Stilbestrol Induced Testicular Degeneration in Hypersexual Males

Abstract

A 27-yr.-old white [male] sex criminal and a 12-yr.-old negro [male] had histories of sexual offences against minor [female][female], premature sexual activity, and abnormally large genital development. Urine bioassays revealed excessive amts. of androgen in both cases and estrogen deficiency with excessive gonadotrophin in the adult [male] (Case 1). Case 1 received orally 5 mg. of stil-bestrol daily for 60 days; subsequently every other day until 565 mg. were administered. Case 2 received 5 mg. daily with a total of 375 mg. In Case 1 after 300 mg. there was a loss of libido, infrequent erections, onset of testicular atrophy; 480 mg. produced a 1/3 reduction in the size of the penis and testes, pronounced bilateral gynecomastia, intense areolar pigmentation and impotence. Five hundred mg. maintained these effects and bilateral testicular biopsies demonstrated complete degeneration of epithelial cells (therapeutic sterility) and reduction of interstitial cells. Total dosage 565 mg. in 5 mos., sexual desire and erection recurred in 4 mos. The penis increased 1/2 in. in length. Gynecomastia disappeared and testicular biopsies revealed advanced regeneration and the presence of spermatozoa. Urine bioassay values were androgen, 180 r. u., estrogen 30 r. u., A.P.L. 75 r. u. as compared to pretherapy assays of 300, 20 and 120 r. u., respectively. Oral adm. of stilbestrol in Case 2 duplicated the effects observed in Case 1. Recurrence of libido, erections, behavior problems, senile growth, and disappearance of gynecomastia occurred within 2 mos. after discontinuing therapy. Testicular biopsies showed a less advanced regeneration of testicular epithelial cells, and 24-hr. urine androgens were 52 i.u. (high normal). Therapy was resumed in both cases. It is estimated that 300 mg. of stilbestrol in 5 mg. doses will cause a recurrence of the therapeutic effect.