The Journal of Sex Research

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Eunuchoid sexuality in four syndromes

Jan Raboch & Jirí Mellan

To cite this article: Jan Raboch & Jirí Mellan (1978) Eunuchoid sexuality in four syndromes, The
Journal of Sex Research, 14:3, 129-136, DOI: 10.1080/00224497809551002

To link to this article: http://dx.doi.org/10.1080/00224497809551002

Published online: 11 Jan 2010.

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 The Journal of Sex Research Vol. 14, No. 3, pp. 129-136 August, 1978

Eunuchoid Sexuality in Four

Syndromes
JAN RABOCH AND JIří MELLAN

Abstract

Using HTDM and SAM Questionnaires, heterosexual development and

sexual activity were investigated in the following patients: two men with a
Klinefelter syndrome associated with developmental anomalies of the penis,
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two patients with testicular agenesis, 14 men with hypogonadism, and three
"fertile eunuchs." Through comparison with a control group of 204 adult
well-developed, fertile, and potent men it was ascertained that the heterosex-
ual development of the patients was distinctly retarded and that their sexual
activity was lower. These insufficiencies in sex life were of the same character
regardless of the diversity of etiopathogenetic mechanisms which had led to
the disturbance of somatosexual development.

The importance of testosterone for the sexual development of men and

their life in adulthood is well known (Beach, 1948). However, only in
recent years has the diversity of mechanisms which negatively influence
male sexuality through the action of testosterone received recognition
(Dorner, 1972). Developmental disturbances of various types allow the
possibility of studying these processes in men (Bobrow, Money, & Lewis,
1971; Money & Clopper, 1975). The aim of this study was to examine the
heterosexual development and the sexual activity of patients with various
disorders of somatosexual development, which were accompanied by
distinct signs of androgenic insufficiency.

Method

Subjects

Heterosexual development and sexual activity were examined in five

groups of patients. The control group consisted of 204 married men aged
19 to 50 years who came to be examined for sterility; of these, 124 persons
Jan Raboch, M.D., is a Professor at the Sexological Institute, Charles University, Prague,
Czechoslovakia. Jiří Mellan, M.D., is Head of the Sexological Department Kiinz, Prague,
Czechoslovakia.
Requests for reprints should be sent to Jan Raboch, M.D., Sexological Institute, Charles
University, Prague 2, Karlovo nam. 32, Czechoslovakia.
129
 130 J. RABOCH AND J. MELLAN

were 19-30, 60 were 31-40, and 20 were 41-50 years of age. The exami-
nation established that they were adequately developed somatosexually,
that they had normozoospermia in their ejaculate, and that their potency
was good. In two men with a Klinefelter syndrome (Raboch, 1975), the
presence of a penoscrotal hypospadias and of epispadias, respectively,
suggests insensitivity of tissues to testicular androgens already present at
the time of differentiation of external genital organs. Both these patients
had one supernumerous X-chromosome, and their karyotype was
47,XXY. An endocrinological examination in adulthood had established
that even after birth these two individuals did not react to testosterone.
In two patients testicular agenesis which was documented by surgical
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exploration was found. The fourth group consisted of 14 men with

hypogonadotropic hypogonadism. The diagnosis was based on the results
of a testicular biopsy and/or the determination of gonadotropins and on
other examinations as well. Three men were diagnosed by spermiological
examination and testicular biopsy as hypoandrogenic syndrome with
spermatogenesis (Pasqualini & Grato, 1955).
The age of each patient with androgenic insufficiency is indicated in
Figures 2 and 3.

Instruments

The examinations were carried out by means of the Heterosexual

Development of Men Questionnaire (HTDM) and the Sexual Activity of
Men Questionnaire (SAM). With these questionnaires, 12 items charac-
terizing heterosexual development and 18 items evaluating sexual activity
in adulthood were investigated (Raboch, Mellan, & Starka, 1977).

Procedure

All patients had filled in the questionnaires after being instructed by

the doctor in the out-patient department of the Institute.

Results

In 18 out of 21 examined patients with disorders of somatosexual

development, the plasma testosterone was determined radioimmunologi-
cally in the period when they were not hormonally treated by means
of the Testok set of the firm Sorin. From the larger control group, 103
well-developed, fertile, and potent men aged 19 to 50 years (Raboch,
 EUNUCHOID SEXUALITY 131

Pondelickova, & Starka, 1976) were randomly selected, and the male sex
hormone in the blood was determined by the protein-binding method of
Horton, Kato, and Sherins (1967). The venous blood was always taken
between 8 and 10 A.M. These data are illustrated in Figure 1.
Figure 1 shows that in not a single one of the 18 patients with some
disorder of somatosexual development did the value of plasma testoster-
one reach the range of statistically normal values (M ± SD), which we
found in the group of somatosexually well-developed, fertile, and potent
men.
In the HTDM Questionnaire the score 0 to 2.0 expresses the retardation
whereas the values 3.1 to 5.0 are an expression of the acceleration of
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sexual socialization. In the control group the HTDM mean value was 2.8
and the SD was 0.75. Figure 2 summarizes the HTDM scores in the group
of 21 eunuchoid men. The mean in this pathologic group was 1.06 and
the SD was 0.75.
The analysis of data in Figure 2 shows that heterosexual development
is markedly retarded in the overwhelming majority of patients with
distinct signs of androgenic insufficiency. Through statistical analysis by
means of x2-test the incidence of developmental retardation (points 0-2.0)
was found superior by 49.8% and more as compared with the control
group, x2 > 22.79, p < .001 for all 12 items.
The SAM Questionnaire contains 18 items which reflect the sexual
activity of the examined men. Here too, the subnormal values are 0 to
2.0, the average ones 2.1 to 3.0, and the above average ones are 3.1 to 5.0.
In the control group the mean SAM value was 2.9 and the SD was 0.2. In
the pathologic group the corresponding values were M — 1.03 with a SD
of 0.67. Figure 3 illustrates the scores in individual patients with distinct
signs of androgenic insufficiency.
The data in Figure 3 show that only in one case of hypogonadotropic
hypogonadism did the SAM score reach the average values found in
fertile and potent men; on the other hand, the sexual activity in the
pathological group was distinctly lower. Statistical analysis of individual
items of the SAM Questionnaire indicates the incidence of a weak sexual
activity (points 0-2.0) higher by 23.4% and more as compared with the
control group. In 15 items a / * 5 6.35, p < .01, and in one item a x2 = 5.5,
p < .05, were found.
Quite interesting are the findings ascertained in a 28-year-old man in
whose urine gonadotropins were not found. His HTDM score was 2.17
and his SAM was 2.28—both values within the normal limits. He stated
that from the age of 18 he had been regularly treated. First he was given
 ±SD v
> NORMAL w
MEAN' to
H YPOGON ADOTROPI C
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EUNUCHOIDS
O TESTICULAR AGENESIS
• "FERTILE EUNUCH"
KLINEFELTERS

>
g
o
a

19-20 21-25 26-30 31-35 36—40 41-45 46-50

AGE IN YEARS
FIG. 1. The plasma testosterone values in the control group of 103 well-developed, fertile, and potent men and in 18 patients with different
forms of eunuchoidism.
 • NORMAL

• HYPOGONADOTROPIC
EUNUCHOIDS
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O TESTICULAR AGENESIS
5ui CD
•i
"FERTILE EUNUCH"
KLINEFELTERS
a
o 4.0 M

C
o
X
o
3
CO
X a
u
(0
x
o
c
UI

27 29 31 33 35 37 39 41 43 45
21 23 25

ACE IN YEARS
FIG. 2. The HTDM Questionnaire scores of well-developed, fertile, and potent men and of patients with distinct signs of androgenic CO
insufficiency. CO
 ±SD \
NORMAL
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• HYPOGONADOTROPIC
EUNUCHOIDS
o TESTICULAR AGENESIS
5JO
• "FERTILE EUNUCH"
KLINEFELTERS

>• 4X>
>
> cd
o
o
% 3.0
>
-I
a
•
2 2.0
•
tn •
o a
1.0 • •

O • • •
• • • •
21 23 25 27 29 31 33 35 37 39 41 43 45

AGE IN YEARS
FIG. 3. The SAM Questionnaire scores of well-developed, fertile, and potent men and individual eunuchoid patients.
 EUNUCHOID SEXUALITY 135

injections of 500 i.u. of chorionic gonadotropin twice a week, and in the

last 6 years he received 50 milligrams of depo-testosterone twice a month.
His penis was of adequate size, 80 mm in length and 30 mm in width, but
his testicles were distinctly hypoplastic with a long axis measurement of
20 mm. He yielded a drop of spermatic fluid with azoospermia in it. After
the interruption of hormonal treatment the value of plasma testosterone
was 1.50 ng/ml. He was married for four years, and his activity in sex life
during the time of treatment was satisfactory.

Discussion
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In a group of 21 adult men with eunuchoid syndromes, heterosexual

development and activity in sex life were investigated by means of
HTDM and SAM Questionnaires. It was to be expected that the course
of their heterosexual development would be retarded and that their
sexual appetite and potency in sex life would be lower. In comparison
with a control group of 204 well-developed, fertile, and potent men, the
differences in 28 out of 30 items of both questionnaires were statistically
significant. In puberty the emission of semen either did not occur or it
was markedly retarded. The need for sexual outlet was small; the fre-
quency of masturbation was low. First datings with girls, petting, and first
sexual intercourse occurred at a much later time, and the number of
sexual partners was small. Two thirds of these men had remained un-
married. When they married, the frequency of sexual intercourse de-
creased rapidly to less than twice a week.
These insufficiencies in sex life were the same, on the whole, regardless
of etiopathogenetic mechanisms which led to a disturbance of the pro-
duction and to an absence of effects of testicular androgens in the
individual forms of eunuchoidism. In hypogonadotropic hypogonadism
the production of RH-LH and the stimulation of the testicles by gona-
dotropic hormones were lacking. In patients with testicular agenesis, the
sites of production of sexual hormones were absent as a consequence of
a developmental disturbance in the course of intrauterine life. In this
developmental stage probably originates the insensitivity of target tissues
to testicular androgens which was found in chromatin-positive men with
malformations of the penis. Two out of three "fertile eunuchs" were
proven to have an enzymatic defect of steroidogenesis in the testicles.
The plasma testosterone values were distinctly subnormal in all ex-
amined cases. However, it must not be forgotten that these
patients—especially those with hypogonadotropic hypogonadism—often
 136 J. RABOCH AND J. MELLAN

psychically react to somatic signs of androgenic insufficiency. Their penis

was in most cases (13) either distinctly subnormal in sizje (shorter than 60
mm) or malformed (in two cases). In no case was the size of the testicles
adequate. Three hypogonadotropic eunuchoids had a distinct bilateral
gynecomastia. Beard growth was either lacking or very rare, and body
hair distribution was of a feminine type in all these patients. Not a single
man of the pathological group yielded, without therapy, more than 1 ml
of spermatic fluid per ejaculation. The psychic reaction to the signs of
insufficient effect of testosterone undoubtedly contributes to the retar-
dation of sexual development and to the imperfect course of sex life in
adulthood.
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References
BEACH, F. Hormones and behavior. New York, London: Hoeber, 1948.
BOBROW, N., MONEY, J., & LEWIS, V. Delayed puberty, eroticism, and sense of smell: A
psychological study of hypogonadotropinism, osmatic and anosmatic (Kallmann's
syndrome). Archives of Sexual Behavior, 1971, 1, 329-344.
DÖRNER, G. Sexualhormonabhängige Gehirndifferenzierung und Sexualität. Jena:
Fischer, 1972.
HORTON, R, KATO, T., & SHERINS, R. A rapid method for the estimation of testosterone
in male plasma. Steroids, 1967, 10, 245-256.
MONEY, J., & CLOPPER, R., JR. Postpubertal psychosexual function in post-surgical male
hypopituitarism. Journal of Sex Research, 1975, 11, 25-38.
PASQUALINI, R., & GRATO, B. Hypoandrogenic syndrome with spermatogenesis. Fertility
and Sterility, 1955, 6, 144-147.
RABOCH, J. Incidence of hypospadia and epispadia in chromatin-positive men. Andrologia,
1975, 7, 237-239.
RABOCH, J., POND LÍČKOVÁ, J., & STÁRKA, L. Plasma-testosteronwerte bein Patienten mit
somatosexuellen Entwicklungsstörungen im Alter von 11 Jahren bis in das Erwachse-
nenalter. Endokrinologie, 1976, 68, 40-44.
RABOCH, J., MELLAN, J., & STARKA, L. Adult cryptorchids: Sexual development and
activity. Archives of Sexual Behavior, 1977, 6, 413-419.
Accepted for publication March 10, 1978

Issue Consultants
The Editor acknowledges with thanks the advice provided by the
following persons, who served recently as reviewers of manuscripts.
Sidney J. Arenson Roger Libby
Alan P. Bell Stephen M. Marson
Sandra L. Bern William H. Masters
Edward Brecher Elizabeth McCauley
Seymour Fisher Murray Miron
Paul Gebhard Donald L. Mosher
Sol Gordon Robert Reitman
Julia Heiman Daniel Rubenstein
John Huppertz John Townsend