Hormonal environment following treatment with a small dose of estrogen--small dose of estrogen alone and in combination with an anti-androgen

The testosterone, luteinizing hormone (LH), follicle stimulating hormone (FSH) and prolactin levels were measured by radioimmunoassay up to one year in 21 patients with prostatic carcinoma treated with diethylstilbestrol diphosphate (DESP), 50 mg/day, and chlormadinone acetate (CMA), 100 mg/day. The purpose of this treatment was to reduce the cardiovascular side effects which were believed to occur dose-dependently and to achieve the direct drug action to the prostate gland. The same measurements were made on 9 patients treated with DESP, 50 mg/day, alone. Marked reduction of plasma testosterone and FSH levels with weaker LH suppressions was observed during the first 1-3 months in both groups. The same levels were maintained up to the end of follow-up in DESP and CMA treatment group. In the DESP treatment group, the plasma level of testosterone showed a gradual increase to 1.0 +/- 0.5 ng/ml at the sixth month. Prolactin level increased gradually in both groups. Cardiovascular side-effects were found in 29% of the patients treated with DESP and CMA and in 22% of those treated with DESP alone. In two patients in the former group gynecomastia with lactation was observed.     

Effects of long-term testosterone administration on pituitary-testicular axis in end-stage renal failure

The endocrine effects of long-term testosterone administration were studied in 6 end-stage renal failure patients. During a 3-month control period where no androgens were administered the mean plasma testosterone level (7.3 nmol/l) was depressed while mean plasma follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (PRL) levels were elevated at 41.2 mU/ml, 105.5 mU/ml, and 63 ng/ml, respectively. These values were repeated during a 6-month study period where each subject was administered testosterone enanthate (400 mg) intramuscularly once a week. Plasma testosterone levels markedly increased in all subjects with a mean elevation of 72.4 nmol/l, while reductions were observed in FSH and LH levels with values of 2.7 and 16.3 mU/ml, respectively. When compared with control period values, these changes were statistically significant (p less than 0.05). Although the mean plasma PRL level of 49.0 ng/ml was reduced when compared with the control period values, this reduction was not statistically significant. Our control period findings of low plasma testosterone levels coupled with high plasma LH and FSH are consistent with Leydig cell dysfunction. The significant reductions in plasma FSH and LH noted during the study period indicate a negative feedback effect produced by the pharmacologic doses of testosterone. Long-term testosterone administration, however, did not significantly affect the elevated mean PRL levels observed in these subjects.     

Endocrine response to a single injection of goserelin 3.6 mg or leuprolide 3.75 mg in men with prostate cancer

Hormonal responses were assessed in men with prostate cancer (T2-4, Nx, Mx) who were randomized to receive either a single injection of goserelin 3.6 mg or leuprolide 3.75 mg. Testosterone increased over the first week, with a significantly higher mean rate of change of total testosterone (day 3) and free testosterone (days 3 and 7) with leuprolide. Following the initial rise in luteinizing hormone (LH), the rate of decrease in LH levels was significantly greater with goserelin by day 28. There are significant differences in endocrine response to goserelin and leuprolide in the 4 weeks following administration.     

Basal and LHRH-Stimulated Gonadotropin Levels and the Circadian Rhythm of Testosterone and the Effect of Exogenous Testosterone Thereon

In seven eugonadal men, aged 20-26 years, a fall in plasma and saliva testosterone (T) levels between 8.00 and 16.00 h of the day was observed, but plasma oestradiol-17 beta levels did not show a significant variation. These findings substantiate the existence of a circadian rhythm in T levels. Concurrent with the decrease of T levels over the day, a small but significant rise in basal LH, but not in LHRH-stimulated LH levels were observed. Then the fall of plasma and saliva T levels over the day was prevented by the administration of 80 mg testosterone undecanoate (Andriol, Organon) by mouth at 8.00 h. A rise in plasma T and even more in saliva T levels was measured, which persisted till at least 16.00 h. At this hour basal LH, but not LHRH-stimulated LH levels appeared to be slightly, though significantly depressed. From our data we conclude that fluctuations of T levels of the magnitude of 25% around the baseline values, affect slightly basal LH levels, but not LHRH-stimulated LH levels.     

Bromocriptine and the hypothalamic hypophyseal function in patients with chronic renal failure on chronic hemodialysis

Ten patients with chronic renal failure on chronic hemodialysis had the following tests to evaluate the integrity of the hypothalamic hypophyseal axis: (A) glucose tolerance test, (B) thyrotropin releasing hormone stimulation test, (C) clonidine stimulation test, (D) insulin induced hypoglycemia, and (E) LH/RH stimulation test. The majority of those tests were abnormal and prolactin values were found to be moderately elevated in all the patients. Bromocriptine (1.25 mg twice a day) was given to all the patients for 1 month and then, while on bromocriptine, the tests were repeated. Although there is a decrement in the concentration of serum prolactin level, none of the hypothalamic hypophyseal abnormalities were corrected. However, five of the ten patients reported an improvement of their impotence with bromocriptine. The patients who responded had high levels of FSH and LH with levels of testosterone above 1 mg/mL. The nonresponders had low FSH and LH levels and very low testosterone levels. Therefore, bromocriptine, although possibly beneficial in some dialysis patients, is not a drug that can normalize abnormal functioning of hormones in the dialysis population.     

它莫西芬对促性腺激素、睾酮及精液参数影响的研究

本文报告它莫西芬治疗特发性少精症对卵泡刺激素_(ESH)、黄体生成素_(LH)、睾酮(T)以及对精子数量、活力、精浆果糖等参数的影响。采用的双盲法对39例受试者分为实验组、实验对照组、安慰组。结果表明服用它莫西芬20mg/日3个月,可以明显增加血中FSH、LH、T水平,对精子活力,精浆果糖浓度无明显影响。对精子密度在3个月服药期间个体差异较大,均数无明显增加。从临床角度而言,它莫西治疗特发性少精症不育可能对配偶妊娠是有益的。     

Bromocriptine therapy in oligozoospermic infertile men

A prospective, randomized double-blind study with crossover using bromocriptine and placebo was performed on a group of 17 infertile males with idiopathic oligozoospermia. Twelve patients completed the duration of this study of eight months by receiving 5 mg of bromocriptine per day for four months followed by four months of placebo or vice versa. Prior to treatment, the sperm count was 8.76 +/- 1.32 (10(6)/ml). The hormonal profile was performed prior to treatment and included estimation of prolactin, T3, T4, thyroid stimulating hormone (TSH), testosterone, follicle stimulating hormone (FSH), and plasma LH. Stimulation studies using LHRH and TRH were also performed. All hormonal estimations were within normal limits. Compared to placebo, bromocriptine had no significant effect on sperm analysis, or basic hormonal profile. The stimulation test with luteinizing hormone releasing hormone (LHRH) was unchanged except for the basic plasma testosterone, which increased. The prolactin decreased following the thyrotropin releasing hormone (TRH) stimulation. Two pregnancies were noted four to six weeks following the end of treatment. Bromocriptine did not seem to be more effective than placebo in the treatment of idiopathic oligozoospermia.     

Serum hormone levels in patients with malignant testicular germ cell tumours without clinical and/or radiological signs of tumour

In patients treated for malignant testicular tumours without clinical and/or radiological signs of tumour, the following serum hormone levels were found: In 15% of the patients there was a slight to moderate rise in luteinising hormone (LH) levels (up to 6 micrograms/l) due to increased pituitary gonadotrophin production; this was particularly evident soon after radiotherapy/chemotherapy. In 50% of the patients there was a slight to marked increase in follicle stimulating hormone (FSH) levels (up to 11 micrograms/l), especially after radiotherapy/chemotherapy. Serum testosterone levels were in the low range (up to 20 nmol/l) in the majority of the hemicastrated patients regardless of previous treatment. A slight to moderate rise in serum oestradiol-17 beta and serum prolactin levels was noted. During combination chemotherapy with vincristine, Adriamycin D, cyclophosphamide, actinomycin D and medroxyprogesterone acetate the serum testosterone levels were extremely low (below 6 nmol/l) with LH and FSH levels within the normal range. The decrease in testosterone levels was reversible after completion of the combination chemotherapy.     

Some effects of furazolidone on the testis and plasma levels of testosterone, luteinizing hormone and prolactin in mature male turkeys

Adult male turkeys were treated orally with furazolidone at doses of 1, 2.5, S or 20 mg/kg for 14 days and their plasma analysed for luteinizing hormone (LH), testosterone and prolactin (PRL) concentrations before, during and after treatment. At 20 mg/kg the drug produced a significant decrease in the plasma levels of LH and testosterone at the end of treatment, whereas at 5 mg/kg the drug had no significant effect. Prolactin concentrations were unaffected by any of the drug doses used. Intramuscular injection of luteinizing hormone releasing hormone (LHRH) at a dose of 5 μg/kg produced after 30 min a significant rise in plasma levels of LH, an effect that was decreased significantly by treatment with 20 mglkg furazolidone. Incubation of normal turkey semen with graded doses of furazolidone or nitrofura-zone for up to 30 min resulted in a dose- and time-dependent decrease in sperm motility. At a concentration of 20 mg/ml a complete absence of sperm motility was observed after incubation with either drug, although, on the whole, nitrofurazone seemed more potent than furazolidone as a sperm-immobilizing agent. Histological changes occured in the 20 mg/kg group and consisted of a decrease in spermatocyte production, corrugation of sperm cell nuclear envelopes and distention of the endoplasmic reticulum of elongate spermatids. It is concluded that furazolidone depresses pituitary LH output but may, in addition, directly affect spermatogenesis and sperm motility.     

Cyclosporine-induced alterations in the hypothalamic hypophyseal gonadal axis in transplant patients

We evaluated the response of 20 male patients, 13 cadaveric kidney and 7 heart transplant recipients, to the administration of 100 micrograms GnRH (gonadotropin-releasing hormone) and 500 micrograms TRH (thyrotropic-releasing hormone). All of the heart transplant recipients and 7 of the kidney transplant patients were receiving a combination of cyclosporine, azathioprine and prednisone; while the 6 remaining kidney transplant patients received azathioprine and prednisone. The patients receiving cyclosporine had decreased plasma levels of prolactin, and manifested a blunted response to TRH administration for prolactin and TSH. The heart transplant patients had a blunted response of LH and FSH to the administration of GnRH. The levels of testosterone were found to be low in all patients regardless of the immunosuppressant therapy. Despite the low testosterone levels, no increment in the concentration of LH or FSH was present. Intramuscular administration of HCG (human chorionic gonadotropin) (Ayerst Laboratories, New York, N.Y.) failed to increase the testosterone concentration in 5 of 6 patients with renal transplants, 3 taking cyclosporine and 3 taking azathioprine. This study suggests that cyclosporine has a selective effect on the hypothalamus and/or hypophysis, resulting in lower baseline levels of plasma prolactin and a pituitary insensitivity to TRH administration. In addition, FSH and LH were low or normal in the presence of low testosterone levels, suggesting that the hypothalamic pituitary gonadal axis is impaired. Furthermore, there may be a direct toxic effect of the immunosuppressant medications on the gonads, manifested as lower testosterone levels and inability to respond to the administration of HCG.     

Influence of orchidectomy or oestrogen treatment on serum levels of pregnancy associated alpha 2-glycoprotein and sex hormone binding globulin in patients with prostatic cancer

Peripheral serum levels of testosterone, immnunoreactive oestrogens (E₂), FSH, LH, prolactin and growth hormone (hGH) and two steroid-sensitive proteins, 'pregnancy-associated α₂-glycoprotein' (α₂-PAG) and sex hormone binding globulin (SHBG), were measured in patients with prostatic cancer before treatment and after orchidectomy or during combined oral and intramuscular oestrogen treatment. Following orchidectomy, the serum levels of testosterone and E₂ decreased whilst the levels of FSH and LH increased significantly. No changes were noted in the serum levels of α₂-PAG, SHBG or prolactin. Oestrogen treatment significantly decreased the serum levels of testosterone, FSH and LH whilst levels of α₃-PAG, SHBG and prolactin were increased significantly. Serum levels of hGH during oestrogen treatment were significantly higher than in patients subjected to orchidectomy. These data are at variance with the established dogma of the oestrogen/androgen balance as a physiological regulator or liver protein synthesis, and indicate that factors other than the endogenous steroids may be operative. hGH may play an important role in this respect.     

Testosterone levels after bromocriptine treatment in patients undergoing long-term hemodialysis

Seventeen out of 34 male patients undergoing long-term hemodialysis had increased basal plasma prolactin levels (mean = 1344 +/- 1158.76 mU/L). Seven of these 17 patients having the greatest degree of erectile impotence were treated with 3.5 to 7.5 mg/day of bromocriptine. After a 4-week treatment period, basal plasma prolactin levels in all seven patients were within normal limits (mean = 210.2 +/- 66.97 mU/L). The treated patients reported an improvement in both libido and potency. At the same time, an increase in plasma testosterone levels was observed, while plasma LH and FSH levels were essentially unchanged.     

Relationship between hormone levels and testicular biopsies of azoospermic men.

This study was conducted to evaluate the testicular biopsies and the sera levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), testosterone (T), and prolactin (PRL) in 96 azoospermic men attending the Andrology Clinic. Plasma levels of FSH were the most common hormone abnormality in the evaluation of azoospermia. Plasma levels of LH and T were useful only in azoospermic men with hypogonadism, whereas plasma PRL levels rarely occurred in azoospermia.     

益气养血颗粒对绝经前乳腺癌患者内分泌功能的调节作用

目的：探讨绝经前乳腺癌患者内分泌功能变化及中药益气养血颗粒对其调节作用。方法：采用放射免疫分析法对１２５ 例乳腺疾病患者的性激素孕酮（Ｐ） 、雌三醇（Ｅ３） 、睾酮（Ｔ） 和促性腺激素促卵泡生成素（ＦＳＨ） 、促黄体生成素（ＬＨ） 及催乳素（ＰＲＬ） 进行检测研究。同时给予化疗和中药治疗。结果：绝经前乳腺癌患者体内Ｅ３ 和Ｐ水平明显降低,Ｔ和ＰＲＬ明显升高,化疗后患者在一定程度上出现了类似绝经后的改变。结论：绝经前乳腺癌患者内分泌功能明显异常,化疗对绝经前患者的治疗作用可能一部分是通过影响机体内分泌机制实现的。益气养血颗粒对患者激素水平具有调节作用,与化疗对内分泌机制的影响具有协同作用。     

Hormonal environment and antiandrogenic treatment in benign prostatic hypertrophy

The plasma luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin, testosterone and human growth hormone (HGH) response to insulin-induced hypoglycemia in patients with benign prostatic hypertrophy and age-matched control patients were not different. Although all 6 drugs used were effective for treating these benign prostatic hypertrophy patients the 3 drugs, chlormadinone acetate, oxendrone and allylestrenol, were especially recommended.     

The oestrogenic effects of ethinyl oestradiol/polyoestradiol phosphate and estramustine phosphate in patients with prostatic carcinoma. A comparative study of oestrogen sensitive liver proteins, gonadotrophins and prolactin

Thirty previously untreated patients with carcinoma of the prostate were prospectively randomised to one of the following treatments: ethinyl oestradiol (Etivex) combined with polyoestradiol phosphate (Estradurin); estramustine phosphate (Estracyt); bilateral orchiectomy. Oestrogenic effects were measured by blood levels of pregnancy zone protein, sex hormone binding globulin, LH, FSH and prolactin. During a follow-up period of 6 months, estramustine phosphate and ethinyl oestradiol/polyoestradiol phosphate induced comparable changes in these proteins, suggesting comparable oestrogenic effects of these two forms of treatment in patients with prostatic carcinoma.     

Effect of hyperprolactinemia and age on the hypogonadism of uremic men on hemodialysis

Primary hypogonadism has been commonly reported among uremic men on hemodialysis, characterized by low testosterone levels, increased luteinizing hormone and sometimes follicle-stimulating hormone levels. Little is known about the influence of hyperprolactinemia and age on this hypogonadism. In 149 hemodialysis patients and in 60 healthy subjects the serum levels of testosterone (T), gonadotropins (LH and FSH) and prolactin (PRL) were assessed through radioimmunoassay. Mean +/- SD hormone levels were: T 274 +/- 125 ng/100 ml, lower than controls; LH 44.7 +/- 46.1 mlU/ml and FSH 17.6 +/- 18.4 mIU/ml, both higher than controls. PRL 31.3 +/- 49.4 ng/ml, higher than controls. A positive correlation between LH and FSH, a negative correlation between PRL and both T and LH was found. Moreover T and FSH were correlated with age only in the normoprolactinemic patients. These data suggest: a common damaging mechanism by uremia on both interstitial and tubular structures of the testis; a central antigonadal influence of hyperprolactinemia even if a direct action on the testis cannot be excluded; a worsening action of age on the gonadal function of these patients.     

Chemohormonal therapy as primary treatment for metastatic prostate cancer: A randomized study of estramustine phosphate plus luteinizing hormone-releasing hormone agonist versus flutamide plus luteinizing hormone-releasing hormone agonist

BACKGROUND: The present study was undertaken mainly to investigate whether chemohormonal therapy with estramustine phosphate plus luteinizing hormone-releasing hormone (LHRH) agonist has a more beneficial effect than the hormonal therapy with flutamide plus LHRH agonist for newly diagnosed patients with metastatic prostate cancer. METHODS: A total of 57 patients with metastatic prostate cancer aged 59-80 years (median 74 years) were entered in the study and were randomized to the treatment of estramustine phosphate (560 mg/day) plus LHRH agonist (estramustine group) or flutamide (375 mg/day) plus LHRH agonist (flutamide group) with stratification for the degree of performance status, histological differentiation and bone metastasis. RESULTS: Both of the treatment regimens were well tolerated with similar incidences of adverse drug reactions. The overall response rates (complete response plus partial response) at 12 weeks after treatment in the estramustine and flutamide groups were 76 and 55%, respectively. The median time to objective progression for the estramustine group (25.4 months) was longer than that of the flutamide group (14.6 months). The serum levels of follicle stimulating hormone and testosterone were significantly lower in the estramustine group. CONCLUSIONS: Chemohormonal therapy with estramustine phosphate plus LHRH agonist showed longer clinical progression-free survival than the hormonal therapy with flutamide plus LHRH agonist (P = 0.03), although there was no significant difference in the overall survival. A larger-scaled trial with more statistical power is required to clarify that the former regimen is more beneficial than the latter for newly diagnosed patients with advanced prostate cancer.     

Testicular endocrine function in patients with prostatic cancer receiving medical castration by long-term administration of LH-RH agonists

Six patients with advanced prostatic cancer who had been treated by long-term administration of LH-RH agonistic preparations (Buserelin or Leupron) were tested for their pituitary-testicular endocrine functions. Serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone (T), prolactin (PRL), estradiol (E2) and dihydrotestosterone (DHT) were measured consecutively. In all medically castrated patients, serum levels of LH, FSH, T, DHT and E2 were suppressed and particularly serum T levels were below the castration level of 1.0 ng/ml. On the other hand, serum PRL levels were unchanged after the long-term treatment with the agonists. Serum LH and FSH levels failed to respond to LH-RH stimulation after the treatment, whereas serum T responded to stimulation by human chorionic gonadotropin (hCG) to various degrees. It was remarkable that, in 4 out of 6 medically castrated patients treated up to more than 3 years, serum T response levels above 1.0 ng/ml were noted. It is suggested that testicular endocrine function to secrete T and DHT in patients under treatment with long-term LH-RH agonist administration are still preserved in response to hCG stimulation.     

The correlation between pretreatment serum hormone levels and treatment outcome for patients with prostatic cancer and bony metastasis

OBJECTIVE: To evaluate whether pretreatment serum hormone levels are a prognostic factor for prostatic cancer with bony metastasis under hormonal treatment. PATIENTS AND METHODS: Between 1980 and 1994, 96 patients with prostate cancer and bony metastasis were included for an evaluation by a retrospective review of their charts. All 96 had received hormonal treatment after a diagnosis of metastatic prostatic carcinoma. Serum testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and prolactin were assessed before treatment. The patients were divided into two groups according to their response during the follow-up. Group 1 (good response) had no change or resolution of metastatic lesion(s) on the bone scan and a declining prostate-specific antigen (PSA) level. Group 2 had increased PSA or progression of metastatic lesion(s) on the bone scan. Tumours were graded as low (2-4), intermediate (5-7) and high (8-10) using the Gleason score. RESULTS: There were 43 patients in group 1 and 53 in group 2; the overall mean (sd) age was 72.5 (6.8) years and the follow-up 29.5 (0.5) months. The respective mean (sd) levels of testosterone, LH, FSH and prolactin before treatment were 4.6 (1.6) ng/mL, 20.2 (13.3) mIU/mL, 19.6 (18.6) mIU/mL and 20.7 (12.1) ng/mL in group 1, and 2.6 (1.0) ng/mL, 27.3 (11.0) mIU/mL, 27.1 (9.8) mIU/mL and 41.3 (28.4) ng/mL in group 2. The level of testosterone was significantly higher in group 1 than in group 2, while LH, FSH and prolactin were significantly lower in group 1 than in group 2. When stratified by tumour grade, patients in group 1 still had significantly higher pretreatment testosterone and lower LH, FSH and prolactin than those in group 2. CONCLUSION: Higher testosterone and lower LH, FSH and prolactin levels were good prognostic factors for patients with metastatic prostatic cancer under hormonal treatment, irrespective of tumour grading.