Inhibition of lactation during the puerperium by testosterone propionate

Birnberg, Charles H.; Kurzrok, Lawrence; Klor, Samuel J.

doi:10.1016/s0002-9378(40)90888-2

Cited by 15 publications

(3 citation statements)

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“…Kurzrok and O'Connell (1938), however, found that 70% of their cases required two daily injections of 10 to 25 mg. of testosterone dipropionate for periods of from three to seven MEDICAL JOURNAL days. This period was decreased if doses of 25 to 50 mg. were given (Birnberg, Kurzrok, and Klor, 1940). Siegler and Silverstein (1940) inhibited lactation by giving total doses of 25 to 125 mg. of testosterone dipropionate in divided doses every 12 hours, with a total of three to five injections.…”

Section: Discussionmentioning

confidence: 99%

Inhibition of Lactation by Hexoestrol Dipropionate

Prescott¹,

Basden²

1944

BMJ

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JOURNALwas our practice to give the infant the same kind of food as he had had before admission unless there was some definite contraindication. Vitamins A, B, C, and D were added to the feeds from the first day, and continued throughout the stay in hospital.3. The early correction of fluid loss. Fluids and proteins were administered intravenously in the form of half-strength serum or plasma (diluted with Hartmann's solution) as soon as there was clinical evidence of dehydration, and in quantities sufficient to restore fluid loss and maintain the infant's daily requirements. The usual allowance of 21 oz. per lb. per day was made, plus an allowance of 3 to 6% of body weight for dehydration in the first 24 to 48 hours. The intravenous drip was begun with half a bottle of Hartmann's + 2+ to 5% glucose, and serum or plasma then added (diluted to half-strength with Hartmann's). The drip was continued, giving alternate bottles of Hartmann's solution and half-strength serum or plasma, until dehydration was completely corrected and the infant was able to take and retain a dilute feed; this was generally in 1 to 3 days. Feeding was usually begun 12 to 24 hour-s after the commencement of intravenous therapy, and the quantity and strength of the milk feed gradually increased, the rate of the intravenous drip being adjusted accordingly.4. Energetic measures to combat shock in those infants admitted in a state of collapse. Warmth, stimulants such as brandy and cor-amine, and oxygen were given, and the intravenous drip was begun immediately. Treatment in these cases was considered as urgent as in " surgical shock." 5. The combating of anaemia by routine administration of iron (in the form of a ferrous sulphate mixture) and blood transfusions as required.6. The prevention of cross-infection; all infants were nursed in cell or barrier wards with strict bed-isolation technique, including the wearing of gowns and masks by all attendants. Summary and ConclusionsOne hundred and forty cases of diarrhoea and vomiting in infants under 15 months of age are analysed.The cases were of average severity as judged by incidence and degree of dehydration ; 69 (49.30/o) were dehydrated, the maximum incidence of severity occurring in the age group 0-9 months. There were 8 deaths, giving a case fatality of 5.700 for all cases, or 11.6% of dehydrated cases; 6 of the 8 deaths followed relapses.There were 27 relapses. The relapse rate in the open "barrier" ward was four times that in the cell wards.Evidence of parenteral infection was found in 124 cases, or 88.6%,h. The type of parenteral infection and incidence of infecting organisms are shown. The changes in body chemistry in dehydration occurring in diarrhoea and vomiting are discussed, and the need for further research in this field is stressed.The gratifying results obtained in this series may be attributed to: (1) the fact that the parenteral infections present were fairly easy to recognize and treat ; and (2) the attention paid to the prevention or early correction of dehydration, and early ...

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Section: Discussionmentioning

confidence: 99%

Inhibition of Lactation by Hexoestrol Dipropionate

Prescott¹,

Basden²

1944

BMJ

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“…Pregnant and puerperal women, as will be shown, tolerate enormous doses of synthetic oestrogenic compounds-a tolerance which seems to be much greater than that of non-pregnant women. Testosterone propionate has been used for the inhibition of lactation by Kurzrok and O'Connell (1938), Birnberg, Kurzrok, and Klor (1940), and Siegler and Silverstein (1940). The lastnamed authors consider that testosterone is better for this purpose than stilboestrol, claiming that stilboestrol causes afterpains and excessive lochia.…”

Section: Literature Of the Oestrogensmentioning

confidence: 99%

Inhibition of Lactation by Synthetic Oestrogens

Barnes¹

1942

BMJ

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The hormone control of lactation was reviewed by Nelson (1936). He concluided that the ovarian hormones, which are present in enormously increased amounts in pregnancy, are necessary for the development of the breasts, but inhibit the secretion of milk. The initiation and maintenance of lactation depend on the anterior lobe of the pituitary.After parturition the oestrogenic hormone ceases to be produced in large amounts, and with this release of control lactation begins. A further factor in the maintenance of lactation is the stimulus of suckling, the mechanism of which is obscure; nor is it known how the oestrogenic hormones inhibit lactation, though it is assumed that they do so by inhibiting the action of the anterior lobe. Folley (1936) showed that when the oestrogenic hormone was administered to the lactating cow, lactation was inhibited and the milk yield was reduced. This effect was temporary and depended on obtaining a high level of oestrogen in the blood. Folley and Kon (1936) studied the effect of sex hormones on lactation in the rat. They found that oestradiol caused a marked inhibition in intact rats, and a definite though less well marked effect in rats ovariectomized on the day after parturition. Testosterone propionate also caused pronounced inhibition, but progesterone and androsterone had no effect.On the basis of these and similar findings it was suggested that oestrogenic hormones might be used for the inhibition of lactation in puerperal women, and numerous reports of this use of the naturally occurring oestrogens have appeared. Foss and Phillips (1938) obtained satisfactory results in 62 cases with oestradiol (progynon B, Schering), giving a total dose of 10,000 I.U. They found that oestrogenic hormone was also useful for flushed and engorged breasts, relieving the symptoms without interfering with lactation. Lehmann (1938) used progynon B oleosum. He found that 100,000 units given by injection in the first 24 hours post partum inhibited lactation in 91% of cases. Inhibition of established lactation was pbtained in 89% of cases with 200,000 units, but in only 50% with 150,000 units. Jeffcoate (1939) gave oestrone by mouth in doses of 2 to 6 mg., gradually decreasing the dose over 3 to 6 days. He found that,it was usually necessary to supplement this by 1 to 2 mg. of oestradiol benzoate by injection. Literature of the OestrogensThe synthetic oestrogenic substance diethyl-stilboestrol, commonly known as stilboestrol, was first described by Dodds, Golberg, Lawson, and Robinson (1938a). It has since been shown by numerous workers that this substance, and others chemically allied to it, are capable of reproducing the biological and clinical effects of the naturally occurring oestrogens. They can be produced relatively cheaply and are equally ad potent when given by mouth as when injected, if not more so. Thus they stand in contrast to the naturally occurring oestrogens, which are generally very much less potent by mouth and are therefore best administered parenterally. Connally, Dann, Reese, and ...

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“…This period was decreased if doses of 25 to 50 mg. were given (Birnberg, Kurzrok, and Klor, 1940). Siegler and Silverstein (1940) inhibited lactation by giving total doses of 25 to 125 mg. of testosterone dipropionate in divided doses every 12 hours, with a total of three to five injections.…”

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confidence: 99%

Factors Influencing Dermatitis in Coal-miners

Knowles¹

1944

BMJ

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430 SEPT. 30, 1944 HEXOESTROL DIPROPIONATE TO INHIBIT LACTATION MEDICAL JOURNAL days. This period was decreased if doses of 25 to 50 mg. were given (Birnberg, Kurzrok, and Klor, 1940). Siegler and Silverstein (1940) inhibited lactation by giving total doses of 25 to 125 mg. of testosterone dipropionate in divided doses every 12 hours, with a total of three to five injections. Lass (1942) states that methyl testosterone in repeated doses of 25 mg. inhibits lactation in 48 hours; total dosage was from 250 to 350 mg. In 7 out of 25 cases methyl testosterone was effectixl on the first day.A new synthetic oestrogen-octofollin or 2:4-di-(p-hydroxvphenyl)-3-ethyl hexane-has recentlv been used for the inhibition of lactation (Murphy, 1943). This, given over a period of four days in doses of 5 m.g. t.i.d., yields results similar to those obtained with stilboestrol.From this discussion it is clear that hexoestrol dipropionate given parenterally is more effective for the inhibition of lactation than the other synthetic oestrogens and testosterone or its derivatives. With the possible exception of methyl testosterone none of these is effective in inhibiting lactation on the first day of treatment. The use of synthetic androgens in high dosage is ruled out on the grounds of expense. SummaryA single intramuscular injection of 12.5 mg. of hexoestrol dipropionate inhibited lactation in 66% of a series of 44 mothers shortly after childbirth. When given within the first three days of delivery lactation did not occur, and there were no signs of breast engorgement or discomfort. Of the remaining 34% all but 2% ultimately responded to repeated injections. Only 18% required treatment for more than three days.A further course of injections, given to suppress " secondary filling," was necessary in only 7% of the cases. This compares well with the figure of 25 to 45% for stilboestrol.Hexoestrol dipropionate, given intramuscularly in one or two doses, was effective in suppressing lactation in five cases in which it had already been established.Hexoestrol dipropionate given by mouth is not so satisfactory as when given by injection.Literature on the inhibition of lactation by oestrogens and androgens is reviewed.Thanks are due to the members of the resident medical staff of the Mothers' Hospital, Clapton, for their assistance and care in keeping records of the cases.

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Inhibition of lactation during the puerperium by testosterone propionate

Cited by 15 publications

References 4 publications

Inhibition of Lactation by Hexoestrol Dipropionate

Inhibition of Lactation by Hexoestrol Dipropionate

Inhibition of Lactation by Synthetic Oestrogens

Factors Influencing Dermatitis in Coal-miners

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