SEX HORMONES IN HUMAN EROTICISM 



1389 



did not change childhood eroticism to adult- 

 hood eroticism when sex-hormone failure 

 persisted beyond the age of 16. There were 

 11 such who were candidates for androgen- 

 substitution treatment and 10 for estrogen- 

 substitution treatment. They evidenced a 

 wide range of variability in their pretreat- 

 ment erotic development, concomitant with 

 such individual differences as dwarfed stat- 

 ure (among the girls only),''' inhibitory 

 training in sexual matters, restricted op- 

 portunities for social development, and 

 amount of close contact with dating or 

 marriage partners. 



Response to treatment may be summed 

 up by saying that these 21 patients went 

 through an erotic development not unlike 

 that of normal boys and girls. It is of in- 

 terest in addition that they exhibited the 

 same wide range of variability of erotic de- 

 velopment and activity after treatment that 

 they had before. It is worth reporting that, 

 among the girls with gonadal aplasia the 2 

 with a female sex-chromatin pattern (and 1 

 younger girl like them) did not respond to 

 estrogens in a way conspicuously different 

 from the 7 with a male chromatin pattern. 



Eroticism following induced puberty 

 turned out, then, to be not so different from 

 eroticism following ordinary puberty in its 

 character and in its dependence on the pres- 

 ence of sex hormones. 



The patients requiring induction of pu- 

 berty proved more instructive in another 

 way. These individuals, if they omitted their 

 substitution therapy for a period, were in a 

 liosition to give information about adult 

 eroticism in the absence of sex hormones. 



D. SUBSTITUTION THERAPY DISCONTINUED 



Of the 11 hypogonadal men entered in 

 Table 22.1, there were 5 who discontinued 

 androgen medication for 3 months or longer. 

 In each case, the absence of androgen from 

 the tissues made a decided difference. The 

 most sensitive indicator was the ejaculate. 



^ Dwarfed boys who also had gonadal faihiie 

 secondary to h.ypopituitarism were not included in 

 this study. Dwarfed girls were of necessity included, 

 since dwarfism is a frequent accompaniment of 

 gonadal aplasia in girls. Except for one juvenile 

 surgical castrate, there were in the clinic files no 

 nondwarfed girls with sex -hormone failure. 



It gradually diminished in volume until no 

 fluid was emitted. In addition, the men re- 

 ported that they had fewer erections and a 

 lessened initiative to masturbate or to make 

 coital advances. With loss of ejaculation, 

 they also lost erotic ejaculatory dreams. 

 They considered that waking erotic imagery 

 and daydreams diminished in frequency of 

 appearance. 



One may generalize and say that these 

 men did not lose completely their erotic 

 imagery, their erotic sensations, or their 

 erotic actions and behavior. What did hap- 

 pen was that eroticism, whether in imagery, 

 sensation, or activity, was not initiated with 

 the same frequency as before. This failure 

 of initiation showed up in the involuntary 

 failure of the penis to erect or to hold an 

 erection, and in the failure of other, more 

 voluntary erotic actions and coordinated 

 endeavors, as well. 



The man who was married when he dis- 

 continued treatment had a good barometer 

 of the failure of his erotic initiative, namely 

 his wife's comments and complaints. In fact, 

 this man, and the two others who married, 

 found that it paid them not to become lax 

 about their injections. They reported a 

 slackening of erotic initiative, including 

 erectile potency, if they delayed even a week 

 in getting their monthlj'- injection of long- 

 acting testosterone. 



The conclusion to be drawn from periods 

 of interrupted treatment in men with sex- 

 hormone failure is that androgen is neces- 

 sary, not only to induce morphologic ma- 

 turity, but also for the maintenance of a 

 well functioning eroticism. 



There were four hypogonadal women who 

 discontinued estrogen medication for 3 

 months or longer. One of them was off treat- 

 ment for 3 months by request. She married 

 during the first month. Two others were 

 single and celibate. One of the latter discon- 

 tinued treatment with stilbestrol for 18 

 months, before resuming on Premarin, be- 

 cause stilbestrol produced unpleasant gas- 

 tric symptoms. The other single woman had 

 been off treatment for 2 years, having dis- 

 covered that the only sequel of significance 

 was cessation of the menses. The fourth 

 woman was divorced. She discontinued 

 treatment after a doctor scared her about 



