Penile and Testicular Underdevelopment in Young Adults

Penile and testicular hypoplasia?

Hello, Doctor Xu.
I am 24 years old, but my penis and testicles are smaller than those of an average adult male, and I have very little facial and body hair.
My penis measures only a little over 7 cm when erect and is not very firm.
Recently, I went to a urologist and had blood tests done, which showed my Testosterone level at 159 ng/dL, Prolactin at 31.1 ng/mL, FSH at 2.8 mIU/mL, LH at 4.5 mIU/mL, and Free Testosterone at 15.7 pg/mL.
After reviewing the test results, the doctor referred me to an endocrinologist.
When I visited the endocrinologist, I was asked to undergo additional blood tests, including TSH, Cortisol, Free T4, and ACTH.
During my follow-up appointment, the endocrinologist informed me that my testosterone levels were low, but the other results were relatively normal, so he did not believe there was an endocrine issue and sent me home.
I would like to ask the doctor: 1.
If there is no endocrine issue, what could be the cause of my underdeveloped penis and testicles? 2.
The urologist suggested testosterone injections for six months, but since I have already gone through puberty, is there still a possibility for further development of my penis and testicles? 3.
What effects could hormone injections have on my body? Thank you very much for your response.

Xiao Hei, 20~29 year old female. Ask Date: 2004/12/06

Dr. Xu Weikai reply Urology

Hello, you can refer to my previous response regarding penis size.
Your penis appears to be on the shorter side.
As for testosterone levels, low levels may indicate a potential congenital endocrine issue.
If an endocrinologist determines there are no endocrine problems, it could be an issue with testicular production; in other words, there may be a problem with the testes themselves.
Regarding treatment options, hormone replacement therapy can be administered before puberty for a duration of two years or continued until puberty, which tends to yield good results.
After puberty, treatment becomes less consistent, and some may even advise against it due to potential carcinogenic risks.
Personally, I don't have much experience in this area, so I recommend seeking a larger hospital (such as National Taiwan University Hospital) where specialized physicians (as such cases are not common) can provide more appropriate care.
Response from Dr.
Hsu Wei-Kai, Director of Urology, Taitung Hospital, Department of Health, Executive Yuan.

Reply Date: 2004/12/06

More Info

Understanding penile and testicular underdevelopment in young adults can be a complex issue, often requiring a multidisciplinary approach to diagnosis and treatment. Based on your description, it appears that you are experiencing symptoms that may suggest a form of hypogonadism or other underlying endocrine issues. Let's address your questions one by one.

1. If it’s not an endocrine issue, what could be causing the underdevelopment of the penis and testicles?
There are several potential causes for underdevelopment of the genitalia that are not strictly endocrine in nature. Genetic conditions, such as Klinefelter syndrome (47,XXY), can lead to underdeveloped testes and lower testosterone levels. Other genetic disorders, such as Turner syndrome in females or Androgen Insensitivity Syndrome in males, can also affect sexual development. Additionally, environmental factors, such as exposure to endocrine disruptors during critical periods of development, can impact genital development. It’s also worth considering that some individuals may have a variation in normal development that does not necessarily indicate a pathological condition.

2. Is it possible for the penis and testicles to continue developing after puberty with testosterone injections?
The potential for further development of the penis and testicles after puberty is limited. Puberty is a critical period for sexual maturation, and most of the growth and changes occur during this time. However, testosterone therapy can lead to some changes in penile size and testicular volume, even in adulthood, although the extent of these changes may vary. It is essential to have realistic expectations and discuss these with your healthcare provider. They can provide insights based on your specific situation and the potential benefits and risks of hormone therapy.

3. What are the effects of testosterone injections on the body?
Testosterone therapy can have various effects on the body, both positive and negative. On the positive side, it may improve libido, energy levels, mood, and muscle mass. It can also enhance bone density and overall physical performance. However, there are potential side effects and risks associated with testosterone therapy, including:
- Increased risk of cardiovascular issues, such as heart attacks and strokes.

- Potential for sleep apnea.

- Acne and oily skin.

- Mood swings or increased aggression.

- Possible infertility due to suppression of natural testosterone production.

- Changes in cholesterol levels and liver function.

Before starting any hormone therapy, it is crucial to have a thorough discussion with your healthcare provider about the potential benefits, risks, and the need for ongoing monitoring. Regular follow-up appointments and blood tests will be necessary to assess hormone levels and adjust treatment as needed.

In conclusion, the underdevelopment of the penis and testicles can stem from various causes, and while testosterone therapy may provide some benefits, it is essential to approach this treatment with caution and under medical supervision. If you have further concerns or symptoms, consider seeking a second opinion or consulting a specialist in reproductive endocrinology or urology for a comprehensive evaluation.

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