Treatment Of Hypogonadism And The Anatomy And Physiology Behind The Sexual Act

Primary attention should be given to the etiological factor.

Androgen replacement: Androgens are given as supplements if Leydig cell inadequacy is present. The available oral preparations are testosterone propionate (10 mg), methyltestosterone (10 mg) or mesterolone (75 mg). Parenteral preparations such as testosterone propionate (50 mg) or testosterone phenylacetate (200 mg) may be given as depot doses once in 2 weeks. Troublesome side effects of androgens are the development of precocious puberty, premature dusion of epiphyses in children, hyspepsia, polycythemia, suppression of endogenous androgens and temporary cessation of spermatogenesis. Prostatic carcinomas may spread under the influence of androgens. Rarely, androgens produce hepatic adenoma on prolonged therapy. Androgen withdrawal leads to tiredness, loss of libido, impotence and hot flushes.

Secondary hypogonadism due to hypopituitarism is treated with gonadotropins. Three gonadotropin preparations are in current use. All of them are polypeptides. They are inactivated when given orally and they have to be given parenterally.

Human chorionic gonadotropin: (HCG). This has got mainly LH activity with only slight FSH activity. HCG is available as a powder in vials of 5000, 10000 and 20000 IU with 10 ml diluents (Antuitrin-S, pregnyl). It stimulates the Leydig cells to secrete androgens.

Human pituitary gonadotropin (HPG): It has strong FSH and weak LH activity. A dose of 1 mg is equivalent to 500- 750 IU. The HPG is used along with HCG in the medical treatment of infertility.

Human menopausal gonadotropin (HMG): The available preparation (Pergonal) has 75 IU units each of LH and FSH activity. It is similar in action to HPG with mainly FSH activity. The usual regimen is to give HMG 75 IU daily for 9 to 12 days to be followed by a single dose of 10,000 units of HCG. In women this course stimulates ovulation. In males it stimulates spermatogenesis.

Indications for gonadotropins are anovulatiory infertility, cryptorchism, delayed puberty, and hypogonadrotropic hypogonadism.

Though, secondary hypogonadism is usually secondary to panhypopituitarism, less commonly, isolated hypogonadotropic hypogonadism may occur. The main features are eunuchoidism, infertility and impotence. Kallman syndrome is the combination of testicular failure, eunuchoidism, cryptorchism, and anosmia. When spermatogenesis persists in the absence of Leydig cell activity, with underandrogenic sation, it is called “fertile-eunuch syndrome”.

The Sexual Act

The capacity for erection, emission, ejaculation of semen and orgasm are all together implied in the term sexual potency. The neural center for erection is situated in S₂ to S₄ segments of the spinal cord. Tactile stimulation of erotogenic zones in the body activate this center. Penile erection is brought about by parasympathetic stimulation. Emission consists of ampullar emptying of semen into the posterior urethra. This is under control of the ejaculatory center of the spinal cord located in L₂ and L₃ segments. Ejaculation jets of semen are expelled through the urethra. The total somatic and psychological experience accompanying ejaculation is called orgasm.