Use of Testosterone Propionate in Functional Bleeding

Abstract

I N THE PAST THREE YEARS testosterone propionate has been used extensively in the treatment of functional gynecologic conditions (1-9). This paper is a report of 10 cases of functional meno-metrorrhagia, treated with synthetic androgen (testosterone propionate), in which the therapeutic results were evidence of the usefulness of the male hormone in functional bleeding.The rationale of this form of therapy and its margins of safety have been discussed at length elsewhere (10-13). Several investigators (14-18) have shown the bisexual action of the androgens in the female rabbit and spayed rats, manifest by estrogenic and progesta' tional activity of the endometrium. (This does not occur in monkeys or human subjects.) Salmon (19) has shown that not only do androgens exercise a direct stimulating effect on the Mullerian tract of rats but they also produce follicle growth and corpora lutea in the ovaries of immature rats. This gonadotropic effect is mediated through the hypophysis The biological properties of the male hormone in women have been studied by many investigators. It has been shown that testosterone propionate inhibits the gonadotropic hyperactivity of the hypophysis of a castrate woman (3), suppresses menstruation (4), produces atrophy of the endometrium (21), deficiency changes in the vaginal smear (4) with disappearance of the glycogen (12), and inhibits peristalsis of the fallopian tubes (23).Dosage. During this entire investigation an effort was made to achieve therapeutic results with as small a dose as possible. Some investigators used as much as 1000 mg. per month, and others reported results with as little as 30 to 75 mg. per month. We tried to strike a balance and used dosages varying from 45 mg. to 325 mg. per month. These dosages were administered in 10, 25 and 50 mg. injections of testosterone propionate (intramuscularly and subcutaneously) in sesame oil.Received for publication February 17, 1941. CASE REPORTSCase 1. H.B. age 22, complained of meno-metrorrhagia for a period of 18 months, following a spontaneous abortion. The first month we observed her she bled every day, using 6 to 8 pads daily. Pelvic examination revealed lacerated cervix and second degree retroversion of the uterus. Preliminary endometrial biopsy, during a bleeding phase showed an early proliferative stage. She was given 75 mg. of testosterone propionate in the next week, after which she noticed a definite diminution in the profuseness of the flow. The next month (now only bleeding very slightly) she received 2,65 mg. of testosterone propionate, and bleeding ceased at the end of the third week. Endometrial biopsy on the 19th day of cycle again showed an early inactive type of estrogenic pattern. The vaginal smears during this course of treatment all showed good estrogenic effect. (The psychological effect upon this patient was extraordinary, her personality reflected a new interest in life.) The third month she received 300 mg. of testosterone propionate and had only 3 days of actual bleeding with a few days of spotting. Bio...