, s+ o3 W2 S4
8
10
" D% M- c& a# C+ V12
9 w$ S4 ?- u- C  W17
Topical testosterone
8 Q% x: Q7 O8 Z34.6 4.5 X 6.5 85
38.8 6.0 X 8.5 70
40.0 6.0 X 6.5 62.5
93.6 6.0 X 7.0 55.5
95.0 6.5 X 7.0 27.2
Av. 60.0
+ {; ?3 u4 _6 w. b+ D+ Vavailable testosterone. Again, emphasis should be placed on
early therapy when lower levels of testosterone appear to
4 V& z! ]8 C# h, e4 l, a# w9 _provide the best responses. The earlier therapy is instituted
the more likely there will be an excellent response with low
) z5 X9 E8 E8 z1 ]! tserum levels. Response occurs throughout adolescence as
7 Q. W$ K) S& \2 Z+ _; n( H; _noted in nomograms of phallic growth. 7 The actual response
  l3 U7 g7 I5 a5 Dto a given serum level of testosterone is much greater at birth
. ~( P- x$ e# k  wand gradually decreases as boys reach puberty. This is most
5 v  s% X9 _# k2 a1 Jlikely related to the conversion of testosterone to dihydrotes-
2 H7 |. t: Q* p6 Z0 ^tosterone and correlates well with the studies of testosterone
; J* B0 M# R$ n/ Q* m! N7 {% Zconversion in foreskin at various ages.
0 L, _( ~5 I; y2 L  lThe question arises regarding early treatment as to whether
one might sacrifice ultimate potential growth as with acceler-
ated bone growth. The situation appears quite the reverse
5 K) a! O9 M( G0 J9 K4 }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
: Z! p5 |2 Y3 `. o) y  Z: Q, zbe that some patients will show little or no response to any
4 S' G5 Y  o. H: P/ R( sform of therapy. This would suggest a defect in the ability to
convert testosterone to dihydrotestosterone and indicate that
0 ~  y. J  E/ g# i1 c, C8 Cphallic and peripheral skin, and subcutaneous tissue should
be compared for 5a reductase activity.
. D5 u, m# n6 Z& }. \2 c. DA, loop enlarges to measure penile girth in millimeters. B,
9 F8 p, @6 `) C, c3 t$ u" ~example of penile girth computed easily and accurately.
5 D* _, d; M( t+ M  g, t; xconversion 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
- _& }+ f" b0 i, f# nthat phallic response during puberty is related directly to the
serum testosterone level. There also is other evidence of local
! O0 j: B& t" o; presponse to testosterone with hair growth and with spermato-
genesis. 5• 6
# b8 i) g$ b5 b' \1 H) e% j0 mAdministration of larger doses of gonadotropin or systemic
& T, [, V" z$ G8 R6 J4 T1 \. Vtestosterone, as well as topical applications that produce
$ {' d1 P' n8 X8 x' s- G' Mhigher levels of serum testosterone (150 to 900 ng./dl.), will
* N2 t7 k4 z5 }- ]" qalso produce phallic growth but risks accelerated skeletal
) v! h1 `$ \, C: g, o0 R9 wmaturation even after stopping treatment. It would appear
that this may be avoided by topical applications of testosterone
+ x  r* [* ^% c0 z, m3 tand monitoring of serum testosterone. Even with this control
. |0 |' S2 O/ b( Y5 h: v  ythe duration of our therapy did not exceed 3 weeks at any
$ @' O0 A8 I, p, A! Atime. It is apparent that the prepuberal male subject may
8 P- E; t% E( psuffer accelerated bone growth with testosterone levels near
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
" i. w7 C& h( l9 v, m* Hchanges. Therefore, after skeletal maturation parenteral tes-
5 [# @1 W! P# p9 d' Gtosterone may be used to advantage. Before skeletal matura-
8 R7 o* A) z) Otion care must be taken to avoid maintaining levels of serum
, \1 m- H6 H7 S$ I3 }4 Ctestosterone more than 100 ng./dl. Low-dose gonadotropin
" ~! L1 w2 f; u- a- {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
$ |$ d8 ^! e% A$ r+ E- AREFERENCES
1. Immergut, M., Boldus, R., Yannone, E., Bunge, R. and Flocks,
R.: The local application of testosterone cream to the prepub-
6 ~5 V) D4 o! s. Uertal 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.,
& G3 |2 r1 ~5 A1 P- ~83: 247, 1973.
& ~* Z% x& |6 z3 U6 N( B3. Jacobs, S. C., Kaplan, G. W. and Gittes, R. F.: Topical testoster-
one therapy for penile growth. Urology, 6: 708, 1975.
% l/ F+ J& K( S* @2 j4. Wilson, J. D. and Walker, J. D.: The conversion of testosterone
8 S- W) a& a! \) H0 _to 5 alpha-androstan-17 beta-01-3-one (dihydrotestosterone) by
skin slices of man. J. Clin. Invest., 48: 371, 1969.
# b( v3 J8 A* k& V0 k. t1 ]6 _5. Papa, C. M. and Klingman, A. M.: Stimulation of hair growth
* _5 {  I  y8 w4 T" Pby topical application of androgens. J.A.M.A., 191: 521, 1965.
9 }$ s) N0 ?5 h/ I+ r' r6. Gittes, R. F., Smith, G., Conn, C. A. and Smith, F.: Local
* j# p6 y% M6 v- o- wandrogenic effect of interstitial cell tumor of the testis. J.
Urol., 104: 774, 1970.
. g' w6 ^7 z9 Y( Y; k; r' H7. Schonfeld, W. A. and Beebe, G. W.: Normal growth and varia-
tion in the male genitalia from birth to maturity. J. Urol., 48: