The four patients with isolated micropenis were diagnosed as 5αRD2 (Table 1) by elevated ratios of serum T/DHT after human CG stimulation, decreased ratios of urine 5α/5β-reduced C19 and C21 steroid metabolites (data not shown), and SRD5A2 mutations identified as compound heterozygotes (Pts. 1 and 2) or homozygotes (Pts. 3 and 4). As previously described, the standard TE therapy for Pts. 1-3 had little effect by 0.2-0.6 cm in SPL [4].
DHT was transdermally applied for the four 5αRD2 patients at ages of 4-11 year (Table 2). Daily application of 25 mg (Pts. 1 and 2) or 12.5 mg (Pts. 3 and 4) of DHT for 8-16 weeks increased SPL by 1.2-2.8 cm (Fig. 1). Although Pt. 1 complained rash and itch in the skin where the DHT gel applied, other adverse effects were not observed concerning bone maturation or lipid metabolism (data not shown). While serum DHT concentrations arose to 0.20-1.1 ng/mL during the treatment, serum LH and FSH levels were apparently suppressed in Pts. 1-4 (Table 2), then recovered to normal ranges at 1-2 months after the treatment is completed (data not shown).
Bạn đang xem: Effects of pre- and post-pubertal dihydrotestosterone treatment on penile length in 5α-reductase type 2 deficiency
Xem thêm : Condoms
After pubertal development was initiated in Pts. 1-3 at 11-12 years of age, skeletal growth, testicular enlargement, and pubic hair appearance were recognized within normal maturation among Japanese boys [9]. While serum T and DHT concentrations increased, the penile growth was retarded staying at 5.0-5.8 cm in SPL, required for the second course of DHT treatment at ages of 18, 16, or 12 year, respectively (Table 2). Pt. 4 remained prepubertal at the latest follow-up, excluded from further studies.
In adulthood, Pts. 1-3 exhibited 6.0 (-3.4), 6.4 (-3.0) and 7.0 (-2.4) cm in SPL (SDS) [10], respectively, with well-developed testis and pubic hair (Table 3). While serum T and E2 levels were sustained as healthy adults, T/DHT ratios remained higher (16-21) than normal (9-15), reflecting impaired 5α-reductase type 2 activity. Ultrasonography for prostate displayed small (Pt. 2) or somewhat large volumes (Pt. 3) for age-matched reference ranges [11], whereas serum levels of prostate-specific antigen (PSA) remained low (Table 3). Semen analysis in Pt. 2 revealed normal sperm count and subnormal semen volume at the age of 20 year (Table 3). No physical concerns such as libido, masturbation, or ejaculate of semen have been documented, but a couple of patients mentioned some anxieties about their micropenis. While all patients preserve gender identity for male, they have not yet experienced sexual intercourse until the latest evaluation.
Nguồn: https://vuihoctienghan.edu.vn
Danh mục: Info
