The Role of Traction in Combination Therapy in Patients with Micropenis and Hypogonadism
Ruslan Petrovich, Maria Astahova
Micropenis is often a symptom of male hypogonadism. There are some congenital syndromes associated with low level of testosterone and micropenis. Many patients do not apply to physicians because of false shame and live with micropenis until declining years. As we now know micropenis is well treatable in all ages. We can see good results of treatment in 20 and 60 years equally. Of course, if the treatment starts early the results may be greater and the patient can estimate to have normal spermatogenesis in case of hypogonadotropic hypogonadism.
Patients and Methods
From 2012 to 2014 16 patients with micropenis and hypogonadism were observed in our clinic. The causes of micropenis were Kallmann syndrome (4 patients), Kleinfelter syndrome (2 patients), anarchism or hypergonadotropic hypogonadism (8 patients), hypogonadotropic hypogonadism and isolated luteinizing hormone (LH) deficiency (2 patients). The age of patients was within the limits of 22-62 years. Nobody of them had sexual experience. Standard examination included penile measurements, ultrasonic investigation of prostate and hormonal examination (LH, FSH, testosterone, estradiol and prolactin). The penile length was within the limits of 4-8 cm in stretched condition and 5-9 in erection (6.8 in average). Prostatic hypoplasia occurred in every patient. The volume of prostate was within the limits of 2-5 cm3. All patients demonstrated low level of testosterone in the range of 1.8-4.2 nmol/l. Each patient was undergone hormonal treatment depending on the reasons of hypogonadism. We used chorionic gonadotropin and testosterone undecanoate (NEBIDO) in patients with hypogonadotropic hypogonadism (Group 1) and NEBIDO only in patients with primary hypogonadism (Group 2). We examined patients every 3 months. In Group 1 we applied chorionic gonadotropin in the doze of 2000 IU twice a week. As testosterone level increased slowly we used NEBIDO according to standard scheme. We find this approach right as the final goal was the penis enlargement. All patients from this group refused to try to improve their fertility for different reasons. We used NEBIDO in patients from Group 2 according to usual scheme too.
After 6 months from the beginning of the treatment all patients demonstrated physiological growth of their penises till 11-13 cm (11.8 in average) in erection. All patients with prostatic hypoplasia demonstrated increase of the volume of prostate in the range of 14-18 cm3. We should admit that after 6 months of the treatment no one of our patients reported of any growth of the penis. For this reason we applied Penimaster Pro extender for all patients in both groups after 1 year of hormonal treatment to get best results. All patents used Penimaser Pro and continued hormonal therapy. After 6 months we estimated the result of the complex treatment. The length of penises during erection increased in all patients and reached 14.6 cm in average (12-15 cm). Thus the total result of penis enlargement in patients with hypogonadism was 7.8 cm in average in erected state after 1.5 year of the complex treatment (NEBIDO and Penimaster Pro).
Combination therapy using testosterone and Penimaster PRO extender in patients with hypogonadism proved to be more effective than testosterone replacement therapy only. The kind of hypogonadism (primary or secondary) does not influence on the results of penis enlargement and the methods of treatment. All patients wish to have best and fast results. However, use of chorionic gonadotropin seems more physiologic in patients with hypogonadotropic hypogonadism, we had to use NEBIDO also to get normal concentration of testosterone quickly. Of course, after the penis enlargement and the beginning of sexual we can return to the subject of spermatogenesis stimulation in young patients with secondary hypogonadism.
We also should notice that the physiological growth of penis during testosterone treatment usually ends by 6-7 month. For this reason, Penimaster Pro extender should be applied as soon as possible. If any patient with hypogonadism has sufficiently large glans penis he should use Penimaster Pro from the first day of testosterone therapy. For other patients extenders must be applied as someone gets his glans big enough to fix Penimaster Pro.
Additional traction with extender is very useful to get best results in penis enlargement during testosterone replacement therapy in patients with micropenis and hypogonadism.