What is small penis
How penis Develops
Causes of small penis
Investigations in small penis
Why doctors donít take this problem seriously
Response of treatment
Side effects of treatment
What is small penis :- As we know average penile length is six inches (i.e. fifteen centimeter). When penis is somewhat smaller than this, is called small penis. And when it is too small than normal is called micropenis. This small penis size is found in approximately one percent of males .The small penis may occur as single disorder or in some persons it may be associated with Thin penis. In some persons penis is so thin that as in children. The urethral opening may be at the penile tip or it may open on the undersurface of penis. It makes them sexually unsure of himself and decreases there confidence. They feel inferiority complex in exposing themselves in public places as in swimming pools & sea beaches etc. Thus it must be consulted urgently, so that diagnosis and treatment can done by team of hormone specialist & micro vascular surgeon. For this you consult at our sex n hormone center for complete diagnosis & treatment. In majority cases proper diagnosis & hormone therapy of about one year duration leads to penis growth in size and normalization of penis in length & thickness. Thus you should go to center where doctor have experience of treating such problems. In very-2 rare cases surgical intervention is needed in which case by microsurgery technique the penis enlargement is achieved in length as well as in thickness (i.e. girth) if required.
Causes : The following are the major cause of small penis & Thin Penis
It may occur due to
Male Hormone Disorder: Hypogonadotropic hypogonadism (hypothalamic or pituitary deficiencies)Hypogonadism, Hypothyroidism, Testosterone deficiency, hyperprolactinemia,Hypogonadotropic states: Hypothalamic Ė pituitary deficiency: Idiopathic GnRH deficiency, Kallman syndrome, Prader-Willi syndrome, Laurence-Moon-Biedl syndrome , Hypothalmic deficiency, pituitary hypoplasia, Trauma, post surgical, postoradiation, Tumour (Adenoma, craniopharyngioma, other), Vascular (pituitary infraction, carotid aneurysm), Infiltrative (Sarcoidosis, histiocytosis, tuberculosis, fugal infection, hemochromatosis) Autoimmunehypophysitis,drug-induced hyperprolactinemia, Untreated endocrinopathies , Diabetes mellitus, Glucorticoid excess, Hypopituitarism, Cushing disease, Addison disease.
Isolated gonadotropin deficiency (non acquired) : Pituitary , Hypothalamic
Associated with multiple pituitary hormone deficiencies : Idiopathic pan hypo pituitarism (hypothalamic defects), Pituitary dysgenesis, Space-occupying lesions (craniopharyngiomas, Rathke pouch cycts, hypothalamic tumors, pituitary adenomas), Following surgery, Following cranial irradiation, Following CNS chemotherapy, Following inflammation, Infiltrative or destructive processes (autoimmune, hemosiderosis), Associated with syndromes involving hypthalamic function, Laurence-Moon-Beidl sundrome Prader-Willi syndrome , Frohlich syndromeGenetic Mutuations : KALI (kakallmann), Gonadotropin-releasing hormonereceptor(GnRHR), FSH3 isulated FSH deficiency, PROP1 (pituitary deficiency), HSEX1 (septo-optic dysplasia), DAX1 Isolated gonadotropic deficiency with or without anosmia, Fertile eunuch syndrone, Idiopathic hypopituitarism, CNS disorders : tumors, infections, pituitary agenesis or hypoplasia, hydrocephalus, Septooptic dysplasia, CNS radiation for leukemia or brain tumor, Prader-Willi and Laurence-Moon-Biedly Syndrome, Thalassemia major
Hyperogonadotropic hypogonadism: testicular failure, development defect, drugs, trauma, congenital defect, congenital adrenal hyperplasia, Chromosomal defect, testosterone hormone biosynthetic defect, Mumps orchitis leading to testicular atrophy,Primary testicular defect-disorders of testicular differentiation or inborn errors of testosterone synthesis, Klinefelter syndrome, Other X polysomies (i.e. XXXXY, XXXY)Rainbow syndrome,
Partial androgen insensitivity
Growth Hormone Deficiency
Thyroid hormone deficiency
Idiopathic small phallus: In many patients all the hormone growth factor & every thing else is normal ,still they have small genitalia. This occurs due to Decreased capacity of penile tissue to grow.This occurs due to defective morpho genesis of the penis in utero so that its growing capacity decreases later in life. This is also one of the common causes of slmall & thin penis.
Investigation & Diagnosis:
For diagnosis of cause of investigation following tests are required. These tests include
complete male hormone profile.
ultrasound of testis
Gowth Hormone analysis
other tests which may be required depending on likelihood of the any of above causes.
In biochemistry liver function or kidney function tests are done.
Dynamic test to judge functional capacity of testis whether testis has the capacity to function normally or not. In this test we inject single injection of gonadotropin as intramuscular injection then three day later the rise in concentration of male hormone is seen to asses whether testis has capacity to function normally or not.
Chromosomal analysis is done to see the genetic structure of testis, because there are many chromosome disorders, which lead to small penis.
Capacity of generation of active testosterone i.e. DHT is tested. This DHT generation test is abnormal in some cases of small penis / thin penis /underdeveloped penis.
Tests to locate testis as ultrasonography or C.T. Scan abdomen is needed if testis is not palpable.
MRI / CT SCAN head if suspecting hypogonadotropic hypogonadism.
Serum inhibin is tested which tells that whether testis is functioning or not.
Serum Iron, T.I.B.C. & ferritin concentration tested for hypogonadism due to hemochromatosis.
Combined Pituitary hormone tests are performed when suspecting pituitary disorder.
Molecular genetic studies done in some special cases.
Serum estrogen increased whenever testicular function is decreased.
Serum DHT is low in some conditions when generation of dihydrotestosterone is decreased.
Assessment of androgen receptor is done when needed, Dynamic tests as HCG test, response to antiestrogen & gonadotropin releasing hormone tests.
Interpretation of all above tests one need to be expert of hormone diseases with good experience. Based on above test result diagnosis of cause of small /or thin penis is made. Once the cause is found then treatment becomes very easy with good results.
Penis Enlargement Options: Before starting treatment for enlargement of penis all above causes are investigated and proper diagnosis is made. Once male hormone deficiency or other cause found treatment becomes easy. Various options of penis enlargement therapy are available for micropenis & small penis .
First We Test: Whether Penis Enlargement Is Possible Or Not.
For this hormone therapy given for three months in form of male hormone injection, skin patches, or oral tablets. If penis enlarges in size i.e. it grows in size by more than 1.25 cm in these three months, it means penis of that patient has potential for further growth. Once it is decided by above test that penis has potential for further growth, in such patient further courses of hormone therapy is given. By few courses of hormone treatment penis enlarges by three to four inches. By this therapy penis girth also increases besides increase in length. This penis lengthening treatment is very effective in those entire patientsís in whom initial penis increasing potential test shows that penis has capability for further penis growth. Thus all patients achieve fully normal penis i.e. good penis length & thick penis. As penis increases in size patientís confidence increases and feeling of well being is achieved.
Treatment:. Treatment can be either
Or Surgical therapy.
We start medical treatment only when above tests shows that penis has capacity to enlarge. It is given in the form replacement of male hormone testosterone & other hormone as growth hormone, DHT hormone & growth factor replacement. These hormones can be given in the form of oral tablets, skin patches, ointments, gel or injections.
As this treatment has no side effects, is economical and easy to take either as oral tablets, skin patches, or as gel or sometimes as injection of hormone.
Thread: Small Penis & Penis Enlargement