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Penis
problems page 1 - click below to go to page 1
1
The retractile penis, and issues of size, both width and length, too big and
too small
2
Foreskin problems, including the long foreskin, smegma and phimosis
3
Fordyce spots, pearly penile papules and genital warts
Penis
problems page 3 - (this page) - click below to see our answers
8
My sexual organs didn't develop normally at puberty
Penis
problems page 4 - click below to go to page 4
9
I can't get an erection as reliably as I used to
If your problem is not answered here, e mail it to: moreinfo "at" penis-website.com
Answers!
Q 8
My
sexual organs didn't develop normally at puberty, especially my penis
which didn't grow properly.
I'm 17 years old, and I have a small penis which is 4 inches long when erect
and 4 inches in girth. I wanted to know if this is what's called a micropenis,
and will it grow any more?
A: the penis and its growth rate and
especially the comparison with one's peers is a sensitive subject for all
young men, but for those who think they haven't developed normally it can be a
real problem, contributing to low self-esteem and feelings of inferiority. The
problem in answering a question like yours is knowing whether your
size is the result of a problem with your
development or whether you simply have genes which mean your penis will
naturally always be smaller than most men's. Consider the normal distribution of size in the sexual organs:
the average
size of a white adult male's erect penis is 5.9 inches long and 5 inches in
girth, i.e. circumference. The majority of men must by definition lie on one
side or other of that normal distribution.
There are some medical conditions which will
result in the penis's failure to develop normally. For example, his testicles
may not produce enough testosterone during the crucial phases of his body's
development, or his body may be insensitive to the effects of his own testosterone.
To decide if you fall into one of these groups, consider whether the other changes
that you'd expect during puberty have happened: have you experienced any ejaculations,
started masturbating, developed a deeper voice and hair on your body (especially
around your genitals)?
If none of these things have happened, or you
think they have happened less than they should have, you might wish to go and
talk to your doctor and ask for a referral to an endocrinologist. This is a
specialist doctor who can assess your level of development and perhaps
kick-start your pubertal development with hormone therapy if it isn't proceeding as it
should.
On the other hand, if you appear to be
developing normally in all other respects, then you may have to accept that you
are a man who has a penis on the lower side of the size distribution. If you read the statistics,
there are about 500,000 men in America alone whose erect penis is four inches
or less in size. But knowing that you are not alone may
be little comfort for you. However, many of these men have happy relationships
and are husbands and fathers. Women love men for much more than the size of
their sexual organs! And of course while it is true that some women value
a large dick, in the way that some men value large breasts, to many more it is
irrelevant, and much less important than finding a man who is loving and
caring.
The simple fact is that having a small penis
is only a problem if it is stopping you getting into sexual relationships, trying out
sex or causing you to lose your self-confidence. If it is, you may
wonder how you are ever going to get sexual with anyone! My suggestion is that
when you meet a special person whom you care about, such things as the shape
and size of
your genitals will actually not matter. If she loves you (assuming it is a
"she"...the same is true for gay men), and you trust her, you can
tell her that you find it difficult to get intimate because of your fears and
concerns about your penis. If her response is favorable, you can proceed without any
risk of getting hurt, and if it isn't, you can end things there and then
without ever having to reveal the appearance of your penis to her.
The more technical aspects of this
problem - American Endocrinologists' Guidelines on Treatment of Male Hypogonadism
Lack of sexual function or sexual development
in men can be caused by a number of factors, including hypogonadism -
that is, malfunctioning of the hormonal and endocrinological systems of the
body.
A treatment protocol has been devised by the American
Association of Clinical Endocrinologists, and it is summarized here for the benefit
of men who think such treatment might help them; the original is easily
available on the internet.
Primary testicular failure is
hypergonadotropic hypogonadism and a treatment for this is testosterone replacement
therapy; men who have gonadotropin deficiency or dysfunction may receive testosterone
replacement therapy and/or treatment for infertility - this is hypogonadotropic
hypogonadism.
Ageing men may also benefit from testosterone
replacement therapy.
The two treatments of choice are testosterone
replacement therapy or gonadotropin therapy; the latter acts on the testicles to
stimulate them to produce testosterone.
Hypogonadism basically means that you have
not got enough testosterone circulating in your body for some reason. The
symptoms are: small testes, penis and prostate; lack of pubic hair, armpit
hair, and facial hair; lack of male musculature; breast development or gynecomastia;
and untypically male proportions in the length of the arms and legs compared
to the body - limb growth is normally inhibited by high levels of testosterone
in the developing male, so a lack of that hormone means the arms and legs may become
unusually long in relationship to the trunk.
If loss of testicular function occurs after
puberty, or in ageing men, the rate of growth of body hair will slow down,
there will be a loss of libido, possibly impotence, and perhaps hot flushes or
flashes. In older men, there may be a risk of osteoporosis.
The first thing a doctor will check is the
existence of any obvious causes of primary testicular failure: such things as Klinefelter's
syndrome, anorchism, testicular failure, mumps, chemotherapy and so on, all of
which can cause the testicles to fail. There may also simply be an underlying
genetic basis which predisposes a man to an insensitivity of his tissues to testosterone,
either in utero or later in his a life. There are many metabolic deficiencies
both of endocrine production and reception within the tissues which can lead
to an effective lack of virilization, among these is 5 alpha reductase
deficiency and androgen receptor abnormalities. In the extreme form, these can
cause Tfm or testicular feminization syndrome.
Postpubertal onset of hypergonadotropic
hypogonadism is caused by endocrinological failure, metabolic deficiency, pituitary
tumor, or hypothalamic disease and manifests as lack of libido, sexual
dysfunction, and so on.
A complete physical examination is the next
step in assessing the presence or absence of virilization: male pattern pubic
hair, gynecomastia, beard growth, testicle size and texture assessed, presence
or absence of varicocele, penis and prostate size are all indicators of normal or
abnormal hormonal profiles.
Adult testicles are between 4.5 and 6.5 cm
long and 2.8 to 3.3 cm wide.
The next step in the process of investigating
hypogonadotropism is to assess hormone levels in the bloodstream. There is a daily
and a circadian rhythm in blood testosterone, so morning levels of the hormone
are measured after an overnight fast. Both free testosterone levels and the levels
of testosterone bound to SHBG (sex hormone binding globulin), which is the principal
form in which testosterone circulates in the blood, are measured.
If the levels of testosterone in a man's bloodstream
are low, then further endocrinological tests are indicated: luteinizing
hormone, and follicle stimulating hormone (LH and FSH) are measured to assess
pituitary function. There are a variety of other hormonal tests which may be
conducted to understand the state of a patient's immune system, including GnRH
(gonadotropin releasing hormone) stimulation test, Clomiphene stimulation
test, and human chorionic gonadotropin stimulation test.
Other studies which can contribute to the
understanding of the overall picture of a man's endocrine system include:
sperm count and semen volume measurement, bone densitometry (hypogonadism
often results in low bone density), pituitary gland imaging, genetic studies,
testicular biopsy and testicular ultrasonography.
Of especial interest to most men who have not
been diagnosed with Klinefelter's syndrome or other obvious gross genetic
abnormality, are the androgen receptor defects which can lead to varying degrees
of masculinization, depending on the degree of defect of the receptor. (By
receptor, we mean the biochemical mechanism at the cellular level where the testosterone
molecule interacts with the cell to influence its morphology and physiology in
a masculine direction.)
In the ultimate case, testicular feminization
is a condition in which there is complete receptor insensitivity to testosterone.
Such a person's body, although genetically male, has no responsiveness to testosterone,
and the appearance of the individual concerned is completely
female, though there may be structural defects in her vagina.
Acquired hyperogonadotropic hypogonadism may
indicate a pituitary problem, and a scan of the pituitary gland may be
required to eliminate tumors, lesions or other abnormalities of the
gland.
As an aside, since we are aware that this
information is supplied under the heading of a young man enquiring how he
could determine if his sexual development was abnormal or incomplete, it's
worth mentioning the controversy over the question of a male climacteric or
andropause. Decreased levels of male hormone are sometimes associated with
decreased libido, impotence, loss of muscle mass, fatigue and increased risk
of myocardial infarction. In some men, testosterone replacement therapy can
reverse these changes and encourage good health; a considerable level of
expertise is needed to interpret the changes in hormone level correctly and
prescribe effective treatment.
For young male subjects, a total testosterone
level of less that 300 ng/dL may indicate that testosterone therapy would be
helpful. (When you apply this guideline to older men, it would indicate about
30% of men beyond the age of 75 years are candidates for testosterone therapy.)
The goal of any hormone replacement therapy
program is to restore sexual function and well-being. Impaired sexual function
and mood disturbances are characteristic of low testosterone levels: these
improve with therapy. Men with untreated hypogonadism score highly for anger,
depression, fatigue, and confusion. All the secondary sexual characteristics
associated with normal testosterone levels will also improve when therapy is
initiated. There are many preparations of testosterone suitable for replacement
therapy: intramuscular injections, both long and short acting; scrotal patches
and gels; and oral preparations.
Testosterone enanthate and testosterone
cypionate are long-acting testosterone esters suspended in oil, which prolongs
the period over which they are absorbed into the body after injection. One
problem associated with injected testosterone is that this method of
administration may result in wide swings between the high and low levels of
the cycle of injection, with associated increase and decrease in symptoms.
Adult male patients who are going through a series of pubertal like changes
for the first time will receive a lower dose of testosterone than men with
late onset hypogonadotropism. There's no doubt that injections can be
inconvenient and difficult for some men, who may prefer to use the scrotal
patch or gels now available.
Problems that need to be monitored include
increased hematocrit, infertility, aromatization of testosterone to estradiol
with concurrent production of gynecomastia, sleep apnea, and possibly changes
in PSA (prostate specific antigen) levels.
The alternative to testosterone therapy is
gonadotropin therapy, although this is effective only in hypogonadotropic
hypogonadism. These preparations can also be used to induce puberty in boys
and to treat androgen deficiency. The agent usually used is human chorionic
gonadotropin, which binds to Leydig cell LH receptors and stimulates the
production of testosterone. The advantages of this treatment regime include
the long lasting effects of the injections (the half life of hCG is rather
longer than the half life of testosterone treatments), and the maintenance of
testicular volume or the promotion of testicular growth, which can be
important both for the maintenance of fertility, and avoiding issues of
changed body-image.
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