TESTICULAR DEFICIENCY: A CLINICAL AND PATHOLOGIC STUDY*†

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Abstract
Histologic examinations of testicular biopsy and post-mortem specimens from over 250 men were studied. Certain conditions, e.g., bilateral obstructions to the excretory apparatus, neoplasms, and infections, were excluded. There remained 141 patients with sterility or endocrine disturbances on whom urinary assays for 17-ketosteroids and follicle-stimulating hormone and adequate clinical examinations were available for comparative analysis. The cases have been classified into 3 groups: those with (A) low, (B) normal and (C) high FSH excretion, respectively. Group A was subdivided according to whether the low FSH excretion was idiopathic, secondary to organic lesions in or near the pituitary, or secondary to estrogen therapy. If pituitary stimulation had never occurred, the testes resembled prepubertal glands. If testicular maturity was attained prior to the decrease in pituitary stimulation, the histologic features were hyposper-matogenesis, lipoid accumulation in the Sertoli cells, thickening of the tubular tunica propria, deposition of peritubular collagen and elastic tissue, and absence of normal Leydig cells. Group B was divided into 2 subgroups according to whether there was an associated endocrine disturbance or not. The first subgroup comprised cases in which the endocrine disturbance was thought to be due to lack of luteinizing hormone, and cases with acromegaly; the second sub-group comprised cases with spermatogenic failure only, viz., arrest of maturation, hypo-spermatogenesis, and cases with oligospermia but with normal testicular histologic structure. Group C contained cases with absence of germ cells but otherwise normal testicular microscopic anatomy, sclerosing tubular degeneration, absence of testes, the male "climacteric," mumps orchitis, and a few miscellaneous syndromes. These studies suggest that there are 2 testicular hormones, one made by the Leydig cells and a 2d by the tubules; that it is the Sertoli cells and not the germ cells which make this 2d hormone; and that the functions of the 2d or "X" hormone are to support spermatogenesis, to inhibit FSH production, to stimulate other gonadotrophins (? luteinizing hormone), and possibly to exert an inhibitory effect on mammary growth.