Jean-François Servais

Basal Pituitary-Gonadal Function in Impotency Evaluated By Blood Testosterone and LH Assays

Psychogenic impotency is a frequent disease whose neuroendocrine and partic ularly androgenic component is not perfectly understood. It is known that in man late castration or testicular organic disease does not necessarily alter the sexual potency; this agrees well with the common clinical observations of the poor efficiency of exogenous testosterone in the treatment of “impotentia coeun-di”. Nevertheless, a net decrease of urinary testosterone excretion has been noticed by Ismail et al. (1970) in a group of 28 impotent patients; in that study, individual values were very widespread. This work has also shown a lack of responsiveness of testes to exogenous HCG in 4 cases tested; however, to our knowledge, no sensitive LH assay has been realized until now, so that the central response to that peripheric insufficiency is not known.

Hormones and sexual impotence

A review of recent studies on the roles of testosterone and prolactin, the two hormones most specifically involved in human male sexuality, reveals that much research work remains to be done in this field. Whilst it is clear, for instance, that androgens variously affect the human male in all life phases, their effects are not completely understood particularly where sexual problems are concerned. In the adult it is now clear that androgen plasma levels are not a reliable guide to sexual orientation. A complicating factor appears to be a disturbed gluco-lipidic function, even one not implying severe diabetes; it now seems likely that impotence in such cases stems not from a lack of androgens but rather from a peripheral arteriolar or neurological problem. The effect of prolactin on the brain and its action via 5α-reductase and/or through an influence on the dopamine hypothalamic turnover needs to be further investigated. It is hypothesized that a confirmation of an action of prolactin on androgen metabolism in the brain would suggest that some psychosexual disturbances may be caused by an excess of cerebral oestrogens; this, in turn, leads to the speculation that treatment with an oestrogen antagonist could be of therapeutic value. Much research is needed, however, before this stage is reached.

A preliminary study of psychoneuroendocrine relationships in psychogenic impotence

INTRODUCTION IN A PREVIOUS study we have shown that psychogenic impotence is associated with a mild disturbance of the pituitary-gonadal axis (Legros, Palem, Franchimont & Servais, 1973). However, the results obtained showed that there were considerable variations in the individual neuroendocrine values; this led us to postulate that there is more than one single disorder in this disease. I t is well known that both in animals and in man, excess exogenous or endogenous steroid leads to various psychological disturbances (Malleson, 1953; Hubble, 1963; Gabrilove, 1966; Hamburg, 1966; Persky, 1966; Kind, 1967; Ladisich & Baumann, 1971). Therefore in this preliminary study we have divided neuroendocrine status into three different groups and we have tried to ascertain if there is a relationship between androgen levels and psychological distress.