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[Current status in the treatment of breast cancer. I. Endocrine management--change of concepts and outlook for the future (author's transl)].

A renewal of interest in endocrine therapy of breast cancer is resulting from the demonstration of steroid hormone receptors in tumor cells sensitive to antiestrogens and the possibility for predicting endocrine responsiveness. Therefore new therapeutical concepts have been developed and some of the established endocrine regimens have been reduced to historical interest. It is more than doubtful that the present schematization in selecting the proper kind of endocrine treatment has any future as methodical difficulties in demonstrating hormone receptors will be overcome and the understanding of their biological function will increase.

Adrenal Cortex Hormones↗

Changes in the activities of microsomal enzymes involved in hepatic steroid metabolism in the rat after administration of androgenic, estrogenic, progestational, anabolic and catatoxic steroids.

Several steroids (5 beta-dihydrotestosterone, 19-nortestosterone, methyltrienolone, norethisterone, medroxyprogesterone acetate, cyproterone acetate, chlormadinone acetate and 16 alpha-cyanopregnenolone) were tested for their ability to influence the activities of three sexually differentiated hepatic microsomal enzymes (3 alpha- and 3 beta-hydroxysteroid dehydrogenase and 5 alpha-reductase) in male and female gonadectomized and intact female rats. Of the steroids tested only 5 beta-dihydrotestosterone was completely ineffective. The other tested steroids elicited varying degrees of "masculinization" with a distinct gradation of effect according to the enzyme activity measured and animal model used. 5 alpha-Reductase was the most sensitive enzyme activity and 3 alpha-hydroxysteroid dehydrogenase the least. Male castrates responded better than female castrates, and these in turn better than intact females. The mechanism of action of three of the steroids (methyltrienolone, medroxyprogesterone acetate and norethisterone) was examined. Both flutamide and estradiol were able to block the action of methyltrienolone and medroxyprogesterone acetate, but not that of norethisterone. It is concluded that methyltrienolone and medroxyprogesterone acetate probably masculinize the enzyme activities by the same mechanisms as androgens, whereas the repression of 5 alpha-reductase activity elicited by norethisterone administration involves a different route.

Aminopyrine N-Demethylase↗

Progestin-specific markers in human cell lines: biological and pharmacological applications.

We review the progestin-specific responses (induced proteins, increased enzymatic activity) described in uterus, mammary tumours and human breast cancer cell lines established from pleural effusions. Recent data from our laboratory using the T47D breast cancer cell line are then given. They include: (a) a general methodology for evaluating the specific effects of steroids on the production of [35S]methionine-labelled proteins released into the culture medium; (b) results concerning the specificity of regulation by the progestins of a 48 000 dalton protein secreted by T47D cells; (c) the evidence for androgen-specific proteins in the same cells; (d) A discussion of the criteria required to define the receptor responsible for a particular effect of steroids. Lastly, we consider the general interest of progestin-regulated proteins in cell culture for pharmacology and biology.

Breast Neoplasms↗

Sex and season influence gonadal steroid biosynthetic pathways, end-product production and steroid conjugation in blotched blue-tongued lizards (Tiliqua nigrolutea).

We examined differences in gonadal steroid production and biosynthetic pathway activity with changing reproductive condition and between sexes in the scincid lizard, Tiliqua nigrolutea. We observed clear seasonal and sexual variation in the production of androgens and steroid conjugates, but detected no 17beta-estradiol or 5alpha-dihydrotestosterone produced by the gonads. An alternative steroid, more polar than estradiol, was detected: an investigation of this steroid is reported separately [Gen. Comp. Endocrinol. 129 (2002) 114]. There were seasonal and sex-related differences in steroid biosynthetic pathway activity. The Delta5 pathway metabolite, dehydroepiandrosterone, was detected only in males, and only from incubations using regressed testicular tissue. There was also a seasonal difference between the sexes in rates of progesterone accumulation, although the absence of corresponding elevated plasma concentrations suggests that the role of progesterone switches from a directly acting hormone to a precursor for others during the reproductive cycle in females. These results suggest that within the traditional view that vertebrate biosynthetic pathway activity and end-products are phylogenetically conserved, there is likely to be considerably species- and/or genus-specific variation.

Animals↗

Further report on the endocrinological profile of two synthetic estrogens with antifertility properties, STS 456 and STS 593.

Two synthetic estrogens, STS 456 and STS 593, with noteworthy post-coital antifertility properties in the rat were studied for their estrogenic, antiestrogenic, progestagenic, antiprogestagenic, antigonadotrophic, androgenic and antiandrogenic effects in laboratory animals. Beside their weak estrogenic activity which corresponds to their slight affinity to the uterine estrogen receptor in the rat, both steroids show remarkable antiestrogenic effects. No progestagenic, androgenic and antiandrogenic effects were found but STS 593 showed some antiprogestagenic activity. The antigonadotrophic efficacy of STS 456 was relatively high while STS 593 was scarcely active. The results are discussed with respect to possible application of these drugs for interceptive purposes.

Anabolic Agents↗

[Hormone treatment of sex disorders in menopause--causal therapy or placebo?].

Clinical reports on successful hormonal treatment of climacteric or menopausal sexual dysfunctions are in contradiction with the lack of oestrous phenomena in humans as well as with the results of double-blind studies finding no objective proof for the alleged hormonal influence. A review of recent studies on the topic showed, that apart from a critical threshold, hormones exert no influence on sexual behaviour that would go beyond the alleviation of vasomotoric or genital menopausal symptoms or their consequences. However, psychosocial and relational factors play a major role in sexual dysfunctions generally and at this age of the "empty nest" and a doctor-patient relationship based on trust may well help in coping with them. Finally, a (new?) understanding of genital sexuality as a concise body-language or literally an incarnation of the relationship is advocated and may add a new dimension and quality to a couple's sex life.

Adult↗

Mechanisms of hormonal and antihormonal action of contraceptive progestins at the molecular level.

19-Nor synthetic progestins undergo extensive metabolism at the target cells. The resulting metabolic conversion products interact with putative steroid receptors within the cells, and through those interactions, they may exert either agonistic, synergistic and antagonistic hormonal effects. Studies conducted in our laboratories have disclosed that norethisterone (NET) and D-(1) norgestrel (LNG), two widely used contraceptive progestins, are biotransformed to several A-ring reduced (dihydro and tetrahydro) derivatives. The resulting metabolites 5 alpha-dihydro NET (5 alpha-NET) and 5 alpha-dihydro LNG bind with relative high affinity to the progesterone and androgen receptors. To gain insight into the underlying molecular events mediating the mode of action of NET and its neutral metabolites, we have examined the expression of their biological effects at target organs by using the rabbit uteroglobin gene model and the beta-glucuronidase activity of the mouse kidney. The results of a series of experiments seem to indicate that the enzyme-mediated formation of the 5 alpha (trans A/B ring junction) NET derivative results in a significant diminution of its progestational and androgenic potencies. Furthermore, 5 alpha-NET acquire a potent anti-progestational/contragestational effect as assessed in the female rabbit. These results demonstrated that 5 alpha-reduction of 19-nor progestins exerts a paradoxical effect, at least in terms of their hormone-like effects. The overall data are in line with the concept that metabolism of synthetic progestins at hormone-sensitive organs modulates their mechanisms of action.

Animals↗