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
8 s! t4 J5 x7 a) J1 C3 U; N1 W% eGONADOTROPIN
RICHARD C. KLUGO* AND JOSEPH C. CERNY
' x/ X! B* N5 d% G! {From the Division of Urology, Henry Ford Hospital, Detroit, Michigan
ABSTRACT
7 j) F' }# [5 {$ xFive 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
: ]0 [6 K9 _  n# w' |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
4 o* U& \/ B1 v# f( Nincrease in length and 5.0 per cent increase of girth. Topical testosterone produced an average
( y- Y/ ?+ t/ q* U3 s8 }/ Aincrease of 60 per cent in penile length and 52. 9 per cent in girth. The greatest growth response
occurred in prepuberal male subjects with a minimal response in postpuberal male subjects. This
0 b$ _5 a: h7 W$ U2 M1 g2 O  ustudy suggests that 10 per cent topical testosterone cream twice daily will produce effective penile
- g8 ~) b6 b; @% F7 O  {2 ~( Lgrowth. The response appears to be greater in younger children, which is consistent with previ-
( ~/ q' c1 k, _( o- E9 Rously published studies of age-related 5 reductase activity.
Children with microphallus regardless of its etiology will
require augmentation or consideration for alteration of exter-
, e2 H, [! ^7 A" q9 U5 {nal genitalia. In many instances urethroplasty for hypo-
2 d* j" o. V3 f. o: L5 Y  L( G, [6 ospadias is easier with previous stimulation of phallic growth.
4 |2 p: i. ~$ B# l! z! z- ~The use of testosterone administered parenterally or topically
. ]: Q& m% q- B) U, D. [; B6 r7 ~' xhas 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
, y) {: |/ @" G( M4 _+ ato gonadotropin and to topical testosterone independently.
MATERIALS AND METHODS
6 l# o* o9 U7 _7 b/ k& `Five 46 XY male subjects between 3 and 17 years old were
evaluated for serum testosterone levels and hypothalamic
function. Of these 5 boys 2 were considered to have Kallmann's
! W; f" |% n4 T( U6 e9 zsyndrome, 1 Prader-Willi syndrome and 2 idiopathic hypotha-
- K, ]' W7 D% O* Dlamic deficiency. After evaluation of response to luteinizing
4 t+ ?) b5 Y8 i( m0 s9 J$ o9 n5 bhormone-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
& q* m  p( p) u7 x  t3 Wtestosterone was applied to the phallus twice daily for 3 weeks.
( a4 c( ^8 b! \! ]Serum testosterone, luteinizing hormone and follicle-stimulat-
ing hormone were monitored before, during and after comple-
% S4 x- x" l$ E' o3 F" t# m9 b6 ]tion of each phase of therapy. Penile stretch length was
8 u, U: w- m8 R  X/ I' U+ ~obtained by measuring from the symphysis pubis to the tip of
6 m6 B# G8 e2 y( d) C/ t1 mthe glans. Penile circumferential (girth) measurements were
obtained using an orthopedic digital measuring device (see
. ~% e' |: }7 G! vfigure).
RESULTS
Serum testosterone increased moderately to levels between
1 t7 o4 {& a2 M" n5 l. ~7 E& V50 and 86 ng./dl. with gonadotropin stimulation. Serum testos-
$ D' q: Y* @, b8 g8 Rterone levels with topical testosterone remained near pre-
treatment levels (35 ng./dl.) or were elevated to similar levels
4 d4 l+ X- y) f5 m! I$ Ldeveloped 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
1 a8 E% g; ]  b' l+ C: Syears 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,
. r. M5 e1 f8 _* gChicago, Illinois, April 24-28, 1977.
( ]4 \( V5 J. I: ?* |" F2 ]& ~* Requests for reprints: Division of Urology, Henry Ford Hospital,
0 a& R8 E" `0 c& Q2799 W. Grand Blvd., Detroit, Michigan 48202.
improvement in phallic growth compared to gonadotropin.
4 T2 t6 D# ~  [& U3 VAverage phallic growth with gonadotropin was 14.3 per cent
) |( i! X5 ]5 X( k& l5 X5 c- l# U9 Eincrease in length and 5.0 per cent increase of girth. Topical
" p1 Y6 p' I% X8 p" a( F1 btestosterone produced a 60.0 per cent increase of phallic length
and 52.9 per cent increase of girth (circumference). The
# q' Q4 [8 m0 ]: Y5 xresponse to topical testosterone was greatest in children be-
( E' W) B+ k0 V& p9 E; |4 u5 Utween 4 and 8 years old, with a gradual decrease to age 17
9 \9 h, F9 X1 ~9 {* [: myears (see table).
* c' L) o3 P4 v) F( |2 b0 I  }DISCUSSION
2 }/ \& a3 C2 F9 ~' HTopical testosterone has been used effectively by other
( F. y! ?1 |( J& C! |5 cclinicians 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,
) o9 S- v' [  k* f7 e5 ssuggesting a local effect.1 Others have obtained growth re-
& U! m0 \% j( p& L& {sponse with high. levels of serum testosterone after topical
  P. d9 Z* e$ g" V; [) q/ Hadministration, suggesting a systemic response. 3 The use of
7 P) {# f9 [5 N4 G3 }$ ^) W( }gonadotropin to obtain levels of serum testosterone compara-
ble to levels obtained with topical testosterone would seem to
9 t5 Z4 z0 a/ V% J' G& nprovide 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-
2 ^$ O6 P8 s) V" L2 S* Penteral testosterone administration will produce genital
growth. Our report shows that the growth of the phallus was
4 \! e7 p' k& [! I3 _4 tsignificantly 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
3 N$ [5 Z, O8 o) t6 [4 Qthan with gonadotropin during therapy, suggesting that topi-
# R5 k, h, v1 ?5 \; A# wcal application produces genital growth by its local effect as
" N* c5 k$ W7 H6 l) Bwell 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
+ U5 K  K- o% e# ?" yconsistent 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-
, j) ?- l  Q! _/ p. `* k( O! }ity gradually decreases with age until puberty when it ap-
proaches the same level of activity as peripheral skin. It may
' _$ B0 {9 V0 ~9 ?. K( swell be that absorption of testosterone is less when applied at
an earlier age as suggested by lower serum levels in children
- k% ^) w5 m6 D& V  K, u1 y  qless than 10 years old. This fact may be explained by the
% |2 t5 b6 D' wgreater ability of phallic skin to convert testosterone to dihy-
drotestosterone at this age. Conversely, serum levels in older
1 N$ E+ E- ^; `3 `. }patients were higher, possibly because of decreased local
667
9 F! x1 W" N6 k% a- x" h668 KLUGO AND CERNY
, g4 H, y$ S! G2 _Pt. Age
4 k9 p) V8 h4 i1 [' c* g0 K(yrs.)
Serum Testosterone Phallus (cm.) Change Length
(ng./dl.) Girth x Length (%)
4
8
10
5 X5 D0 T/ ~+ P1 ~8 b  t. r: y& e12
6 k5 l- x: U& i% y/ t0 V' ~3 S17
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
5 \# _$ C- T  a- g6 ~4 `7 @85.9 4.5 X 5.5 9.0
4 f7 k' I8 W2 C6 q' n5 sAv. 14.3
4
; o% Z1 p; C: [: e; m5 W8
10
12
17
Topical testosterone
% A& Q  I- {  u9 u! s+ B; g6 I" ^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
" c: e( M% E4 {; e4 w+ i93.6 6.0 X 7.0 55.5
) |# p9 l, B/ M( e* `0 x95.0 6.5 X 7.0 27.2
Av. 60.0
available testosterone. Again, emphasis should be placed on
early therapy when lower levels of testosterone appear to
provide the best responses. The earlier therapy is instituted
the more likely there will be an excellent response with low
serum levels. Response occurs throughout adolescence as
0 e3 @# Z! v/ l1 r7 Y# R) S2 Pnoted in nomograms of phallic growth. 7 The actual response
& Z; G# A- [. q+ o4 Qto a given serum level of testosterone is much greater at birth
and gradually decreases as boys reach puberty. This is most
2 e! o( B% k# P6 j6 \4 @$ Alikely related to the conversion of testosterone to dihydrotes-
tosterone and correlates well with the studies of testosterone
4 C4 g  g& a) o3 r, c# b  ]/ h! Iconversion in foreskin at various ages.
0 _( s4 ^! }. y; G+ HThe question arises regarding early treatment as to whether
one might sacrifice ultimate potential growth as with acceler-
* I5 F# _" _/ D( r: O' n0 c# pated 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
& |9 b5 P0 m, Z1 t2 m. q" jmay be lost. We have not observed any regression of growth
; V4 D6 G  k. h6 qattained with topical or gonadotropin therapy. It may well
be that some patients will show little or no response to any
) |( N( }/ E% R$ @0 wform of therapy. This would suggest a defect in the ability to
convert testosterone to dihydrotestosterone and indicate that
/ ]+ N; d6 _( _/ f' x3 j: ophallic and peripheral skin, and subcutaneous tissue should
be compared for 5a reductase activity.
; N$ B; `& r( [' b$ JA, loop enlarges to measure penile girth in millimeters. B,
example 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
  G  P, V, o; Q" C+ qtestosterone with topical application. It would also appear
that phallic response during puberty is related directly to the
3 G2 B! G4 g% ]serum testosterone level. There also is other evidence of local
response to testosterone with hair growth and with spermato-
" Z2 @# J+ z0 P( l4 L! Pgenesis. 5• 6
Administration of larger doses of gonadotropin or systemic
) m8 s7 o2 Y3 E$ l" Y$ b6 Itestosterone, 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
- O8 I3 w: m5 j4 f6 ?% _6 \maturation even after stopping treatment. It would appear
that this may be avoided by topical applications of testosterone
# p$ k# q& [0 |( s% y; nand monitoring of serum testosterone. Even with this control
the duration of our therapy did not exceed 3 weeks at any
time. It is apparent that the prepuberal male subject may
suffer 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
8 \, }0 W# w( x7 {% W. o4 V* {changes. Therefore, after skeletal maturation parenteral tes-
8 a5 ?" W7 P0 B% U% v  e  vtosterone may be used to advantage. Before skeletal matura-
tion care must be taken to avoid maintaining levels of serum
  Q3 K8 V: c* Y; P( Ktestosterone more than 100 ng./dl. Low-dose gonadotropin
depends upon intrinsic testicular activity and may require
( j# y5 ~1 g3 y0 A/ bprolonged administration for any response.
' I: d1 C" @4 e" p8 u; bAlternately, topical testosterone does not depend upon tes-
ticular function and may provide a more constant level of
REFERENCES
2 ~: q4 r8 G, R8 ^! R1. Immergut, M., Boldus, R., Yannone, E., Bunge, R. and Flocks,
8 p+ s5 f" V- {R.: The local application of testosterone cream to the prepub-
! R* p% t4 u3 A4 @" Wertal phallus. J. Urol., 105: 905, 1971.
( ]7 }9 Y" Q3 c2. Guthrie, R. D., Smith, D. W. and Graham, C. B.: Testosterone
! \( |& o0 T  rtreatment for micropenis during early childhood. J. Pediat.,
83: 247, 1973.
) S+ @! X' A5 Q! g3. Jacobs, S. C., Kaplan, G. W. and Gittes, R. F.: Topical testoster-
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
! B/ a5 @+ D! e( A5 n2 P+ V! hskin slices of man. J. Clin. Invest., 48: 371, 1969.
) o# L# z  K4 N$ c, ?5. Papa, C. M. and Klingman, A. M.: Stimulation of hair growth
by topical application of androgens. J.A.M.A., 191: 521, 1965.
3 K) `( I' W, h* d6. Gittes, R. F., Smith, G., Conn, C. A. and Smith, F.: Local
. s0 O# E: P7 m& h4 i5 Zandrogenic effect of interstitial cell tumor of the testis. J.
. H1 Z! `. n$ Y5 a+ j6 R0 Q6 b2 BUrol., 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: