A number of surgeons use preoperative androgen stimulation for a period of time prior to hypospadias surgery. The aim is to increase glans circumference, penile length and improve prepucial vascularisation pre-surgery. Data confirming the results of these aims is scarce. This paper describes a study looking at 62 consecutive patients who had a midshaft or proximal hypospadias operated on over the course of three years and in whom objective measurements of glans width were made pre and post intramuscular testosterone cypionate at 2mg.kg or two to three doses with the aim of increasing glans width from <14mm to >15mm. If this dose failed then increasing doses at three to four weekly intervals were given. Surgery was scheduled six weeks after the last dose. Of 62 patients, 28 did not need testosterone injection. Fifteen had a midshaft hypospadias and five received testosterone. All increased their glans width to >15mm. Twenty-nine (out of 47) boys with proximal hypospadias had testosterone. Twenty-three had the initial dose of 2mg/kg and of these six required doses up to 4-16mg. A further six had initial increasing doses of 4-32mg/kg. Scant pubic hair development was noted in patients receiving up to 32mg/kg doses. The paper discussed the possibility of androgen receptor insensitivity in patients with proximal hypospadias. The results of this series corroborate the concept that hypospadias is at one end of the spectrum of disorders of sex differentiation. 

Objective use of testosterone reveals androgen insensitivity in patients with proximal hypospadias.
Snodgrass W, Villanueva C, Granberg C, Bush N.
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Henrik Steinbrecher

Southampton University Hospital NHS Trust

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