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PubMed1980

Steroids in spermatic and peripheral vein blood in testicular feminization.

Steroid secretion by the testes in three postpubertal patients with testicular feminization was studied by comparing the steroid concentrations in spermatic and peripheral blood samples obtained prior to gonadectomy. Testosterone, dehydroepiandrosterone (DHEA), and androstenedione were the predominant steroids secreted by these testes. Values for spermatic vein testosterone (60 to 700 nmoles/liter) were lower than those previously reported for normal men, but values for DHEA (20 to 240 nmoles/liter) and androstenedione (30 to 250 nmoles/liter) were within the range found in normal men. The testes of these three patients also secreted pregnenolone, progesterone, 17 alpha-hydroxyprogesterone, dihydrotestosterone, testosterone sulfate, and estradiol. After gonadectomy, the plasma concentration of estradiol declined considerably less than that of testosterone, indicating that estrogen formation from adrenal precursors continued after gonadectomy in these patients.

Adolescent↗
PubMed1992

Testicular feminization: the androgen insensitivity syndrome.

Testicular feminization (TF) is a syndrome due to androgen insensitivity. It occurs in a complete (CTF) and an incomplete (ITF) form. We have treated 21 patients with TF over the last 24 years. Eight patients presented because of ambiguous genitalia, seven presented as "females" with inguinal hernia and testes were found at surgery, five were diagnosed by karyotyping performed for a family history of TF, and one presented with an incarcerated hernia and primary amenorrhea. Two patients had prior surgery for inguinal hernia but the diagnosis was not recognized. All patients had a 46,XY karyotype. Patients with CTF were phenotypically female while those with ITF had a variable appearance of the external genitalia depending on the degree of androgen insensitivity. Seventeen patients underwent gonadectomy and one patient planned for delayed gonadectomy was lost to follow-up. Seventeen patients had been raised as females since birth. One patient with ambiguous genitalia, who was initially raised as a male, was reassigned female gender at 1 year of age when the diagnosis of ITF was made. Three patients were raised as males even after the diagnosis of ITF was made. Patients raised as males underwent multiple genital reconstructive procedures with poor results. In view of the poor anatomic and functional results of genital reconstructive surgery and the consequent psychological problems, patients with TF should be raised as female. Careful evaluation of infants with ambiguous genitalia and documentation of absent fallopian tubes in "females" presenting with inguinal hernia will lead to early diagnosis of TF, correct sex assignment, and early gonadectomy.

Adolescent↗
PubMed1981

Testicular feminization syndrome (androgen insensitivity).

Three children with testicular feminization syndrome have been seen in the past 4 yr. Each presented with at least one large inguinal hernia. The gonad was proven to be a testis by frozen section. Gonadectomy and herniorrhaphy were done. The plan is to remove the second gonad after puberty. The causation and genetics of this condition are briefly discussed.

Androgen-Insensitivity Syndrome↗
PubMed1986

Testicular feminization: a model for testicular descent in mice and men.

The position of the testis was determined in patients and mice with the testicular feminization (TFM) syndrome, to answer the question, do androgens cause testicular descent? In 16 children with complete or partial TFM syndrome with androgen insensitivity, plus two children with a deficiency of androgen secretion, the testes were at or beyond the internal inguinal ring in 35 out of 36 instances. In male mice with TFM, the testes had descended normally to the internal ring by the time of birth but further descent was absent. These observations suggest testicular descent is a two-stage process comprising transabdominal and transinguinal phases. The first phase is not controlled by androgen, and hence is normal in TFM; by contrast the second phase is androgen-dependent, and absent in TFM. It is speculated that the first phase may be regulated by Müllerian Inhibiting Substance, although this is unproven. Because testicular descent in TFM can be separated into two stages, the TFM mouse should prove a useful model for studying the hormonal control of descent of the testis.

Androgen-Insensitivity Syndrome↗
PubMed1993

Subtotal de-epithelialization and partial concealment of the glans clitoris: a modification to improve the cosmetic results of feminizing genitoplasty.

An unsatisfactory appearance of the external genitalia after otherwise successful genitoplasty may result from failure to reduce the size of a hypertrophied glans clitoris and change its appearance from a large bulbous structure to a small conical cap. A more pleasing cosmetic result can be achieved by modifying a technique for glansplasty originally described by Lattimer: subtotal glans de-epithelialization and partial glans concealment. Six patients with virilized external genitalia (3 with congenital adrenal hyperplasia, 2 with gonadal dysgenesis and 1 true hermaphrodite) underwent feminizing genitoplasty using this modified technique at ages 3 to 13 months. All patients have achieved pleasing cosmetic results that are vastly superior to our experience with other methods for clitoral reduction.

Clitoris↗
PubMed1990

Single-stage feminization genitoplasty.

We present a modified technique for feminization genitoplasty, which combines the main features of the Hendren and Crawford pull-through operation and the Kogan reduction clitoroplasty. The unique features of the operation are the use of a flap of preputial skin to construct the vestibule and the anterior vaginal wall, and the universal use of the urogenital sinus to form the distal urethra, which avoids creation of female hypospadias. The new introitus is ample and, because there is no cut-back of the urogenital sinus, we avoid accidental incision of the urethral sphincter and the potential for urinary incontinence. There is no pull-through of the vagina because the introitus is created by mobilization of anterior and posterior skin flaps. The clitoris and the neourethra are exteriorized through the folded preputial skin, which simulates the normal female anatomy. The cosmetic and functional results in 9 children who have undergone this procedure have been excellent.

Adrenal Hyperplasia, Congenital↗
PubMed1997

Prenatal exposure to morphine feminizes male sexual behavior in the adult rat.

The endogenous opiate system plays a role in fetal sexual differentiation during development. We examined long-term effects of prenatal morphine on adult sexual behavior in male rats. Pregnant Fischer 344 rats were given increasing doses of morphine (0.75-12.0 mg/day) in slow-release emulsion during gestational days 12-18. Control rats were injected with vehicle and were either pair-fed with morphine rats or ad lib fed. At birth, all litters were culled to eight pups and fostered to naive dams. Testing began when rats were 10-12 weeks old. Masculine behavior was assessed using receptive stimulus females and recording instances of mount, intromission, and ejaculation. Feminine receptivity of the male rats was assessed following castration and priming with ovarian hormones; lordosis quotient of the experimental males was recorded using stimulus male studs. Males prenatally exposed to morphine exhibited normal rates of male copulatory behavior but a significantly higher lordosis quotient, suggesting that prenatal morphine induced long-lasting feminizing effects.

Animals↗
PubMed2001

[Testicular feminization, germinal tumor, NK lymphoma: what is the relationship?].

CASE REPORT: The authors report the case of a ten-year-old girl, who had been treated for a malignant germinal tumour five years before, presenting with a leukaemia-like syndrome associating bone pain, liver and spleen nodules and bone marrow involvement. The cyto-pathological analysis showed undifferentiated cells and CD56 and protein S100 were found as the only positive markers. The child received several subsequent lines of chemotherapy and ultimately died of the disease. COMMENTS: Particular cytogenetic abnormalities were observed (iso1q10, iso6p10) and were in favor of an unusual NK cell lymphoma. CONCLUSION: This analysis revealed a XY genotype (testicular feminization syndrome).

Androgen-Insensitivity Syndrome↗
PubMed1998

Increased tolerance to vecuronium in a patient with testicular feminization.

Muscle relaxant pharmacophysiology can be altered in various clinical situations. We report increased requirement of vecuronium in a patient diagnosed with testicular feminization. Increased level of endogenous testosterone and steroidal-core structure of vecuronium may explain the increased tolerance to vecuronium in this patient.

Adult↗
PubMed1999

Reflections on health care consumerism: insights from feminism.

Health care consumerism is a movement concerned with patients' interests in health care, crucially those that are repressed or partly repressed by dominant interest-holders. Like feminism, health care consumerism attracts dislike and confusion as well as enthusiasm. But just as the voicing of women's repressed interests leads to their gradual acceptance by dominant interest-holders, so does the voicing of patients' repressed interests.

Journal Article↗
PubMed1999

A case of complete testicular feminization: laparoscopic orchiectomy and analysis of androgen receptor gene mutation.

BACKGROUND: Analysis of an androgen receptor gene mutation and a bilateral laparoscopic orchiectomy were performed on a 19-year-old patient diagnosed as a case of complete testicular feminization. METHODS: DNA sequencing of an androgen receptor gene mutation and laparoscopic orchiectomy were performed. RESULTS: A novel point mutation substituting a proline residue (CCG) for a leucine residue (CTG) was observed in codon 892 of exon 8 in the hormone-binding domain of the androgen receptor gene. Bilateral intra-abdominal testes were resected uneventfully by means of laparoscopic orchiectomy. CONCLUSION: We conclude that genetic analysis of androgen receptor gene mutation is essential for diagnosis of teon and laparoscopic orchiectomy is a useful therapeutic alteration as a minimally invasive treatment.

Adult↗
PubMed1996

Development of a hypoplastic uterus in a patient with testicular feminization syndrome 21 years after gonadectomy.

We describe a case of hypoplastic uterus, identified by transrectal ultrasonography and magnetic resonance imaging, which developed 21 years after gonadectomy for testicular feminization syndrome. Its likely origin was Müllerian-fusion remnant resulting from a deficiency in functional Müllerian inhibiting substance (MIS) and/or desensitization of the Müllerian tract to MIS, caused by diethylstilbestrol administration to the patient's mother during the sensitive period of the 6th and 9th gestational weeks of her pregnancy. This Müllerian-fusion remnant remained latent, due to insufficient estrogen stimulation both endogenously (until gonadectomy) and exogenously during hormone replacement therapy. Initial growth was possible induced in response to high doses of estrogen that the patient received over the last 3 years for the treatment of osteoporosis.

Adolescent↗
PubMed1991

Effect of androgen insensitivity on diabetogenesis in db/db male mice with testicular feminization (Tfm).

In C3H mice, a major component of susceptibility to the diabetogenic action of an obesity mutation (diabetes, db) is male gender associated. We tested whether increased male susceptibility was an androgen receptor mediated process. C3H.SW/Lt-derived db/db males were rendered androgen-receptor function-deficient by introducing the testicular feminization (Tfm) mutation of the X-linked androgen receptor gene. The db/db Tfm/Y males (phenotypically female in appearance) developed severe diabetes indistinguishable from that observed in standard db/db X + Y males. Castration of standard C3H.SW/Lt-db/db males (producing mutants with normal androgen receptors but reduced serum testosterone) also failed to block the gender-enhanced susceptibility. In contrast, female db/db littermates exhibited a milder hyperglycemia, and were more resistant to pancreatic beta cell necrosis and islet atrophy than any of the groups of db/db males. Although these data indicated that male-enhanced sensitivity to diabetogenic stress was independent of circulating androgens, the possibility that the gender dimorphism is predicated upon tissue ratios of active estrogens to androgens in glucose-producing tissues such as liver is discussed.

Androgen-Insensitivity Syndrome↗
PubMed1989

Testicular responsiveness to a single hCG dose in patients with testicular feminization.

The suggestion that androgens may regulate testosterone (T) production in rat Leydig cells by a receptor-mediated feed-back mechanism, led us to investigate whether in vivo the absence of testicular androgen receptors, as it occurs in testicular feminization (TF), may modify the characteristic testicular response observed in men and prepubertal children after a single dose of hCG. Subjects consist of: 1) six normal men, 2) two adult patients with the complete form of androgen insensitivity syndrome (TF), 3) 12 normal prepubertal boys, 4) one prepubertal boy with the same form of TF. Each subject received i.m. a single dose of hCG 3500 IU/m2 b.s. and blood samples were collected basally and 2, 4, 24, 48, 72 and 96 hours after the hormonal stimulus. Serum levels of T, 17 alpha hydroxyprogesterone (17OHP) and 17 beta estradiol (E2) were measured at each collection time. In normal men a significant increase in T (M +/- SE) was observed at 4 h (758.6 +/- 135 ng/dl, P less than 0.05) and a more significant increase at 48 h (1082 +/- 60.3 ng/dl, P less than 0.001). E2 and 17OHP peaked significantly at 24 h (81.5 +/- 9.6 pg/ml and 460.7 +/- 90.9 ng/dl respectively). This response pattern is characteristic of the testicular desensitization which occurs in normal man after a single hCG dose. The same response pattern has been observed in the two TF adult patients suggesting that human testicular desensitization in vivo does not depend on androgen receptors.(ABSTRACT TRUNCATED AT 250 WORDS)

17-alpha-Hydroxyprogesterone↗
PubMed1992

[Mastopathy in partial testicular feminization].

We report on a patient with synchrony of mastopathic alterations and incomplete testicular feminization. In the 54-year old patient, typical climacteric complaints as well as mastopathy-associated symptoms occurred. After orchiectomy and subsequent oestrogen substitution, clinical symptoms disappeared.

Androgen-Insensitivity Syndrome↗
PubMedDate not supplied

Dermatoglyphics in the testicular feminization syndrome.

Dermatoglyphic characteristics, both quantitative and qualitative, of fingers and palms of 19 46,XY propositae with the complete form of the testicular feminization syndrome, derived from 28 index kinships, have been analysed in detail. The results reveal trends which allow the tentative conclusions to be reached that in normal circumstances, and insofar as the sex chromosome influence is concerned, aspects of the development of the palmar patterns of loops and triradii may be directly influenced by the sex chromosomal complement of the fetus; by contrast the digital ridges, and, secondarily, the digital patterns, may be influenced to an extent by testicular androgens.

Adolescent↗
PubMedDate not supplied

Body size and shape in 46,XY females with complete testicular feminization.

Twenty-five anthropometric measurements were recorded from eight adult 46,XY females with complete testicular feminization and they were compared with those of female relatives of the patients and control females. In most dimensions 46,XY females were larger than normal females, the difference being close to one SD unit. The mean height of 46,XY females was 171.5 cm. The body proportions of 46,XY females were similar to those of normal females though, according to the results of analysis of covariance where the effect of size was controlled, there may be a tendency to slimmer body. The present findings suggest the presence of genes on the Y chromosome with a general size-increasing effect. They also indicate that the Y chromosome has an influence on the quantitative sex difference in body size. These conclusions are in accordance with the results of earlier studies which have indicated Y-chromosomal influence on stature and tooth size.

Androgen-Insensitivity Syndrome↗
PubMed1991

Laparoscopic bilateral orchiectomy for testicular feminization syndrome.

A 13-year-old female patient with complete androgen insensitivity (testicular feminization syndrome) had an excision of bilateral intra-abdominal testicles via the laparoscopic approach. The patient had a very smooth, fast recovery from her surgery. The laparoscopic approach should be considered for most patients in need of surgical removal of undescended or intra-abdominal testes.

Adolescent↗