We evaluated 15 children with hypospadias or micropenis for the presence of 5 a-reductase deficiency. Serum testosterone and dihydrotestosterone(DHT) concentrations were measured before and 3 days after HCG stimulation. Also, testosterone : dihydrotestosterone (T:DHT) conversion ratios were calculated in each children in order to determine the activity of 5 a-reductase. DHT was abnormally low in 14 children, and T:DHT conversion ratios were abnormal in 12 children in basal state. But T:DHT conversion ratios were abnormal in 2 children after HCG stimulation. In children, 5 a-reductase deficiency can not be diagnosed low serum DHT or abnormal T:DHT conversion ratio, but diagnosed abnormally high T:DHT conversion ratio after HCG stimulation.
Child* ; Cholestenone 5 alpha-Reductase* ; Dihydrotestosterone ; Female ; Humans ; Hypospadias ; Male ; Testosterone

PURPOSE: Benign prostate hyperplasia(BPH) can be treated with alpha1-adrenergic blocker that relaxes prostate smooth muscle or 5 alpha-reductase inhibitor that reduces serum dirtydrotestosterone. The efficacy of the combination of 5 alpha -reductase inhibitor(finasteride) and alpha1-adrenergic blocker(doxazosin) was evaluated in patients with benign prostate hyperplasia. MATERIALS AND METHODS: Eighty five patients with BPH was treated and followed over 6 months and divided into three groups: Group 1(doxazosin 3mg/day), Group 2(finasteride 5mg) and Group 3(combination of both drugs). Initially, all patients were evaluated by international Prostatic Symptom Score(IPSS: irritative, obstructive, sum, life quality), uroflowmetry, residual urine, serum prostate specific antigen(PSA) and prostate weight by transrectal ultrasonography. IPSS, uroflowmetry and complications were evaluated every month. Residual urine and PSA were assessed at every 3 months, prostate weight at every 6 months. RESULTS: In Group 1 and 3, IPSS were more decreased than In Group 2 immediately(p < 0.001). In Group 1 and 3, maximal flow rate was more increased than in group 2 immediately(p < 0.001). There was no difference of mean change of residual urine among three group. In Group 2 and 3, serum prostate specific antigen and prostate weight were more decreased than in Group 1 (p < 0.001). CONCLUSIONS: In medical treatment of BPH, the combination therapy of alpha1-adrenergic blocker and 5alpha-reductase inhibitor shows early symptomatic improvement and decreased prostate weight without significant complications.
Cholestenone 5 alpha-Reductase ; Humans ; Hyperplasia* ; Muscle, Smooth ; Prostate* ; Prostate-Specific Antigen ; Ultrasonography

The lignans in Urtica cannabina were isolated by preparative HPLC, silica, and ODS column chromatographies, and identified by NMR and HR-MS. The inhibitory activities on 5α-reductase were evaluated in vitro. As a result, ten secolignans,(2R,4S)-2,4-bis(3-methoxyl-4-hydroxyphenyl)-3-butoxypropanol(1), 3,4-trans-3-hydroxymethyl-4-[bis(3,4-dimethoxyphenyl)methyl] butyrolactone(2), 3,4-trans-3-hydroxymethyl-4-[(3,4-dimethoxyphenyl)(3-methoxyl-4-hydroxyphenyl)methyl] butyrolactone(3), 3,4-trans-3-hydroxymethyl-4-[bis(3-methoxyl-4-hydroxyphenyl)methyl] butyrolactone(trans urticol, 4), 3,4-trans-3-hydroxymethyl-4-[bis(3,4-dimethoxyphenyl)methyl] butyrolactone-3-O-β-D-glucopyranoside(5), 3,4-trans-3-hydroxymethyl-4-[(3,4-dimethoxyphenyl)(3-methoxyl-4-hydroxyphenyl)methyl]butyrolactone-3-O-β-D-glucopyranoside(6), 3,4-trans-3-hydroxymethyl-4-[bis(3-methoxyl-4-hydroxyphenyl)methyl]butyrolactone-3-O-β-D-glucopyranoside(trans-urticol-7-O-β-D-glucopyranoside, 7), cycloolivil-4-O-β-D-glucopyranoside(8), isolariciresinol-4'-O-β-D-glucopyranoside(9), and olivil-4'-O-β-D-glucopyranoside(10), together with a polyphenol [α-viniferin(11)], were isolated from U. cannabina for the first time. Compound 1 was a new lignan. Compound 7 was potent in inhibiting 5α-reductase.
5-alpha Reductase Inhibitors ; Cholestenone 5 alpha-Reductase/pharmacology* ; Chromatography, High Pressure Liquid ; Lignans/pharmacology* ; Magnetic Resonance Spectroscopy ; Molecular Structure ; Urticaceae/enzymology*

5 alpha-reductase deficiency resulting in male pseudohermaphroditism is a rare disease characterized by clitoral-like phallus, bifid scrotum, urogenital sinus, testis cited in labioscrotal folds. Evaluation of plasma T/DHT ratios in infancy, particularly after hCG stimulation of the testes and elevated urinary tetrahydrocortisol (THF) to 5 alpha-tetrahydrocortisol(5 alpha-THF) ratios provide a valuable dianostic test for 5 alpha-reductase deficiency. We report one case of 5 alpha-reductase deficiency who were presented with ambiguous genitalia and elevated T/DHT ratio before and after hCG stimulation.
46, XY Disorders of Sex Development ; Cholestenone 5 alpha-Reductase* ; Disorders of Sex Development ; Plasma ; Rare Diseases ; Scrotum ; Testis ; Tetrahydrocortisol

5 alpha-reductase deficiency is a rare autosomal recessive disorder caused by mutations in the SRD5A2-gene, resulting in absent or diminished dihydrotestosterone (DHT) formation and, hence, in an underdevelopment of the external genitalia in patients with 46,XY karyotype. Recently we experienced a 17 years old patient with chief complaint of primary amenorrhea, who showed 46,XY karyotype, enlarged clitoris, virilization, undeveloped breast and palpable bilateral inguinal mass. We diagnosed it as 5 alpha?reductase deficiency and removed the bilateral gonads, so we report it with brief review of literature.
46, XY Disorders of Sex Development ; Adolescent ; Amenorrhea ; Breast ; Cholestenone 5 alpha-Reductase* ; Clitoris ; Dihydrotestosterone ; Female ; Genitalia ; Gonads ; Humans ; Karyotype ; Virilism

PURPOSE: To compare the mechanism of cell loss and changes in the ventral prostate of young adult Sprague-Dawley rats after treatment with finasteride, a potent 5 alpha-reductase inhibitor, or castration. MATERIALS AND METHODS: Rats were divided into two group: finasteride treated and castrated. Finasteride-treated rats were given 1 mg/kg a day orally. The rats were sacrificed on days 1, 3, 5, 7, 10, 14, and 21. The ventral prostate was weighed and either prepared for histologic examination to detect apoptotic evidence or frozen in liquid nitrogen for the determination of the intraprostatic dihydrotestosterone (DHT) concentration and DNA content. RESULTS: Both finasteride and castration decreased prostate weight and DNA content, the decrease being more pronounced in the castrated group. By 3 days of finasteride treatment, the intraprostatic DHT concentration decreased to a greater extent with no further significant change thereafter, whereas castration gradually decreased the intraprostatic DHT concentration up to day 10, with no further significant decrease thereafter. Apoptotic bodies were typically observed in castrated but not finasteride-treated animals. CONCLUSIONS: Castration caused a more profound involution of rat ventral prostate than did finasteride. The extent of prostatic involution did not correlate with the intraprostatic DHT concentration. We could not find evidence of apoptosis in finasteride-treated animals.
Animals ; Apoptosis ; Castration* ; Cholestenone 5 alpha-Reductase ; Dihydrotestosterone ; DNA ; Finasteride* ; Humans ; Nitrogen ; Prostate* ; Rats* ; Rats, Sprague-Dawley ; Young Adult

PURPOSE: The optimal interval at which to repeat prostate-specific antigen (PSA) measurement is controversial. We evaluated the probability of the serum PSA value increasing above specific cutoff values (4.0 ng/ml, 3.0 ng/ml, and 2.5 ng/ml) on annual follow-up visits in men with a lower baseline PSA than each cutoff value. MATERIALS AND METHODS: Between 2002 and 2006, a total of 14,459 men aged 40 to 79 years who underwent serum PSA determinations at least twice during health examinations at 11 medical centers were enrolled in this study. To reduce probable bias, we excluded men with pyuria, those with a baseline or follow-up PSA level of 10.0 ng/ml or more, and those with a history of medication with 5 alpha-reductase inhibitors. Serum PSA underwent logarithmic conversion to work out the normal distribution. The cumulative rate of freedom from increase in PSA above 4.0 ng/ml, 3.0 ng/ml, and 2.5 ng/ml was estimated with the Kaplan-Meier method according to baseline PSA range and age. The significance level was 1%. RESULTS: The rate of increase in PSA was lower in men who had a baseline PSA value in the low range and whose age was in the 40s or 50s. However, the cumulative rate of freedom from increase in PSA decreased as the PSA cutoff value was lowered. The optimal screening interval for men in their 40s and 50s whose baseline serum PSA level was 1.0 ng/ml or lower was 3 years when the significance level for PSA rising above 4.0 ng/ml was 1%. It was 2 years and 1 year, respectively, when the cutoff value was lowered to 3.0 ng/ml or 2.5 ng/ml. An annual PSA screening interval was recommended in men older than their 60s. CONCLUSIONS: The PSA test interval should be individualized according to baseline PSA, age, and PSA cutoff value.
Aged ; Bias (Epidemiology) ; Cholestenone 5 alpha-Reductase ; Follow-Up Studies ; Freedom ; Humans ; Male ; Mass Screening ; Prostate-Specific Antigen ; Pyuria

Androgens, the male sex hormones, play an essential role in male sexual differentiation and development. However, the influence of these sex hormones extends beyond their roles in sexual differentiation and development. In many animal species, sex hormones have been shown to be essential for sexual differentiation of the brain during development and for maintaining sexually dimorphic behavior throughout life. The principals of sex determination in humans have been demonstrated to be similar to other mammals. However, the hormonal influence on sexual dimorphic differences in the nervous system in humans, sex differences in behaviors, and its correlations with those of other mammals is still an emerging field. In this review, the roles of androgens in gender and cognitive function are discussed with the emphasis on subjects with androgen action defects including complete androgen insensitivity due to androgen receptor mutations and 5alpha-reductase-2 deficiency syndromes due to 5alpha-reductase-2 gene mutations. The issue of the complex interaction of nature versus nurture is addressed.
Androgens ; physiology ; Cholestenone 5 alpha-Reductase ; deficiency ; genetics ; Cognition ; physiology ; Humans ; Male ; Mutation ; Sex Characteristics ; Sexual Behavior ; physiology ; Syndrome

PURPOSE: In Korea, there was no specific guidelines for the management of benign prostatic hyperplasia (BPH). We reviewed the practice patterns of Korean urologists in the management of BPH and aimed to describe the need to develop specific guidelines. MATERIALS AND METHODS: A probability sample was taken from the Korean Urological Association Registry of Physicians, and a structured questionnaire, that explored practice patterns in the management of BPH, was mailed to a random sample of 251 Korean urologists. RESULTS: For the initial evaluation of BPH, most urologists routinely performed prostatic specific antigen (PSA) (96.4%), digital rectal exam (94.4%), international prostate symptom score (IPSS) (83.2%) and transrectal ultrasound (79.2%). Symptom assessment (36.4%) followed by transrectal ultrasound of prostate (TRUS) (20.0%) was considered as the most important diagnostic examination affecting the decision about individual treatment options. Almost all urologists (92.2%) chose medical treatment as the first-line treatment option for uncomplicated BPH with moderate symptoms. Of the respondents, 57.2% had prescribed alpha blocker and 41.6% alpha blocker plus 5-alpha reductase inhibitors as the medical treatment option for BPH. The prescription of 5-ARIs was dependent on the size of the prostate and the severity of symptoms. CONCLUSION: The results of our current survey provide useful insight into variations in the clinical practice of Korean urologists. They also indicate the need to develop further practical guidelines based on solid clinical data and to ensure that these guidelines are widely promoted and accepted by the urological community.
Adrenergic alpha-Antagonists/therapeutic use ; Cholestenone 5 alpha-Reductase/antagonists & inhibitors ; Data Collection ; Humans ; Korea ; Male ; Prostatic Hyperplasia/*diagnosis/*drug therapy ; Urology/statistics & numerical data

PURPOSE: We evaluated the pathologic characteristics and prognosis of pathologic T0 (pT0) prostate cancer (PC). MATERIALS AND METHODS: Of 1,196 consecutive men who underwent radical prostatectomy (RP) between January 1992 and November 2008, 34 patients (mean age, 68.8+/-7.9 years; range, 48-85) had pT0 PC. They were categorized into 4 groups according to neoadjuvant hormone therapy (NHT) and diagnostic methods. The initial PSA, 5 alpha-reductase inhibitor (5alphaRI), Gleason score of prostatic needle biopsy (PNB) or transurethral resection of the prostate (TURP), clinical stage, and presence of high-grade prostatic intraepithelial neoplasia were evaluated. Clinical and biochemical progression were also evaluated. RESULTS: 34 patients were categorized into 4 groups (Group I: 9 without NHT, diagnosed by PNB [1.1%]; Group II: 8 without NHT, diagnosed by TURP [11.3%]; Group III: 16 with NHT, diagnosed by PNB [5.5%]; Group IV: 1 with NHT, diagnosed by TURP [3.8%]). Group I had serum prostate-specific antigen (PSA)<15.0 ng/ml, one positive biopsy core, and a Gleason score< or =7. Group II had serum PSA<10.1 ng/ml, chips involved with cancer<10.0%, and a Gleason score< or =6. There were more patients taking 5alphaRI and high-grade PIN among patients without NHT. None of patients with pathologic pT0 PC had clinical or biochemical progression during follow-up, except 3 patients with NHT (mean, 22 months; range, 2-105 months). CONCLUSIONS: Patients without NHT had more favorable clinical and pathologic results. In our study, except for 3 patients with NHT, all patients had undetectable PSA levels after RP. We need more time for follow-up to conclude whether the prognosis of pT0 PC is favorable.
Biopsy ; Biopsy, Needle ; Cholestenone 5 alpha-Reductase ; Follow-Up Studies ; Humans ; Male ; Neoplasm Grading ; Prognosis ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Intraepithelial Neoplasia ; Prostatic Neoplasms ; Transurethral Resection of Prostate