Studies of Male Hypogonadism. I. Androgen Metabolism in a Male with Gynecomastia and Galactorrhea1

Abstract

An 18-yr-old eunuchoidal male complained of gynecomastia and galactorrhea of 8 yr duration. Clinical studies excluded the gross lesions generally associated with these findings. The testostei'one excretion rate was low and showed a subnormal rise during acute stimulation with human chorionic gonadotropin despite a 3-fold increase in 17-ketosteroids. The control excretion of luteinizing hormone was normal. Spermatic vein analysis of steroids demonstrated secretion of dehydroepiandrosterone but not of testosterone or androstenedione. The conversion rate of androstenedione to urinary testosterone glucuronoside was reduced. The reduced testosterone excretion rate is best explained by a testicular defect in testosterone synthesis and in addition a diminished ability to convert precursors peripherally to testosterone glucuronoside.