CLASSIFICATION OF MALE HYPOGONADISM AND A DISCUSSION OF THE PATHOLOGIC PHYSIOLOGY, DIAGNOSIS AND TREATMENT*

Abstract

INTRODUCTION CLASSIFICATION, diagnosis and treatment of testicular failure have been radically altered and at the same time have been placed on a rational basis by the introduction of two important technics: 1) determining the alterations in microscopic anatomy of the testis from a study of biopsy specimens, and 2) determining the urinary excretion of pituitary gonadotropic hormones. The biopsy studies reveal whether the testicular lesion involves primarily the seminiferous tubules or the interstitial cells of Leydig. Biopsy studies also indicate the prognosis and treatment insof ar as they reveal whether the testicular tissue is irreparably damaged or is potentially capable of being stimulated. The urinary gonadotropins reveal whether the testicular failure is secondary to pituitary failure or whether it is primary. Thus instances of gonadal failure may be divided into two distinct groups: 1) those having distinctly higher than normal titers of gonadotropins—the hypergonadotropic syndromes, and 2) those having distinctly subnormal titers of gonadotropins—the hypogonadotropic syndromes.