Thursday, October 31, 2019

Medical experiments of old

A Nature.com review of a book looking at the wildly varying results of studies of testosterone begins with this anecdote:
On 1 June 1889, renowned neurologist Charles-Édouard Brown-Séquard shocked his colleagues. Speaking at the Paris Society of Biology, the 72-year-old announced that a slurry made from the ground testicles of guinea pigs and dogs (injected under his skin ten times in three weeks) made him stronger. He also noted that his “jet of urine” lengthened by 25%.
One of the things quack Dr Morell used to inject into Hitler was ground bulls testicles, I think.  So it's interesting to see that the allure of this form of medication had such a long history even by World War 2.

Oh, yes my memory is correct.  I don't recall the claim that it was given to Adolf specifically to help his performance with Eva Braun:
The report also states that Morell injected Hitler with extracts from the prostate glands or ground testicles of young bulls, to boost his nearly non-existent libido ahead of a night with Eva Braun, his lover, who was 23 years his junior.

"Morell gave Hitler a preparation called Testoviron, a kind of testosterone preparation, usually before Hitler was going to spend a night with Eva Braun," Cambridge University historian Richard Evans said.

"Eva Braun was young and much fitter. Hitler was much older, he was lazy, he didn't take much exercise and I'm sure he asked Doctor Morell to help him out before he went to bed with Braun."
Update:  it has occurred to me - wouldn't extra testosterone be more likely to worsen the "jet of urine" than increase it?  Because testosterone helps prostate cancer, and I would have assumed that any enlarged prostate problems would be worse with higher testosterone.

However, a medical article indicates that my guess is probably wrong, at least for benign prostatic hyperplasia:
Most studies, however, have shown no effect of exogenous androgens on PSA or prostate volume for older hypogonadal males. In an RCT of 44 late-onset hypogonadal men, Marks et al. found that those treated with TRT did not have a significant increase in prostate tissue levels of testosterone or DHT, despite having significantly increased levels of serum testosterone. More recent evidence from placebo-controlled studies of hypogonadal men receiving androgen therapy, indicate that the differences between those men receiving testosterone and those on placebo were insignificant in regards to prostate volume, PSA and BOO.

These findings are echoed by Jin et al. who studied 71 aged matched hypogonadal patients. For younger hypogonadal patients, the zonal and total prostate volumes (TPVs) were significantly smaller than their aged matched eugonadal colleges whether they were treated with TRT or not. However, from mid-life, central, peripheral and TPV increased with age among healthy controls and men with androgen deficiency regardless of TRT. This demonstrated age is a more important determinant of prostate growth than ambient testosterone concentrations maintained in the physiological range for older men.
 ....
  Lower urinary tract symptoms in men are traditionally considered the ultimate clinical expression of BPH/BPE due to BOO. Nonetheless, LUTS are a set of subjective and objective symptoms, the causes of which are multifactorial and generally not disease specific. In fact, the natural history of LUTS is complex, and symptoms can wax and wane with time even without any treatment.
Although there is no double-blinded RCTs to date, current studies seem to demonstrate that either TRT does not worsen LUTS or that it may, in fact, improve symptoms. This is not a new concept; as early as 1939, Walther and Willoughby used testosterone to treat 15 men with “BPH” with the improvement in their LUTS over 2 years; although this treatment seemed to have been dismissed or forgotten for some time.

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