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

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
. w) ~: a" ]+ P) b7 y: uGONADOTROPIN
RICHARD C. KLUGO* AND JOSEPH C. CERNY
% J0 s7 b! \6 u8 f. R1 C; yFrom the Division of Urology, Henry Ford Hospital, Detroit, Michigan
0 y& U7 n1 S/ Z! m& X, u$ CABSTRACT
) q! Q- t$ c& z* y& ?Five patients were treated with gonadotropin and topical testosterone for micropenis associated
" V0 e. ?" F% i3 o( Vwith 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
4 p& p/ X1 {- u9 p" {1 k  Q! G% u1 N, A0 Qcream 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
increase in length and 5.0 per cent increase of girth. Topical testosterone produced an average
. C$ C4 H! Y) ]increase of 60 per cent in penile length and 52. 9 per cent in girth. The greatest growth response
) C4 E9 c  N0 Q# R1 l% B! m# Q# moccurred 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
growth. The response appears to be greater in younger children, which is consistent with previ-
ously published studies of age-related 5 reductase activity.
Children with microphallus regardless of its etiology will
" |1 v4 c7 M4 Q* u7 lrequire augmentation or consideration for alteration of exter-
/ E% t; o0 d4 b6 ?1 ?7 jnal genitalia. In many instances urethroplasty for hypo-
* q, m; ^, z1 J9 N, R; {/ c4 q5 espadias is easier with previous stimulation of phallic growth.
' }+ Z  W# B: b! R: Y5 r- B$ m) ~3 cThe use of testosterone administered parenterally or topically
! T( c! o1 S  [& [- Yhas produced effective phallic growth. 1- 3 The mechanism of
response has been considered as local or systemic. With this
  Y* d& H" {; P0 J, q2 iin mind we studied 5 children with microphallus for response
2 p0 v$ U3 s& v! M7 rto gonadotropin and to topical testosterone independently.
: b: `$ S0 C$ J! T; BMATERIALS AND METHODS
Five 46 XY male subjects between 3 and 17 years old were
! f. v" k/ J, }% jevaluated for serum testosterone levels and hypothalamic
function. Of these 5 boys 2 were considered to have Kallmann's
9 T( i  P8 a3 l8 e3 w& T3 e& r, [. nsyndrome, 1 Prader-Willi syndrome and 2 idiopathic hypotha-
4 s1 e0 a+ y/ R) w" d9 wlamic deficiency. After evaluation of response to luteinizing
) A2 l* v  d; j+ m2 P; U/ L! yhormone-releasing hormone these patients were treated with
) ~& v3 f1 |1 k, M4 c1,000 units of gonadotropin weekly for 3 weeks. Six weeks
/ b4 Q0 M4 O; \% W- S' tafter completion of gonadotropin therapy 10 per cent topical
testosterone was applied to the phallus twice daily for 3 weeks.
1 w& q: ?; Q7 E, q7 zSerum testosterone, luteinizing hormone and follicle-stimulat-
ing hormone were monitored before, during and after comple-
tion of each phase of therapy. Penile stretch length was
obtained 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
0 a6 D# c9 c! afigure).
5 [7 k9 ^8 x" n  d8 eRESULTS
# H; `  q/ K4 A* k) y' _+ RSerum testosterone increased moderately to levels between
50 and 86 ng./dl. with gonadotropin stimulation. Serum testos-
, k9 d- E/ g0 y, \5 D0 t+ Aterone levels with topical testosterone remained near pre-
3 j. S- k" Z7 ?8 O- j  ]/ ^treatment levels (35 ng./dl.) or were elevated to similar levels
developed after gonadotropin therapy (96 ng./dl.). Higher
1 G4 q/ R" o  o% ]. Wserum levels were noted in older patients (12 and 17 years old),
* m" c4 e7 x9 lwhile lower levels persisted in younger patients (4, 8, and 10
5 z# g- H0 D$ O. |. T$ ayears old) (see table). Despite absence of profound alterations
$ P0 ^2 t# I8 Q) _. m+ Fof serum testosterone the topical therapy provided a greater
Accepted for publication July 1, 1977. ·
Read at annual meeting of American Urological Association,
- h/ T, w7 p5 F: H1 }# }% DChicago, Illinois, April 24-28, 1977.
* Requests for reprints: Division of Urology, Henry Ford Hospital,
; S0 p1 A/ c3 Z0 ?! U4 n2799 W. Grand Blvd., Detroit, Michigan 48202.
6 @  V( }! G2 ]improvement in phallic growth compared to gonadotropin.
! m0 F! F) G8 G1 AAverage phallic growth with gonadotropin was 14.3 per cent
increase in length and 5.0 per cent increase of girth. Topical
/ V$ e5 P$ F9 R: d9 Ktestosterone produced a 60.0 per cent increase of phallic length
and 52.9 per cent increase of girth (circumference). The
, b' j% c0 E4 x; A! |- c! Tresponse to topical testosterone was greatest in children be-
5 _+ q3 j& c* X2 ~9 Vtween 4 and 8 years old, with a gradual decrease to age 17
- O+ ?" k5 E+ j# I7 ?( syears (see table).
DISCUSSION
Topical testosterone has been used effectively by other
clinicians but its mode of action remains controversial. Im-
/ K: F, i, P2 G$ S" S! Bmergut 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-
& a& v1 v( K+ |, |% I- w- Rsponse with high. levels of serum testosterone after topical
administration, suggesting a systemic response. 3 The use of
0 h- @$ o% v, Wgonadotropin 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
topical testosterone to systemic testosterone effect. It cer-
tainly has been established that gonadotropin as well as par-
: w3 C- [. C5 D# b! ?, Venteral testosterone administration will produce genital
5 ~* B2 U7 p0 ^/ ?7 wgrowth. 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
than with gonadotropin during therapy, suggesting that topi-
& p0 J9 s9 |" S5 W: l7 dcal application produces genital growth by its local effect as
& Q* {& M4 h* h/ v% S) ]well as its systemic effect.
- K) [7 S" V2 WReview of our patients and their growth response related to
9 G$ m+ o4 o3 X" Uage shows a greater growth response at an earlier age. This is
consistent with the findings of Wilson and Walker, who
* g/ O  m$ U) Y+ Rreported an increased conversion of testosterone to dihydrotes-
# T- J, e0 i! O1 Y6 ?0 S  qtosterone 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
* y6 l$ @: o) i7 P/ j$ jwell be that absorption of testosterone is less when applied at
$ k7 g4 p1 y* h# z8 J$ ean earlier age as suggested by lower serum levels in children
+ H! i: a' U# k4 j5 ]less than 10 years old. This fact may be explained by the
- S4 {* P& N: ]1 Bgreater ability of phallic skin to convert testosterone to dihy-
) ?* F4 \( s$ y8 S4 A2 ^drotestosterone at this age. Conversely, serum levels in older
patients were higher, possibly because of decreased local
9 X+ e' }7 p7 n, H1 @667
" u" q+ N% s$ V3 U668 KLUGO AND CERNY
) r# a0 n2 A* h; i) YPt. Age
(yrs.)
/ f/ q  }9 Q& V5 Y5 l/ K: TSerum Testosterone Phallus (cm.) Change Length
(ng./dl.) Girth x Length (%)
4
8
10
# J3 ^1 d- t# A& k12
17
Gonadotropin
: n' b" r* T- g5 o71.6 2.0 X 3 16.6
50.4 4.0 X 5.0 20.0
! V- c/ C  z, \8 h1 k% ^22.0 4.5 X 4.0 25.0
84.6 4.0 X 4.5 11.1
1 ~: u2 Y/ z" ^, k7 q. M' l7 p85.9 4.5 X 5.5 9.0
; p- f% S! d& P3 o' A3 U3 G6 qAv. 14.3
( D2 {2 w+ E$ c0 w4
) i! c& V2 ^% I) P8
- q% _: S. E$ M2 ?4 `4 G0 q10
6 _+ N- X+ m. ^# _* O! V) `! Y1 `12
17
Topical testosterone
34.6 4.5 X 6.5 85
$ M0 J$ T- I$ i. p, p38.8 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
! T' k$ h. F" @, \. A, HAv. 60.0
available testosterone. Again, emphasis should be placed on
early therapy when lower levels of testosterone appear to
  N& Y8 X. a: V; g$ {8 }provide the best responses. The earlier therapy is instituted
. }1 C' G  b' P  _( K% P& u7 qthe more likely there will be an excellent response with low
# k, @* Q7 Q1 M5 I; h) z' nserum levels. Response occurs throughout adolescence as
noted in nomograms of phallic growth. 7 The actual response
to a given serum level of testosterone is much greater at birth
; C+ G* Y' W) k8 v0 T5 i0 n9 kand gradually decreases as boys reach puberty. This is most
- E9 I2 @% u) I& w! F1 mlikely related to the conversion of testosterone to dihydrotes-
3 w, g0 @9 T! a/ ~& T4 v! s+ Rtosterone and correlates well with the studies of testosterone
conversion 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
with phallic response. If the early growth period is not used
when 5a reductase activity is greatest then potential growth
# w! {$ I6 f+ C  h: F  S' N% P! Wmay be lost. We have not observed any regression of growth
attained with topical or gonadotropin therapy. It may well
4 s: [7 y- C1 h& [- J- Cbe that some patients will show little or no response to any
+ r+ W% z; v8 y! m; iform 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,
& `0 y) y  U& O" r1 Vexample of penile girth computed easily and accurately.
9 I) r' }! u% @# t9 w* W' R% Hconversion of testosterone to dihydrotestosterone. It is in this
" g+ T8 N1 M! q+ [older group that others have noted high levels of serum
testosterone with topical application. It would also appear
/ _9 q) A" ]& C  Dthat phallic response during puberty is related directly to the
& q+ ?3 ^  M: v: @6 G5 p/ mserum testosterone level. There also is other evidence of local
response to testosterone with hair growth and with spermato-
$ e9 u- m9 t" v$ |4 t' Ygenesis. 5• 6
Administration of larger doses of gonadotropin or systemic
; ^4 D1 `" J( O" w. ntestosterone, as well as topical applications that produce
5 q- p6 z2 A) S  P+ ^higher levels of serum testosterone (150 to 900 ng./dl.), will
7 W  U, a+ w. z# g# P$ @also produce phallic growth but risks accelerated skeletal
( W( \' j* A1 J3 K( imaturation even after stopping treatment. It would appear
1 j4 d7 `) B$ V8 P- _. Ethat this may be avoided by topical applications of testosterone
and 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
) @+ Q/ c* s  u& R/ \suffer accelerated bone growth with testosterone levels near
' f' Q7 x, a; y& N* l. @200 ng./dl. When skeletal maturation is complete the level of
$ G* w7 U) U  L4 I' g) }serum testosterone can be maintained in the 700 to 1,300 ng./
* i0 c3 D; Z* Y8 y; t( p  {6 Qdl. range to stimulate phallic growth and secondary sexual
changes. Therefore, after skeletal maturation parenteral tes-
2 E6 x/ c9 X  P, x$ [tosterone may be used to advantage. Before skeletal matura-
) {2 `$ T6 }! G8 S0 O3 \7 x/ gtion care must be taken to avoid maintaining levels of serum
testosterone more than 100 ng./dl. Low-dose gonadotropin
depends upon intrinsic testicular activity and may require
prolonged administration for any response.
' V* L/ n8 ^, n' Q1 n9 N- e0 IAlternately, topical testosterone does not depend upon tes-
ticular function and may provide a more constant level of
: r! r* X& a4 J& WREFERENCES
5 i" i9 t" Y  A1. Immergut, M., Boldus, R., Yannone, E., Bunge, R. and Flocks,
R.: 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.,
& O6 J( e; G( v5 u- g7 ?4 O6 h* {83: 247, 1973.
9 }" ?, A7 G7 C4 M* \3. Jacobs, S. C., Kaplan, G. W. and Gittes, R. F.: Topical testoster-
6 _$ Y. q/ C# R9 \one therapy for penile growth. Urology, 6: 708, 1975.
5 n; P5 o1 x9 ^4. Wilson, J. D. and Walker, J. D.: The conversion of testosterone
. J, E: h' t- K9 }" h8 M3 Yto 5 alpha-androstan-17 beta-01-3-one (dihydrotestosterone) by
skin 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.
1 w$ l8 A* s6 K8 G. eUrol., 104: 774, 1970.
9 G5 ]' N( C' H; b* p: J) W' z7. Schonfeld, W. A. and Beebe, G. W.: Normal growth and varia-
" Y4 S6 q9 M% `1 f. r6 J5 ~4 h2 H7 j0 Htion in the male genitalia from birth to maturity. J. Urol., 48: