SynopsisA syndrome characterized by the psychopathological features of anorexia nervosa occurs in male subjects. There have been 25 cases previously reported in the literature which appear to be fairly typical of the condition and the present paper adds the case histories of another six patients. Endocrine investigation on these patients reveals a disorder of urinary excretion levels of testosterone and of total gonadotrophic activity, which is comparable to the disturbance of sex hormones that accompanies the menstrual disturbance of female patients with anorexia nervosa. The exact nature of the endocrine disturbance in the male, however, is still less well understood than that in the female.

SynopsisSerum luteinizing hormone(LH) responses to a course of clomiphene citrate were studied in eleven patients with anorexia nervosa at different stages of the illness. In malnourished patients basal levels of LH were invariably low. With the resumption of a normal weight a small but definite rise in LH levels was observed but this spontaneous response to weight gain was variable in that many patients continued to exhibit abnormally low LH levels.The response to clomiphene in terms of a rise in basal LH levels after administration of the drug, followed by a second peak of LH and subsequent menstrual bleeding, was clearly dependent in part on the patient's nutritional state. In the malnourished state the response to clomiphene was usually either absent or incomplete. After the resumption of a more normal weight, the patients invariably showed an initial rise in LH after the clomiphene, but the second LH peak and subsequent menstruation were frequently not demonstrated. Six patients maintained a normal body weight for at least six months after a course of clomiphene, but only three of them resumed cyclical menstrual bleeding. It was concluded that factors additional to the nutritional state contribute to the prolonged amenorrhoea in anorexia nervosa and that clomiphene appears to have only a limited role in the treatment and management of patients with the disorder. Some aspects of current knowledge of the endocrine mechanisms that regulate normal menstruation and of the mode of action of clomiphene are outlined.The results of the present study are discussed against this background in an attempt to elucidate further the hypothalamic disorder underlying the amenorrhoea in anorexia nervosa.

Serial urinary gonadotrophin measurements were made during dietary treatment of patients with anorexia nervosa and with obesity. Results indicate that food restriction and weight loss give rise to a general reduction in gonadotrophin excretion. An important endocrine feature of anorexia nervosa is a lack of cyclical gonadotrophin excretion even after normal body weight has been restored. This loss of rhythmicity cannot be accounted for simply in terms of weight loss. It is suggested, on the basis of reported animal studies, that the endocrine disturbance in anorexia nervosa may be due to a failure of the anterior hypothalamic mechanisms concerned with the control of rhythmic gonadotrophin secretion.

SYNOPSISA male patient is described whose loss of sexual interest and activity was due to gonadal failure, presumably the result partly of Klinefelter's syndrome and partly of orchitis, though the latter was unilateral. He showed no change during a placebo control period, but within a few days of starting replacement treatment with testosterone he reported a return of sexual interest and showed a response to sexually arousing stimuli; sexual attitudes also improved. This case is of interest because of the specific and rapid psychological response to the correction of an androgen deficiency.