Congenital hypogonadotropic hypogonadism and micropenis: Effect of testosterone treatment on adult penile size - Why sex reversal is not indicated
Congenital hypogonadotropic hypogonadism and micropenis: Effect of testosterone treatment on adult penile size - Why sex reversal is not indicated
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DOI：
10.1016/s0022-3476(99)70244-1
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发表时间：
1999-05-01
影响因子：
5.1
通讯作者：
Kaplan, SL
中科院分区：
文献类型：
--
作者：
Bin-Abbas, B;Conte, FA;Kaplan, SL
小阴茎通常是由于胎儿睾酮缺乏所致。这种形式的小阴茎的临床管理一直存在争议，对于睾酮治疗能否诱导功能充足的成年阴茎存在分歧。因此，一些临床医生建议对受影响的男婴进行性别逆转。我们研究了8名从婴儿期或儿童期到成熟期（18至27岁）继发于先天性垂体促性腺激素缺乏症的小阴茎男性受试者。4例患者在2岁前接受睾酮治疗（第一组），4例患者在6 - 13岁之间接受睾酮治疗（第二组）。报告时，I组的平均阴茎长度为1.1 cm (-4 SD；范围，0.5至1.5 cm)， II组的平均阴茎长度为2.7 cm （-3.4 SD；范围，1.5至3.5 cm）。所有患者在婴儿期或儿童期每隔4周接受1个或多个疗程的肌内注射enanthate睾酮（25或50mg）。在青春期时，剂量逐渐增加到每月200毫克，后来改为成人替代方案。成年后，ⅰ组和ⅱ组的平均阴茎最终长度为10.3 cm +/- 2.7 cm，范围为8 ~ 14 cm（白种人成年后的平均阴茎拉伸长度为12.4 +/- 2.7 cm）。8名男性中有6名性活跃，所有人都报告了正常的男性性别认同和社会心理行为。我们的结论是，在婴儿期和儿童期1或2个短期的睾酮治疗可以使继发于胎儿睾酮缺乏的小阴茎男孩的阴茎尺寸增加到正常的年龄范围；在青春期接受替代治疗的结果是，成人阴茎的大小在平均值的2个标准差以内。我们没有发现临床、心理或生理适应症支持受影响的男婴转化为女婴。此外，这项研究的结果不支持从大鼠数据中得出的观点，即在婴儿期或儿童期治疗睾酮会损害青春期的阴茎生长，并影响成年阴茎的长度。
Micropenis is commonly due to fetal testosterone deficiency. The clinical management of this form of micropenis has been contentious, with disagreement about the capacity of testosterone treatment to induce a functionally adequate adult penis. As a consequence, some clinicians recommend sex reversal of affected male infants. We studied 8 male subjects with micropenis secondary to congenital pituitary gonadotropin deficiency from infancy or childhood to maturity (ages 18 to 27 years). Four patients were treated with testosterone before 2 years of age (group I) and four between age 6 and 13 years (group II). At presentation, the mean penile length in group I was 1.1 cm (-4 SD; range, 0.5 to 1.5 cm) and in group II it was 2.7 cm (-3.4 SD; range, 1.5 to 3.5 cm). All patients received one or more courses of 3 intramuscular injections of testosterone enanthate (25 or 50 mg) at 4-week intervals in infancy or childhood. At the age of puberty the dose was gradually increased to 200 mg monthly and later to an adult replacement regimen. As adults, both group I and II had attained a mean final penile length of 10.3 cm +/- 2.7 cm with a range of 8 to 14 cm (mean adult stretched penile length for Caucasians is 12.4 +/- 2.7 cm). Six of 8 men were sexually active, and all reported normal male gender identity and psychosocial behavior. We conclude that 1 or 2 short courses of testosterone therapy in infancy and childhood augment penile size into the normal range for age in boys with micropenis secondary to fetal testosterone deficiency; replacement therapy at the age of puberty results in an adult size penis within 2 SD of the mean. We Found no clinical, psychologic, or physiologic indications to support conversion of affected male infants to girls. Further, the results of this study do not support the notion, derived from data in the rat, that testosterone treatment in infancy or childhood impairs penile growth in adolescence and compromises adult penile length.