Male sex hormone therapy as a specific treatment for. prostate hypertrophy
In contrast to female sex hormones, the marketing of male sex hormones was not immediately successful. In 1931 Laqueur complained that the selling of Hombreol did not show any progress and advised Organon to supply free preparations to leading Dutch general practitioners. The reason for the disappointing sales was sought in the poor quality of this product, which had led to negative results in clinical trials. To solve this problem, Laqueur’s laboratory and Organon put more effort into improving the quality of male sex hormone preparations. Scientists found the answer ironically in making hormone preparations from a combination of both male and female sex hormones. In contrast with the earlier problems in producing male sex hormone preparations (in which scientists removed female sex hormones from the raw material to prepare purified male sex hormone preparations), scientists now added female sex hormones to male sex hormone preparations in order to improve their therapeutic activity. In 1931, Laqueur advised Organon to organize large-scale clinical trials with combined preparations of male and female sex hormones: HombreolMenformon. The prescription of this new product was mainly indicated in cases of prostate hypertrophy and psychological disorders, such as depression and melancholy.27 In 1937, Organon put a new hormone preparation on the market under the trade name of Testosteron. In contrast to the other male sex hormone preparations, this hormone was prepared from testes instead of urine. The successful isolation and chemical identification of testosterone in Laqueur’s laboratory in 1935 faciliated the synthetic production of male sex hormone preparations, thus making available for therapeutic purposes much larger and less expensive quantities of male sex hormones. In 1936 Dutch urologists were approached by Laqueur to participate in the organization of clinical trials (Organon Archive 18 December 1936). A review of the medical literature in Het Hormoon in 1938 indicates that the synthetically manufactured testosterone esters (testosterone acetate and testosterone propionate) were used on a wide scale in the late 1930s (Tausk 1938b).
In sum, male sex hormone preparations were promoted mainly as a specific therapy for prostate hypertrophy and more tentatively for sexual and psychological disorders. Following the dualistic paradigm of sex endocrinology, the clinical use of male sex hormones was restricted to men. Emphasis on prostate hypertrophy as the major indication is evident in Laqueur’s request in 1930 to the Ministry of Defence to obtain permission to collect male urine in military barracks. Laqueur explained the relevance of collecting male urine:
It is rather likely that male sex hormone preparations affect a whole series of symptoms of old age in men, not only sexual functions, and also bring about favorable effects in a psychological sense. I envisage in particular the therapeutic treatment of prostate hypertrophy, one of the most serious geriatric complaints in men, which is possibly related to the absence of adequate male hormone.
(Organon Archive 14 October 1930)
The indication of prostate hypertrophy was also emphasized in Organon’s negotiations with the Health Financing Institutions to obtain funding for male sex hormone therapy (Organon Archive 19 October 1938).
The reception of male sex hormone therapy shows vast national differences. An inquiry among German urologists, surgeons, neurologists, dermatologists and general practitioners in 1937 illustrates that prostate hypertrophy and sexual and psychological disorders were indeed the three major indications for male sex hormone therapy. The same inquiry also indicates that the medical practice of male sex hormone therapy in Germany was much more varied than in The Netherlands, including dermatological disorders, anomalies in the development of genital organs and the stimulation of beard-growth (Organon Archive 20 April; 8 May 1937). In the United States the medical profession was rather critical of the promotion of male sex hormones. In 1939 the Council on Pharmacy and Chemistry published an evaluation of male sex hormone therapy in the Journal of the American Medical Association:
Within the past few months extravagant claims for the action of the male sex hormone testosterone have appeared in professional and lay publications…it is the Council’s belief that many claims for it have been grossly exaggerated.
The council considered hormonal treatment as successful only in cases of absent or atrophic testes, or in cases of undescended testes:
all other claims are either exaggerated or immature and should be disregarded until substantial evidence becomes available on which to evaluate them.
(Council on Pharmacy and Chemistry 1939)
In The Netherlands, male sex hormones did not develop into a widely applicable treatment, as did female sex hormones. In the Pocket Lexicon of Organ and Hormone Therapy, Organon recommended male sex hormone therapy in only 3 of 129 indications in which treatment with hormone and organ preparations was advised (Anonymous 1937). Compared to female sex hormones, Organon’s marketing strategy for male sex hormones was modest. Organon’s propaganda was restricted to advertising campaigns and did not include asking industrial companies to test hormone therapy among their male employees, as had been done to promote female sex hormones.