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Induction of an LH surge with estradiol benzoate in a patient with incomplete testicular feminization syndrome.

A 31-year-old patient with incomplete testicular feminization syndrome characterized by a 46, XY karyotype in a phenotypic female with absent müllerian structures, marked clitoromegaly, testes and wolffian duct structures, partial labioscrotal fold fusion, and male levels of circulating androgens is described. She was challenged with estradiol benzoate (EB) to simulate the preovulatory surge of estradiol seen in cycling women. This EB challenge resulted in a negative feedback response for FSH but an LH surge similar to that induced with EB in cycling women. This suggests that in the incomplete testicular feminization syndrome there is hypothalamic or pituitary resistance to the blocking effects of androgens on LH surge production.