ANDROGEN DEFICIENCY IN AGING MEN - 07/09/11
Résumé |
The concept that the testes contain some magical substance that enhances vigor has existed since ancient times. Galen wrote in Peri-Spermatos: “What is, therefore, the cause that castrates slow down in their whole vital capacity?”10 Ayruvedic medicine advocated ingestion of testes to treat impotence and obesity, and more than 2000 years ago, Pliny prescribed eating testicles to improve sexual vigor.
In 1889, Brown-Sequard8 reported that he had reversed his own age-related problems by injecting himself with testicular extracts. In his carefully written report, he acknowledged that the effect could have been a placebo one. Brown-Sequard's report unleashed a flurry of testicular extract treatment that continued throughout the end of the nineteenth century and the early part of the twentieth century. The leading proponent of this approach was Voronoff, who in the 1920s charged up to $5000 for a chimpanzee testicular transplant into the rich of Europe.23 A human-to-human testicular transplant was performed by Lespinasse in Chicago.10 Stanley at San Quentin prison transplanted fresh testicles from executed inmates into other prisoners. The physicians who popularized testicular extract transplants became renowned as the erector doctors. By the end of World War II, testicular transplants had led to a backlash, and Pincus, a leading American endocrinologist,26 wrote that testes transplants had been “obnoxiously publicized in the late nineteenth and twentieth centuries” and, in his opinion, had derailed the development of endocrinology by “the exploitation of the idea of rejuvenation by hormones.”
In 1935, Laqueur of Organon reported successful extraction of pure testosterone from bulls' testicles.12 In the same year, Butenandt and Hanish9 and Ruzicka and Wettstein49 both reported a method to synthesize testosterone from cholesterol. For their work, they received the Nobel Prize in 1939. In 1940, Thomas and Hill53 reported successful treatment of the male climacteric with testosterone propionate. This report was followed in 1944 by one in the Journal of the American Medical Association on the use of testosterone to treat the male climacteric.25 In some of their 20 cases, Heller and Myers25 used sesame oil as a placebo to rule out the placebo effect. Between this time and the 1970s, many physicians treated the male climacteric with testosterone. A leading proponent of this therapy was Reiter, a German physician.47 Only in the last few years has sufficient scientific evidence been accumulated to begin to satisfy the medical establishment that testosterone levels decline with age and that testosterone replacement therapy may play a role in enhancing functional capacity as well as increasing libido as men age.
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| Address reprint requests to John E. Morley, MB, BCh, Division of Geriatric Medicine, St. Louis University Health Sciences Center, 1402 S. Grand Boulevard, Room M238, St. Louis, MO 63104 |
Vol 83 - N° 5
P. 1279-1289 - septembre 1999 Retour au numéro
Article précédent
- ERECTILE DYSFUNCTION IN THE AGING MAN
- Fran E. Kaiser
- THE OLDER MAN'S HEART AND HEART DISEASE
- Wilbert S. Aronow
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