|
These authors report
the long-term outcomes of 46,XY males with micropenis, but no other
genital deformity, identified and treated intermittently with
androgens or hCG during infancy, childhood and/or adolescence. Lee
and Houk determined adult stretched penile length (SPL) and social
adjustment in 20 patients with SPL <–2 SD of normal at
initial examination: 11 had hypogonadotropism and 3 primary
testicular failure; in 6 patients no cause of the micropenis was
identified. SPL increased in all subjects; adult SPL was >–2
SD of the adult mean in 14 subjects and between –2.5 and –2
SD in 4; 2 patients had adult SPL <–2.5 SD of the mean.
Among these 20 patients and another 2 with micropenis first evaluated
as adults, 21/22 were heterosexual; 8 were/had been involved in
long-term heterosexual relationships. Relative to age-matched control
subjects, those with micropenis (N=12 studied) had comparable
findings in regard to heterosexual dating and sexual functioning,
male friendships, education, employment, sports/leisure activities;
none had a psychiatric illness. Despite normal adult SPL, 5 primarily
obese patients stated that their penises were small. The
investigators concluded that in adult men who had micropenis as
children/adolescents: 1) 90% had adult SPL within the broad range of
normal; 2) there was “reasonable social adjustment,” no
psychological pathology, and gender-appropriate sexual functioning.
Husmann evaluated
adult SPL in 20 men with micropenis (here defined as SPL <–2.5
SD of normal) diagnosed and treated during infancy in whom SPL did
not increase appreciably despite multiple courses of testosterone.
Five patients had a mutation in the androgen receptor, 6 had
hypogonadotropism, and 9 had no known cause of the micropenis. Mean
pretreatment SPL was –3 SD (range –5.5 to –2.6) for
age/race and mean adult SPL was –3.4 SD (range –5.9 to
–2.2). All patients considered their penises to be small, and 5
had undergone (unsatisfactory) surgery to enlarge their penises;
19/20 were heterosexual; 12/20 men were sexually active, but 4 were
incapable of vaginal penetration; 5 patients had mental illnesses
requiring professional therapy. Despite these findings, Husmann
concluded that these patients accept a male gender identity and many
engage in a “satisfying heterosexual relationship.”
Lee
PA, Houk CP. Outcome studies among men with micropenis. J Pediatr
Endocrinol Metab 2004. 17:1043-53.
Husmann
DA. The androgen insensitive micropenis: Long-term follow-up into
adulthood. J Pediatr Endocrinol Metab 2004.17:1037-41.
Editor’s
Comment: In the report of Lee and Houk, in 5/20 patients (1
hypogonadotropic subject, 1 with primary testicular failure, and 2
with “idiopathic” micropenis) SPL SD score did not
appreciably increase between diagnosis and adulthood, but these
subjects are not specifically discussed further, and their
psychosocial status is unknown. It would have been of interest if
Husmann had also reported his experience with the outcome of patients
with micropenis responsive to testosterone. These data are reassuring
in that they further demonstrate that there is no basis to consider
sex reversal in the 46,XY male with micropenis as their gender
identity is firmly masculine. Furthermore, with current surgical
procedures for penile reconstruction, the opportunity for
satisfactory penile enlargement has improved substantially.1
Allen W. Root, MD
Reference - (linked to  )
- Jordan GH, Rosenstein DI, Gilbert D. Growth Genet Horm 2002;18:33-8.
|
Current GGH - Vol. 24 No. 1
print version (pdf)
Printer Friendly
Email Paper