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Date of last update: 8/13/2017.

Forum Name: Urology Topics

Question: Premature Birth, Hypospadias, Hernia Affect Penis/Testicle?

 Vir77 - Wed Dec 02, 2009 4:22 pm

I am an 18 year old male. I was born very prematurely, I cannot recall the exact number of weeks premature but I weighed 1lb 6 ounces at birth if that helps. I had hypospadias repair done a few months after my birth once I was taken out of the incubator. I also had a hernia in my testicle repaired at the same time. I am rather small for my age and my growth plates are fused so I will not grow any taller than my 5ft. I took human growth hormone in these shot things for about a year on the advice of a doctor but I only grew maybe half an inch. I went through puberty fairly normally. My voice dropped to a low bass, I developed pubic hair and lots of body hair, facial hair, more muscle etc. I appear very masculine physically apart from my small penis/testes. All the usual secondary sexual characteristics so I do not think it is a lack of testosterone that is my problem.
I have a very small penis and testes. The testicle where my hernia was is rather shrunken. My penis when flaccid is on average 2 inches long sometimes a little more or a little less. It is about 1in to 1in 1/2 wide when flaccid. When erect it is 4 in to 4 in 1/2 long and 1 and 1/2 in width approx. My testicles are rather small and the one is shrunken.
I went to see a urologist and he took one look and said "you have micropenis" "so sorry for your bad luck" "absolutely nothing that can be done" "there's the door". I looked up this micropenis but it seems that my erect penis is much larger than anyone's with micropenis though I do not know for certain.
I do not understand why I am like this. I thought testosterone was the factor in determining penis/testes size, I have plenty of it but it just never grew properly. Is it because of my hypostadias and hernia when I was born? Because I was born very prematurely? I want to go see another urologist because I do not think I have micropenis. Since I am 18 is there any hope it will grow more? Since the human growth hormone did not help my height does that mean my penis is fused in size just like my bones? Any answer or explanation more than "you have micropenis" would be appreciated. I need something more than that to go to a urologist in person with.

Thank you very much for your time. I hope I provided enough information to get some kind of answer.
 Dr.M.Aroon kamath - Sun Dec 27, 2009 1:13 am

User avatar HI,
Micropenis(microphallus) is a small but otherwise normally formed penis with a stretched length of less than 2.5 standard deviations (SD) below the mean.Traditionally, the term 'micropenis' has been used to mean a penis that is otherwise normally formed, and the term 'microphallus' refers to micropenis + an associated hypospadias.

The penis is measured on the dorsal aspect, while stretching the penis, from the pubic symphysis to the tip of the glans.

One may get confused by the various penile measurements such as
- mean flaccid penile length,
- mean erect penile length (used in adolescents and adults),
- mean stretched penile length(usually used for penile
measurements in the newborn) etc.

Moreover, the length & girth of the phallus differs among populations.It has been found to correlate well with anthrapometric measurements such as weight and height.
Also, there are suggestions that many measurements should be carried out and a mean lenghth calculated.

Besides an idiopathic micropenis, two major causes of abnormal hormonal stimulation have been identified:

- Hypogonadotropic hypogonadism (decreased production of gonadotrophin-releasing hormone [GnRH])
- Hypergonadotropic hypogonadism (due to failure of the testes to produce testosterone).

The signs & symptoms of androgen deficiency depend upon
- time of onset &
- the degree of gonadotropin deficiency.

Androgen deficiency occuring in early fetal life-- wolffian structures fail to develop, leading to ambiguous external genitalia, hypospadias, microphallus, or a combination of these.

In patients with isolated hypogonadotropism, placental hCG(human chorionic gonadotropin) stimulates the fetal testis to produce sufficient androgens in early fetal life and so, in most patients, the ext genitalia do develop normally
During the second half of fetal life however, the developing gonad is under the influence of both LH and FSH. Deficiency of LH and FSH at this stage, may delay testicular descent and result in micropenis.

If gonadotropin deficiency occurs after birth but, before puberty, then
- delayed puberty/ arrested sexual development
- delayed epiphyseal fusion(eunachoid body habitus)
- retention of high pitched voice
- failure of temporal recession of hair-line.

Androgen deficiency occuring after completed puberty may present with
- regression of secondary sex cahresters,
- decreased libido & sexual dysfunction,
- infertility
- loss of fat mass,
- loss of muscle mass &
- infertility.

The initial evaluation is done to define whether the cause of the micropenis is central (hypothalamic/pituitary) or testicular. A full endocrinological work-up has to be carried out immediately. Karyotyping is also mandatory in all patients with a microphallus.

Testicular endocrine function must be assessed next (baseline and stimulated testosterone, luteinizing hormone (LH) and follicle stimulating hormone (FSH) serum levels). Stimulated hormone levels also may give an indication of the growth potential of the penis.

In patients with hypogonadotropic hypogonadism where, the testes are non-palpable, laparoscopy should be utilized to confirm 'vanishing testes syndrome' or intra-abdominal undescended hypoplastic testes. This investigation may be delayed until the age of 1 year.

Apart from chromosomal abnormalities, certain non-chromosomal abnormalities may also result in microphallus.One such,are mutations in a family of genes known as " homeobox genes" (HOX).

HOX genes are believed to play a fundamental role in the development of the vertebrate central nervous system, axial skeleton, limbs, gut, urogenital tract and external genitalia.

In your case, it is quite obvious from your account that there is no ambiguity about your external genitalia. Elucidation of the cause of your problem is more important than whether the penis is 'actually' micropenis or otherwise.

In borderline cases one may be right or wrong by a few millimeters.
Best wishes!

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