Further Studies on the Pathophysiology of Testicular Feminization Syndrome1

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Abstract
The relative binding affinity of serum proteins for testosterone (BAPT) has been evaluated in 5 normal men, 3 normal women, 4 patients with testicular feminization syndrome and 3 young hypogonadal men. A “coefficient of cutaneous testosterone 5α-reductase activity” (T5αR) was also calculated in the same patients by means of an in vivo method which consisted of the combined administration of radioactive testosterone differently labeled via percutaneous and intravenous routes and then of the comparison of the isotopic ratios of urinary 5α- and 5β-androstane-3α,17β-diols. From the results obtained, it appears likely that the proportions of BAPT and T5αR in normal men are in versed both in patients with feminizing testes and in hypogonadal men. In addition, after treatment of one hypogonadal man with dihydrotestosterone (DHT), a male sex differentiation was observed and both BAPT and T5αR became equal to those of normal men. On the contrary, in the case of a castrated patient with testicular feminization syndrome, such observations were not made after the same treatment. Thus, a relationship is evoked between the amount of unbound testosterone circulating in plasma and the 5α-reduction of testosterone to DHT in target cells. This metabolic step, according to several authors, might be necessary for the binding of DHT to cytoplasmic protein as well as for transport of DHT to specific nuclear protein.

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