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
$ f9 a& w4 u" Z8 N* }1 zGONADOTROPIN
RICHARD C. KLUGO* AND JOSEPH C. CERNY
. k3 l* I% p, \) T8 ~- q% h( D4 P! i" x9 NFrom the Division of Urology, Henry Ford Hospital, Detroit, Michigan
ABSTRACT
Five patients were treated with gonadotropin and topical testosterone for micropenis associated
' \# v- N! h; B' L8 wwith 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
6 ?; P; X; M. k5 f' ^( Fcream 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
# p4 }+ u1 z7 k6 }0 g: m+ ~" e, Tincrease 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
; g; Z( E9 v+ A, ~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
0 N. w; x3 s  Cgrowth. The response appears to be greater in younger children, which is consistent with previ-
: M2 x4 z3 B: I6 z2 T% b  aously published studies of age-related 5 reductase activity.
# k# N+ G- A4 CChildren with microphallus regardless of its etiology will
require 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
! c% O% Q0 s2 @+ a/ g; I) 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
3 e% `6 o" Q. Y  q& o5 [: Ito gonadotropin and to topical testosterone independently.
, [7 K2 k# D+ Z% |0 J/ l9 Z! z" CMATERIALS AND METHODS
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
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
, K! ^$ _5 Y- p; H1,000 units of gonadotropin weekly for 3 weeks. Six weeks
after completion of gonadotropin therapy 10 per cent topical
1 w# k. s. Z7 y" W* W$ ptestosterone was applied to the phallus twice daily for 3 weeks.
$ w4 @0 y! J2 P8 F. a8 {7 `Serum testosterone, luteinizing hormone and follicle-stimulat-
3 w' o  i# J! a3 N! Aing hormone were monitored before, during and after comple-
6 i( P( n3 |+ F( a0 l9 i. otion of each phase of therapy. Penile stretch length was
) v- i3 M& |: ]3 T0 Pobtained by measuring from the symphysis pubis to the tip of
the glans. Penile circumferential (girth) measurements were
obtained using an orthopedic digital measuring device (see
5 \' M- B0 N8 ?+ [figure).
RESULTS
9 N* w2 V- M* w7 aSerum testosterone increased moderately to levels between
' S; `! s5 o* w; M  o2 |50 and 86 ng./dl. with gonadotropin stimulation. Serum testos-
. W( |0 b' Y* O3 {  ?: ^, [: Pterone levels with topical testosterone remained near pre-
7 M) p& j' h9 U& G, q/ e) {# F  _treatment levels (35 ng./dl.) or were elevated to similar levels
developed after gonadotropin therapy (96 ng./dl.). Higher
6 |' _# B* ~" l5 z( ^1 {/ _! tserum levels were noted in older patients (12 and 17 years old),
0 Q/ g" ?) A- `while lower levels persisted in younger patients (4, 8, and 10
( N0 |& V+ [# [% H6 C3 e) Byears 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,
' w, w  G$ f% |& l" tChicago, Illinois, April 24-28, 1977.
3 K5 W  A! I6 N3 p5 h% j* j* 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
0 ^9 @% ~, r; a2 H* Kincrease in length and 5.0 per cent increase of girth. Topical
4 D0 k* @2 d% ?3 F1 Etestosterone 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-
' o8 e  f/ T9 y- A6 gtween 4 and 8 years old, with a gradual decrease to age 17
. L/ o" r- i/ s3 Zyears (see table).
! }- u' l, d9 R" V! Q- ^. RDISCUSSION
Topical testosterone has been used effectively by other
clinicians but its mode of action remains controversial. Im-
/ C$ _7 Y7 C8 F, W# ?8 Hmergut and associates reported an excellent growth response
- i2 k! d' d( }$ T; Cto topical testosterone with low levels of serum testosterone,
suggesting a local effect.1 Others have obtained growth re-
# |$ k" [8 A' K* Z$ E6 Xsponse with high. levels of serum testosterone after topical
; A/ ^- w5 ]# C. s1 c6 B( D  {& K5 m' \administration, suggesting a systemic response. 3 The use of
gonadotropin to obtain levels of serum testosterone compara-
# S! K; F6 @" w: g: |/ Zble to levels obtained with topical testosterone would seem to
( L; ]" G" k1 X; Tprovide 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-
0 s* W4 R3 o& u: N! t% c0 ]  genteral testosterone administration will produce genital
growth. Our report shows that the growth of the phallus was
6 G+ W; c# S5 L+ l$ ?9 osignificantly 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
- P4 W  X% n' K5 @# C5 s6 Jthan with gonadotropin during therapy, suggesting that topi-
cal application produces genital growth by its local effect as
4 `6 a9 r$ \8 W1 Z4 l6 \$ Swell 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
6 J7 Y4 Z- I. h" ^0 ~& lreported an increased conversion of testosterone to dihydrotes-
tosterone in the foreskin of neonates and infants.4 This activ-
7 @, B. _. x6 z1 j( s  A8 g. M2 Jity gradually decreases with age until puberty when it ap-
; {% H9 Y7 X" y& M, H% Rproaches the same level of activity as peripheral skin. It may
/ ~5 h- d) i: d1 ]4 E- Vwell 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
, B/ F- f$ W$ q( E( s9 e( mgreater 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
7 a# {4 i9 e1 B7 W667
: M, K* P( k7 q! W668 KLUGO AND CERNY
! ~% w. b; S! L0 \9 N3 A1 WPt. Age
5 u! S2 y9 P" p(yrs.)
Serum Testosterone Phallus (cm.) Change Length
(ng./dl.) Girth x Length (%)
8 _  A0 `" }* E  n8 L' H; T4
8 |; c6 K$ F5 j8
10
1 B+ \9 U( h5 {+ d12
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
85.9 4.5 X 5.5 9.0
Av. 14.3
" n1 e! \4 L: ^) [. j# k8 |4
2 {" e9 b: F' D& x  O8
10
12
" a. Z. d6 W! |8 Z: a17
Topical testosterone
34.6 4.5 X 6.5 85
7 e& D' u4 p& {6 \9 D, K38.8 6.0 X 8.5 70
, @6 |% v6 ]8 z5 @40.0 6.0 X 6.5 62.5
; Q) D0 ]5 a; I  O, t" D93.6 6.0 X 7.0 55.5
& v# i. s2 D. S" }95.0 6.5 X 7.0 27.2
3 ^( C) _3 l9 N- L0 @4 r5 v1 |3 n4 CAv. 60.0
available testosterone. Again, emphasis should be placed on
early therapy when lower levels of testosterone appear to
) V/ Z3 ~$ T5 ?6 Dprovide the best responses. The earlier therapy is instituted
, x: a# ?/ f7 \. Athe more likely there will be an excellent response with low
serum levels. Response occurs throughout adolescence as
1 B' ?& V/ [0 l. u4 Inoted in nomograms of phallic growth. 7 The actual response
to a given serum level of testosterone is much greater at birth
  g/ _7 V: W1 p% m& ^/ b9 O# \$ pand 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
5 G: e+ A) S. e- Lconversion in foreskin at various ages.
The 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
" s/ K" @6 c8 @3 u" U6 H5 T% Iwith phallic response. If the early growth period is not used
4 s8 c' j. p/ _- D3 N( S" [" wwhen 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
' Q; s+ Q& ?6 m7 M* Lbe that some patients will show little or no response to any
4 y; F+ L$ D3 i; E7 J4 K$ Mform 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
1 M( c: |  D5 O* L& A/ @. J& I+ q' gbe compared for 5a reductase activity.
A, loop enlarges to measure penile girth in millimeters. B,
5 e; G3 c. }0 c' _5 Q1 S" yexample of penile girth computed easily and accurately.
conversion of testosterone to dihydrotestosterone. It is in this
$ e+ R) i% x4 e& h0 uolder group that others have noted high levels of serum
  I% _) \3 S; o0 q0 [! ~/ |* Xtestosterone with topical application. It would also appear
  w3 f$ \) b& k" o" @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-
genesis. 5• 6
Administration of larger doses of gonadotropin or systemic
testosterone, as well as topical applications that produce
! s. `) A! ^% A& ]higher levels of serum testosterone (150 to 900 ng./dl.), will
also produce phallic growth but risks accelerated skeletal
maturation even after stopping treatment. It would appear
. ~9 K. X, S$ |that this may be avoided by topical applications of testosterone
. t6 d. i  i2 Xand 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
3 s1 a, @3 O" Z7 y8 mserum 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-
tosterone may be used to advantage. Before skeletal matura-
tion care must be taken to avoid maintaining levels of serum
& p4 R$ Y. x/ h2 z. ^testosterone more than 100 ng./dl. Low-dose gonadotropin
depends upon intrinsic testicular activity and may require
/ Q7 \2 O9 X2 A+ {7 b* Q( \; @prolonged administration for any response.
Alternately, topical testosterone does not depend upon tes-
) B( y0 c/ A9 O6 |9 t, vticular function and may provide a more constant level of
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" j5 n4 q" {8 p& Q8 \. G* ~1. Immergut, M., Boldus, R., Yannone, E., Bunge, R. and Flocks,
: D8 m2 m, q, E; ^3 tR.: The local application of testosterone cream to the prepub-
ertal 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.,
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3. Jacobs, S. C., Kaplan, G. W. and Gittes, R. F.: Topical testoster-
one therapy for penile growth. Urology, 6: 708, 1975.
* O- l0 z- e* w2 A( I5 j$ u, B% Y2 ^4. Wilson, J. D. and Walker, J. D.: The conversion of testosterone
to 5 alpha-androstan-17 beta-01-3-one (dihydrotestosterone) by
skin slices of man. J. Clin. Invest., 48: 371, 1969.
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$ h: A& W; a! C0 Q& p6. Gittes, R. F., Smith, G., Conn, C. A. and Smith, F.: Local
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