SMALL PENIS IN A 14 YEAR OLD BOY? 20 May 2014

SMALL PENIS  IN A 14 YEAR OLD BOY?       20 May 2014
QUESTION-Hi, a boy came to my attention because small penis. Chronological age of 14 yo. He had a history of a cryptorchidism in one side and a retractile testis in the other side. It was corrected with surgery when he was a child. He has no alteration in the sense of smell. In the physical examination, he presents a teste of 2,5cm longitudinal diameter, Tanner stage 2, phallus  4,5cm stretched (after compression of pubic fat). There was a discrete gynecomastia in both sides. The weight was 68kg (%90th) and the height 158cm (%25th).  I`ve ordered laboratory evaluation, as follows: LH 2,93; FSH 2,69; testosterone 150 ng/dL, E2 <11,8 ng/dL. The bone age was compatible with the chronological age (14 y.o). How should this case be interpreted and managed? RESPONSE-- It seems that this boy is in early pubertal with testes around 5ml  (based on the testis length provided) and some virilisation. One doesn’t see anything abnormal in the limited information provided. The gonadotropins are detectable but with a relatively low T of 5.2nM (150 ng/dl) which is about half the lower adult limit of normal. This is expected in early puberty prior to full activation of the hypothalamo-pituitary-testicular axis. His penis length is consistent with early puberty when ~6 cm is average; growth would be expected over the next 5 years presuming puberty progresses. Some degree of gynecomastia is physiologically normal in puberty but usually resolves spontaneously. It may be difficult to estimate true glandular from adipose tissue is such an obese boy. His bone age equals his chronological age which is consistent with him being in normal puberty. I presume there is no family history of delayed puberty, that perhaps he has normal older siblings etc. One presumes he is otherwise in good health and progressing in his schooling. The history of cryptorchidism may be associated with higher rates of testis cancer and infertility in later life. Regular observation, perhaps 6 monthly, will allow pubertal development and hormone levels to be tracked and action taken if/when things do not proceed normally.  I don’t see what one could/should do regarding his leading concern of penile length at this time other than re assurance. Regards, Rob McLachlan MD, PhD , Section Editor