Oestrogen modulation of gonadotrophin and prolactin release in women with anovulation and their responses to clomiphene

Male sexual function and its disorders: physiology, pathophysiology, clinical investigation, and treatment

This review is designed to help the reproductive endocrinologist integrate his or her professional activity with those of other disciplines including urology, radiology, neurology, and psychology in order to successfully manage all of the inseparable aspects of male sexual and reproductive functioning. Significant advances in the field of male sexual physiology and pathophysiology and new methods of investigation and treatment of male sexual disorders are outlined. The review synthesizes available data on the following: norms of sexual organs, aging and sexuality, role of central and peripheral neurochemicals in each stage of the sexual cycle, role of corporeal smooth muscles in the hemodynamic control of erection and detumescence, influence of psychological factors, drugs, and disease on all aspects of sexual functioning, and use of nocturnal penile tumescence monitoring, imaging investigations, and neurophysiologic studies in the diagnostic workup of males with sexual dysfunction. Clinical algorithms are presented where appropriate. Extensive discussions on newly developed strategies in psychological and behavioral counseling, drug therapy, tissue engineering, nonsurgical devices, and surgical treatments for all forms of sexual disorders are also provided. Lastly, the effect of sexual dysfunction and its treatment on quality of life in affected men is addressed, along with recommendations for future research endeavors.

Oestrogen-gonadotrophin feedback mechanisms in the puerperium

The effect of oestradiol benzoate on serum gonadotrophin concentrations before and after LHRH administration was studied in lactating and non-lactating women at 3 and 6 weeks post-partum. Except in the non-lactating women at 6 weeks, basal serum FSH concentrations were suppressed by oestrogen. There were no significant changes in basal concentrations of LH after oestrogen in the lactating women in either the 3- or 6-week studies. Individual increases in the basal LH concentrations in two out of six non-lactating subjects in the 6-week study occurred but overall there were no significant changes. In the 6-week study amplification of the LH response to LHRH was found in both groups, the effect being significantly greater in the non-lactating women. Overall FSH responses were also significantly different in the two groups, being suppression in those lactating ad amplification in those not lactating. The LH/FSH ratios following LHRH administration in the 6-week non-lactating study were similar to those seen in the early follicular phase in regularly menstruating subjects. The basal ratios in the lactating subjects were, however, significantly less than those seen in the non-lactating subjects both at 3 and 6 weeks. This difference was associated with the relative enhancement of LH release in non-lactating subjects and enhancement of FSH release in those lactating. Taken together the results indicate the presence of an intact negative feedback of oestrogen on gonadotrophin release in both groups being enhanced at 6 weeks post-partum in the lactating subjects; also in the lactating subjects at 6 weeks there was less amplification by oestrogen of the responsiveness of the anterior pituitary to LHRH. At 6 weeks, however, in the non-lactating group these responses were similar to those seen in normal regularly menstruating subjects. These dynamic endocrine studies suggest a possible hypothalamic-pituitary mechanism which may help to explain the delayed return of ovulatory cycles in lactating women.

Adrenal function in subgroups of the PCO syndrome assessed by a long ACTH test

Fifteen patients with the polycystic ovarian (PCO) syndrome were classified into Group A (n = 6) and Group B (n = 9) based on their LH responses to LHRH before and at 44 and 92h after administration of oestradiol benzoate. Adrenal function in both groups was assessed by comparing the hormone responses to ACTH (0.5mg twice daily for 4 days) with those obtained in nine normally ovulating women during the early follicular phase of their cycles. In Group A patients there was no significant difference from normals in the serum concentration of dehydroepiandrosterone sulphate (DHAS), 17 alpha-hydroxy-progesterone (17-OHP) or androgens (testosterone and dihydrotestosterone). In contrast, the serum concentrations in Group B were significantly higher (P less than 0.01) for each of these steroids before ACTH, and remained higher at 2 and 4 days for DHAS, but not for the other two steroids. The concentration of oestrone was significantly higher (P less than 0.05) in Group B patients before, and 2 days after, ACTH, while in Group A patients higher concentrations (P less than 0.02) were found only after 2 days. The concentrations of oestradiol, on the other hand, were not different from normal in either group before ACTH and became lower than normal in both groups at 2 days and remained lower at 4 days in Group B. The concentration of cortisol was within the normal range throughout in Group A, but was lower than normal after 4 days in Group B patients (P less than 0.05). The ratios between the sums of concentrations of DHAS to cortisol on days 2 and 4 (P less than 0.001) or 17-OHP to cortisol (P less than 0.05) were elevated in Group B compared with normal subjects. LH, FSH and prolactin values were normal throughout in Group A, but in Group B patients the mean value for LH was significantly elevated before ACTH and at 4 days after ACTH (P less than 0.02).