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Microphallus Treatment & Management

  • Author: Karen S Vogt, MD; Chief Editor: Stephen Kemp, MD, PhD  more...
 
Updated: Jun 23, 2016
 

Medical Care

Testosterone therapy in the form of 3 monthly intramuscular (IM) injections has been used to increase penis size in infants and children.

Testosterone therapy has generally been found effective in treating micropenis due to testosterone deficiency. In 1999, Bin-Abbas et al showed that 1 or 2 courses of 3 testosterone injections (25-50 mg) administered at 4-week intervals in infancy or childhood resulted in sufficient increase in penis sizes to reach the reference range for age.[2]  With appropriate pubertal and adult replacement, patients achieved normal adult penis size and reported sexual activity and appropriate gender identity.[2] Thus, evidence suggests that treatment with testosterone during infancy or childhood primes the penis for later growth during puberty.

Infants with other hormonal deficiencies (growth hormone deficiency, hypothyroidism, adrenal insufficiency) should receive appropriate hormonal replacements.

A study by Becker et al on three related 46,XY males with PAIS found mixed results from the treatment of micropenis with topical dihydrotestosterone (4-month course of daily gel application). In the prepubertal patient, stretched penile length (SPL) increased from 2.5 cm to 3.5 cm, while in the peripubertal patient, it increased from 3.5 cm to 5.7 cm. However, an adult patient who had already undergone 1 year of weekly, high-dose testosterone treatment demonstrated no additional increase in SPL following topical therapy.[31]

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Surgical Care

Gender reassignment with appropriate genitoplasty has been performed. Because most boys with micropenis and descended testes are sensitive to testosterone therapy, consider genitoplasty only in extreme situations in which testosterone insensitivity is demonstrated. Even then, some authors question the wisdom of gender reassignment.[32, 33]

Circumcision should be avoided, or at least delayed, until appropriate evaluation, gender assignment, and therapy are completed. If associated with penile growth, testosterone therapy may facilitate the circumcision (see Medical Care).

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Consultations

As soon as an infant is discovered to have micropenis, a pediatric endocrinologist should be consulted. In some cases, the involvement of a pediatric urologist can also be helpful. Psychological support and social services assistance may be useful.

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Contributor Information and Disclosures
Author

Karen S Vogt, MD Pediatric Endocrinologist, Department of Pediatrics, Division of Endocrinology, Walter Reed National Military Medical Center

Karen S Vogt, MD is a member of the following medical societies: American Academy of Pediatrics, American Diabetes Association, Endocrine Society, Pediatric Endocrine Society

Disclosure: Nothing to disclose.

Coauthor(s)

Michael J Bourgeois, MD Director of Pediatric Undergraduate Medical Education, Associate Professor, Department of Pediatrics, Division of Pediatric Endocrinology and Metabolism, Texas Tech University School of Medicine

Michael J Bourgeois, MD is a member of the following medical societies: American Academy of Pediatrics, American Diabetes Association, Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London) Professor and Chair, First Department of Pediatrics, Athens University Medical School, Aghia Sophia Children's Hospital, Greece; UNESCO Chair on Adolescent Health Care, University of Athens, Greece

George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London) is a member of the following medical societies: American Academy of Pediatrics, American College of Physicians, American Pediatric Society, American Society for Clinical Investigation, Association of American Physicians, Endocrine Society, Pediatric Endocrine Society, Society for Pediatric Research, American College of Endocrinology

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kemp, MD, PhD Former Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas for Medical Sciences College of Medicine, Arkansas Children's Hospital

Stephen Kemp, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Pediatric Society, Endocrine Society, Phi Beta Kappa, Southern Medical Association, Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

Arlan L Rosenbloom, MD Adjunct Distinguished Service Professor Emeritus of Pediatrics, University of Florida College of Medicine; Fellow of the American Academy of Pediatrics; Fellow of the American College of Epidemiology

Arlan L Rosenbloom, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Epidemiology, American Pediatric Society, Endocrine Society, Pediatric Endocrine Society, Society for Pediatric Research, Florida Chapter of The American Academy of Pediatrics, Florida Pediatric Society, International Society for Pediatric and Adolescent Diabetes

Disclosure: Nothing to disclose.

References
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