Small Penis / Penis Enlargement

Small Penis / Penis Enlargement

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 men .The small penis may occur as single disorder or in some persons it may be associated with thin penis. In some persons penis is very thin as in children. It makes them sexually unsure of himself and decreases their 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 be started as soon as possible. For this you may 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 consult at our 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 of small penis: The following are the major causes of small penis & Thin Penis: Male Hormones Disorder: (1) Hypogonadotropic hypogonadism: (hypothalamic or pituitary deficiencies) Hypogonadisms, Hypothyroidisms, Testosterone deficiency, hyperprolactinemias, Hypogonadotropics states: Hypothalamic - pituitary deficiencies: Idiopathic GnRH deficiency, Kallman syndromes, Prader-Willi syndromes, Laurence-Moon-Biedl syndromes, pituitary hypoplasia, Trauma, post surgical, postiradiation, Tumour (Adenoma, craniopharyngioma, other), Vascular (pituitary infraction, carotid aneurysm), Infiltrative (Sarcoidosis, histiocytosis, hemochromatosis) Autoimmune hypophysitis, drug-induced hyperprolactinemia, untreated endocrinopathies, Diabetics Glucorticoid excess, Hypopituitarisms, Cushings disease, Addisons disease. Isolated gonadotropin deficiency (non acquired): Pituitary, Hypothalamic Associated with multiple pituitary hormone deficiencies: Idiopathic pan hypo pituitarism (hypothalamic defects), Pituitary dysgenesis, Following inflammation, Infiltrative or destructive processes (autoimmune, hemosiderosis), Fertile eunuch syndrome, Idiopathic hypopituitarism, (2) 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, (3) Partial androgen insensitivity (4) Growths Hormones Deficiency (5) Thyroids hormones deficiency (6) 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 morphogenesis of the penis in utero so that its growing capacity decreases later in life. This is also one of the common causes of small & thin penis. Diagnostic tests for diagnosing cause of small penis First of all we take detailed history then do thorough examination of whole body system including genitalia. On history & examination we get certain clue for likelihood of some of the above causes. Then we perform those relevant tests in that particular patient. Thus by doing some of below mentioned tests diagnosis of cause of small penis is made. The following are the list of investigations; need to be done in the cases of underdeveloped small/ or thin penis These tests includes: Complete male hormone profile. Thyroids test Serum prolactins SHBG Ultrasound of testis Growths Hormones analysis DHT Level 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 assess 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 clomiphene LH, FSH rise in response to gonadotropin releasing hormone tests. All above tests need to be interpreted by expert of hormone diseases with good experience. Based on above test results diagnosis of cause of small /or thin penis is made. Once the cause is found then treatment becomes very easy with good results. TREATMENT OPTIONS FOR PENIS ENLARGEMENT Penis enlargement by Hormone Therapy: Before starting treatment for enlargement of penis all above causes are investigated and proper diagnosis is made. Then we test whether penis enlargement is possible or not.. 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 patients's 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 patient's confidence increases and feeling of well-being is achieved. How this treatment works: When we give below-mentioned hormones by any of the below-mentioned routes. The concentration of these hormones in blood circulation rises. This leads to binding of more hormones on androgen receptors of penis. After binding with receptors these hormones leads to certain changes in the penis tissue. This leads to multiplication of penile tissue leading to further growth. This continued multiplication of penile tissue leads to further penis growth. This continued multiplication of penis tissue under the effect of above mentioned hormone treatment continues till penis size normalizes. Usually in one-year time penis size as well as penis thickness i.e. girth normalizes. Unluckily most doctors have less knowledge about hormone treatment so that they neither investigate the patient nor give hormone or other medical therapy for penile growth. Treatment of Small Penis Various options of penis enlargement therapy are available for micropenis & small penis. This treatment can be either: Hormone Therapy: availalable as pills, hormonal skin patches or injections Surgical therapy: Penis enlargement surgeries HORMONE TREATMENT 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. The various Treatment options are: 1) Male hormone testosterone replacement: The replacement of male hormone testosterone is one of the common treatments for penis enlargement. The various preparation of testosterone is: a) Oral preparation, which is available in capsule form. It needs to be given one to three capsules daily. These have no side effects. b) Tran dermal Testosterone given as scrotal patch. It is very effective & has no side effects. It can be also given as Testosterone gel, which can be applied on any part of the skin. c) Sublingual Testosterone cyclodextrin is now available which is very fast acting & very effective is fast & better sex organ & secondary sexual character development. d) Local application of D.H.T. gel is new preparation for male hormone replacement. It is very effective for increasing penile size, & in cases of cure of underdeveloped penis size in boys. e) Injections of Testosterone esters: These include Testosterone enanthate & testosterone cypionate given intramuscular injections every 10 to 14 days. f) Long acting testosterone as testosterone bucilate given once in 4 months. g) Testosterones implants are now available which once injected remain effective for up to six months. h) New human androgen receptor modulators they increase the effect of male hormone over androgens. 2) Growths Hormones Therapy: Growth hormone is given when somatotropin deficiency is found. 3) IGF-1 therapy: is given when somatomedin-c is subnormal. 4) DHT Therapy: is given in many patients. It is very effective in most patients. This treatment is also effective in many patients when all above treatment has failed. The other good thing about this is that it is available as skin gel so taking this is simple & has no side effects. This treatment is very effective in those in whom male hormone is unable to work due to inability to generate the final end product for testosterone efficacy due to 5 alpha reductase defects. In such patient replacement of final target hormone is replaced leading to good penile growth. In such situation even male hormone can be used in higher than usual doses leading to achievement of good penile enlargement. 5) Gonadotropin therapy is also very effective in penis enlargement. 6) Gonadotropin Releasing hormone therapy is effective in many cases of under develop genitalia. But unluckily many doctors do not take the problem seriously leading to patient not given proper treatment. Thus many patients remain having small size of penis & associated lifelong inferiority complex. Response of Treatment: When any of above treatment is started the response is very good & has no side effects. In one study when the above hormone started, penis size increases by 1.0 cm in first month & then 0.3 cm every month in later months. After few courses of above treatment penis enlarges by three to four inches in length & also in girth i.e. thickness. Thus the trial of treatment should be given to all adults with small penis before asking them to go for surgery. Side Effects: It has no side effects if given in proper disease and in-patients when it is really indicated. This it is absolutely safe in young patients below 50 years. PENIS ENLARGEMENT SURGERY Surgical Treatment is required when medicine are not effective then there are various surgical procedures are there which can lead to long & thick penis. At our centre our micro surgeon performs all penis enlarging or girth increasing surgery. Penis lengthening surgeries are performed by specialist surgeon (microscopic surgery) when penis is significantly small medicines have failed. Sometimes it is performed to improve the performance & satisfaction of man. Three types of surgeries are performed. (i) Penis Lengthening Surgeries (ii) Penis Girth increasing surgeries. (iii) Chordee correction Response of Treatment When any of above treatment is started the response is very good & has no side effects. In one study when the above hormone started, penis size increases by 1.0 cm in first month & then 0.3 cm every month in later months. After few courses of above treatment penis enlarges by three to four inches in length & also in girth i.e. thickness. Thus the trial of treatment should be given to all adults with small penis before asking them to go for surgery. Side Effects: It has no side effects if given in proper disease and in-patients when it is really indicated. This it is absolutely safe.