Can Testosterone Alter the Degree of Hypospadias? A Comprehensive Study

CONTEXT: In this study, we observed using serial injections of parenteral testosterone whether we can alter the degree of hypospadias. AIMS: The aim was to study the effect of testosterone on different parts of the phallus in hypospadias and to see if we can alter the degree of hypospadias. SETTINGS AND DESIGN: This was a prospective observational study. SUBJECTS AND METHODS: Forty-five boys with proximal and mid-penile hypospadias below the age of puberty who did not have prior testosterone injection or surgery were recruited in this study for the duration of 1 year and given testosterone injection intramuscularly and measurement taken using Vernier caliper at regular interval followed by surgery. The follow-up was at the 1(st), 3(rd), and 6(th) months of surgery. RESULTS: Of 45 patients who received intramuscular testosterone injections, 40 showed some degree of response. Of these 40 patients, 23 showed a significant improvement in phallic size, whereas 17 showed a clinically insignificant response only. Of these 23 patients, 14 improved from a mid-penile to a distal penile hypospadias, whereas 7 improved from proximal penile to mid-penile hypospadias, and 2 showed an exceptionally good response and improved from proximal penile to distal penile hypospadias, whereas 5 patients exhibited no response at all. CONCLUSION: Through this study, we can conclude that intramuscular testosterone can be effective in some patients with proximal and mid-penile hypospadias to convert them into either mid- or distal penile hypospadias by the differential response of different parts of the phallus, and this may favorably alter the type of procedure required for the hypospadias repair.