SEX HORMONES IN HUMAN EROTICISM 



1385 



laboration originally with Dr. Joan G. 

 Hampson and latterly with Dr. John L. 

 Hampson and Dr. John W. Shaffer also. 

 Seven variables of sex were examined for 

 incongruities that might exist among them 

 in hermaphroditic patients: (1) nuclear sex, 

 i.e., the sex-chromatin pattern of cell nuclei 

 (Barr, 1957), or the actual chromosome 

 count (Ferguson-Smith, 1960) ; (2) gonadal 

 sex; (3) hormonal sex and pubertal femini- 

 zation or virilization; (4) the internal ac- 

 cessory reproductive structures ; (5) external 

 genital morphology; (6) sex of assignment 

 and rearing; (7) gender role and sexual ori- 

 entation established while growing up. 



From the evidence these investigators col- 

 lected, it became quite clear that, among 

 other incongruities in hermaphrodites, the 

 gender role and erotic orientation as man or 

 woman may be independent of hormonal 

 sex. Full elucidation of the relationship be- 

 tween functioning of the sex hormones and 

 of eroticism in men and women is far from 

 complete, however. It is the aim of this 

 chapter to contribute to the elucidation of 

 this problem. 



II. Empiric Endocrine Restrictions 



Unraveling of erotic-hormonal relation- 

 shii)s is subject to three restrictions imposed 

 by the biochemical nature of the sex hor- 

 mones. The first pertains to study of the ef- 

 fects of hormone administration. It arises 

 from the possible biotransformation of an- 

 drogens into estrogens, in the male, and of 

 gestagens into androgens in the female. The 

 possibility of such transformations restricts 

 what may be inferred from the results of ex- 

 perimental administration of the sex hor- 

 mones. It cannot, for instance, be assumed 

 after injection of a specific hormone, say 

 testosterone, that the observed sequelae are 

 direct effects of the testosterone. Some of 

 the hormonal substance may have been con- 

 verted into an estrogen after its absorption 

 into the blood. Thus, conversion of androgen 

 into estrogen may explain duct proliferation 

 in the breasts (gynecomastia) of a male cas- 

 trate treated with large doses of testoster- 

 one, or in some untreated rapidly maturing, 

 ordinary adolescent males. 



The second restriction in the unraveling 

 of erotic-hormonal relationships pertains to 

 determinations of blood and urinary hor- 



mone levels. It arises from the fact that the 

 sex hormones, in vivo, are unstable chemical 

 compounds. From a given androgenic ster- 

 oid, related forms may be derived by molec- 

 ular rearrangement, addition, or reduction 

 (see chapter by Villee). These changes ap- 

 pear to take place constantly in the bio- 

 synthesis and metabolism of androgen in 

 the living body. The same holds true for 

 estrogens and gestagens. 



It is impossible at the present stage of 

 scientific knowledge to identify the full va- 

 riety of related forms of the sex hormones 

 that are functionally active in the body, or 

 to estimate their quantity. Quantitative as- 

 sessments of androgens or estrogens in rou- 

 tine laboratory practice are not assessments 

 of the hormones actually circulating in the 

 blood and stimulating the cells of the vari- 

 ous tissues and organs. Determinations of 

 hormone levels in blood and urine are, in 

 general, determinations of derivative forms 

 and metabolic end-products of the actual 

 compounds active in the body, some of them 

 biologically inert. 



Biochemical instability of the sex hor- 

 mones does not mean that laboratory hor- 

 monal measures are useless. What it does 

 mean is that the level of biologically active 

 circulating hormone must be inferred from 

 the laboratory findings. The inference may 

 not be made unless appropriate norms and 

 criteria have been empirically established. 

 In individual cases the further significance 

 of laboratory findings can be pinned down 

 only when they are appraised within the 

 context of clinical and other findings about 

 the patient or subject concerned. To illus- 

 trate, an above-average level of urinary 

 ketosteroids in a male may be without spe- 

 cific significance. It would be highly sig- 

 nificant, however, if the sample came from 

 a patient who showed other signs such as 

 tumorous enlargement of the adrenal gland 

 or testis, or, in a younger patient, signs of 

 precocious virilism. 



The third restriction in unraveling erotic 

 hormonal relationships pertains to bioassays 

 as they are routinely performed. A sex-hor- 

 mone compound which is judged biologically 

 active, and not inert, is so judged on the 

 basis of its stimulating effect on appropri- 

 ate morphologic sexual characteristics in 

 test animals. Thus, a biologically active 



