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Influence of exogenous testosterone on sperm production, seminal quality and libido of stallions.

The effect of exogenous testosterone on sperm production, seminal quality and libido was studied in 24 stallions. Based on pretreatment data, a stallion was assigned to 1 of 3 groups each containing 8 animals. One member of each group received 0 (Group 1), 50 (Group 2), or 200 micrograms (Group 3) testosterone propionate per kg body weight every 2 days for 88 days. The lower dose of testosterone had no significant effect on most of the parameters studied: the higher dose depressed total scrotal width at Day 90 post-treatment (P less than 0.01), total spermatozoa ejaculated between Days 60 and 90 (P less than 0.01) and 96 progressively motile spermatozoa between Days 60 and 90 (P less than 0.10). One half of the stallions from each treatment were castrated on Day 90. In the operated stallions, the mean number of spermatids per g testicular parenchyma in the controls (Group 1) was significantly (P less than 0.05) higher than that in Group 3 whereas the difference between the number of spermatids/testis in the same stallions of these two groups was significant only at P less than 0.1. Testosterone propionate treatment did not influence time to erection, interval from first mount to ejaculation or number of mounts per ejaculation. The treatment of normal, intact stallions with testosterone propionate did not enhance libido and caused a severe depression of reproductive capacity.

Animals

Decreased libido--a side effect of carbonic anhydrase inhibitor.

Thirty-nine cases of decreased libido in glaucoma patients on carbonic anhydrase inhibitors are reported. This symptom completely reversed or markedly improved after discontinuation of the drug in all cases. Twelve of these patients restarted their carbonic anhydrase inhibitor medication which resulted in a recurrence of decreased libido symptoms. There were 3 cases of impotency which reversed after discontinuation of the drug. Most likely, these symptoms are a result of the malaise and depression occurring in some patients on carbonic anhydrase inhibitor therapy.

Adult

Target sites for suppressing fertility in the male.

The present status and perspectives in the control of fertility in the male have been reviewed. There are two potential sites in the male reproductive processes that can be used as targets for regulation of fertility in the male: (1) inhibition of spermatogenesis, and (2) interference with sperm maturation in the epididymis. A variety of compounds tested for their antispermatogenic action in laboratory animals have no future for the control of fertility in the human male because of a number of undesirable side effects (cf. Prasad, 1973). Progestational compounds inhibit spermatogenesis by affecting the hypothalamo-hypophysial system and result in impairment of libido. The possibility of adjustment of the minimal dose of progestational compounds required to induce suppression of spermatogenesis and reduction of plasma testosterone to a level compatible with the maintenance of normalcy of libido and potency needs to be studied. A new approach to contraception in the male involves the use of a combination of progestational compounds for suppression of spermatogenesis along with testosterone (administered through silastic capsule implants or as intramuscular injections) for maintenance of libido and accessory sex gland function. A number of such combinations have been tested clinically with some success. However, the limitations of side effects, such as weight gain, gynecomastia, and psychological complications preclude their long-term use for contraception in man. Short-term use of these combination regimens by the male for 1 year followed by use of a contraceptive method by the female may be desirable to encourage partnership in family planning. Although testosterone and other androgens suppress spermatogenesis in man, the feasibility of their use for contraception depends on the establishment of a dosage and mode of adminstration that provide antispermatogenic action without causing more general metabolic alterations. Inhibition of spermatogenesis by selective interference with the action of FSH on the Sertoli cells by active or passive immunization or by selective suppression of synthesis and release of FSH by administration of "Inhibin" offers exciting possibilities in the control of fertility in the male. Studies on the physiology of the rete testis highlight its importance as a post-tubular site of action of antifertility agents in conveying (to the epididymis) compounds interfering with epididymal functions and/or viability of spermatozoa. A new approach to the induction of functional sterility in the male by selective alteration of epididymal function by a local androgen deprivation effect has been successfully tested in clinical trials. Small doses of cyproterone acetate, administered orally, result in maintenance of libido and accessory sex gland function accompanied by a decrease in the motility of ejaculated spermatozoa and incomplete inhibition of spermatogenesis...

Androgen Antagonists

New ideas on mental disorders.

Three types of mental disorder, based on libido-destrudo balances are introduced: (1) Hyperinstrumental-narcissistic type, or psychopathic type with destrudo object hypercathexis; (2) Dysmutual-cyclic type with libido-destrudo shifting cathexis; (3) Hypervectorial-schizotype with object hypercathexis of libido. Five levels of regression: neurosis, character neurosis, latent psychosis, psychosis, and dementia are linked to declining ego strength.

Bipolar Disorder

Clinical investigations for emotional effects of neuropeptide hormones.

After the demonstration that hypothalamic peptides can have a direct effect on the central nervous system, a series of studies was initiated to investigate the hypothesis that hypothalamic peptides could have an effect on emotions and affect. TRH was administered to 6 patients with endogenous depressions in a double-blind, cross-over design with transient improvements in the mental depression of 4 of the 6 patients. In a second study involving 8 seriously depressed patients given 1000 mug of TRH for 10 days, no significant antidepressant effect of TRH was observed. In a pilot, double-blind study of 18 women with endogenous depressions, the group receiving MIF-1 60 mg per day in a single daily dose for 6 days responded better than the placebo group, which in turn responded better than the group receiving MIF-1 150 mg per day. In a second, double-blind study testing MIF-1 in endogenous depressions, 5 patients met the criteria for substantial improvement out of a total of 8 receiving MIF-1 75 mg per day. In contrast, only one patient met these criteria in each of the remaining 2 groups, consisting of 10 patients receiving MIF-1 750 mg per day and 5 patients receiving placebo. Finally, 6 men complaining of decreased libido and/or potency were given intravenous injections of LHRH 700 mug or saline once daily for 3 consecutive days per week in a double-blind, cross-over design. In addition, 3 men were given much higher doses of LHRH in a single-blinded study. No substantial effect on libido or sexual performance was observed.

Adult

Treatment of idiopathic normogonadotropic oligoasthenospermia with synthetic luteinizing hormone-releasing hormone.

An assessment of the effectiveness of synthetic luteinizing hormone-releasing hormone (LH-RH) in the treatment of idiopathic normogonadotropic oligoasthenospermia was made in 21 subjects selected on the basis of at least three previous sperm counts; a history of long-standing infertility; normal urinary gonadotropin excretion; normal serum levels of luteinizing hormone, follicle-stimulating hormone, and testosterone; and lack of any evidence of other clinical, endocrine, vascular, infectious, and/or urologic involvement. On testicular biopsy, 14 patients showed hypospermatogenesis or arrest up to the spermatid stage (group 1), while the remaining 7 had more severe spermatogenetic disorders (group 2). Libido and/or potency were previously unaltered in all subjects. Five patients in group 1 and five patients in group 2 received intramuscular injection of 100 to 500 mug of LH-RH daily for no less than 60 days (long-term treatment); the remainder received the drug for 30-day periods, with 30-day intervals (short-term treatment). Qualitative and quantitative assessment of the results during and after treatment showed frank improvement in spermatozoal concentration, vitality, and motility in group 1 patients, particularly in those undergoing long-term treatment (three of five patients under these conditions were able to impregnate their wives). The long-term regimen also resulted in predomantly qualitative improvements in group 2 (one of five patients impregnated his wife). The short-term regimen was less effective. Improvements under either regimen usually occurred at the end of, or after, treatment. Six of seven patients in group 1 who were followed for a long period retained values above preliminary values for 90 to 150 days after the drug was discontinued. Increased libido and potency were spontaneously reported by 15 patients, 20 to 30 days after the start of administration of synthetic LH-RH.

Cell Count

Evidence for hyperoestrogenaemia as a risk factor for myocardial infarction in men.

Fifteen men who had had a myocardial infarction between the ages of 32 and 42 years were compared with fifteen age-matched healthy men. Seven of the patients had a strikingly slow rate of beard growth, three had evidence of gynaecomastia, and three had a loss of libido. The slow beard growth and decreased libido, and possibly the gynaecomastia, preceded the myocardial infarction. Mean serum oestradiol and oestrone concentrations were significantly increased in the patients, 43.5 +/- 8.8 (standard deviation) and 50.7 +/- 9.5, respectively, compared wth 33.5 +/- 5.5 and 37.5 +/- 5.8 pg/ml in the controls (p less than 0.001). Mean serum testosterone and dihydrotestosterone concentrations were not significantly different in the two groups. Serum oestradiol and oestrone concentrations were directly proportional to each other as were those of testosterone and dihydrotestosterone. These results suggest that the hyperoestrogenaemia preceded the myocardial infarction and that hyperoestrogenaemia may be an important risk factor for myocardial infarction in men.

Adult

Cyclical combination chemotherapy and gonadal function. Retrospective study in males.

The effect of cyclical chemotherapy on fertility and gonadal function was investigated in seventy-four male patients who had been treated for advanced Hodgkin's disease. All patients were azoospermic after therapy, and, with a median follow-up period of 27 months (range 1--62 months), only four patients have regained spermatogenesis. Testicular biopsy showed an absence of germinal epithelium without other gross architectural changes. Despite this high degree of infertility, 60% of patients were practising contraception. A decline in libido and sexual performance with frequent long periods of sexual inactivity was noted by most men during therapy. Although some recovery was apparent once therapy was stopped, this was incomplete in approximately half of the patients. Follicle-stimulating-hormone levels were consistently raised after therapy at all periods of study. Median luteinising-hormone levels were at, or just above, the upper limit of normal, and median testosterone levels were normal. Increased prolactin levels were noted in 42% of patients, of whom about a half had an identifiable cause for hyperprolactinaemia. Return of spermatogenesis could not be predicted by serial hormone assessment. Because of the guaranteed infertility and the low frequency and unpredictability of recovery of spermatogenesis, sperm storage should be available for male patients undergoing cytotoxic therapy, since most of these patients may enjoy prolonged survival. Hormone-replacement therapy will usually be unnecessary. However, the probability of major changes in libido and sexual performance should be discussed with patients so that additional stress can be avoided. Contraceptive advice should be available to those who require it.

Adolescent

Demoniacal possession and psychoanalytic theory.

Psychodynamic explanations of demoniacal possession have been based mainly on Freud's retrospective interpretation of the illness of Christoph Haitzman. Freud applied libido theory to his analysis of the case and subsequently influenced the psychoanalytic theory of paranoid symptom formation and the psychoanalytic approach to the psychoses. Fairbairn, and later Guntrip, applied an object relations theory to the case and conceptualized demoniacal possession in terms of bad internalized objects. They used the example of Haitzman to illustrate an object relations approach to the understanding and treatment of severely disturbed patients. In this paper the psychoanalytic treatment of a case of demoniacal possession is described to indicate the multiple dynamic meanings which possession may have and to demonstrate the necessity for integrating and applying aspects of libido and object relations theories. Current trends in psychoanalysis are towards recognizing the psychotic core which is frequently masked by an apparently psychoneurotic illness so that analysis must reach beyond oedipal conflicts to the primitive internalized object relations. A psychoanalytic study of demoniacal possession contributes much to the understanding of such patients but particularly to the conceptualization of borderline and psychotic states. It is in the treatment of these patients that the role of the psychotherapist is more akin to that of the exorcist.

Adult