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Suggest treatment to increase testicle size

Answered by
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Dr. Binu Parameswaran Pillai

Endocrinologist

Practicing since :2003

Answered : 1414 Questions

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Posted on Sat, 16 Aug 2014 in Thyroid Problem and Hormonal Problems
Question: I had a growth hormone deficiency as a child from age 6 to 12. This was due to a kidney problem. This was not diagnosed and not treated but kidney problem now gone.
It effected my growth hormone metabolism. Also it may have weakened the FSH level during per puberty. I have rather small testicles; below normal size. It is probably because sertoli cells did not proliferate as much as expected during age 6 to 12. Currently my FSH is around 4.6 and LH around 5. I am fertile; SC is 50 million/ML. Is there a way to trick them into proliferating again? FSH? Are there any stem cell treatments that might work? Are stem cells being used to make new SSC which are (injected) into testicle?
doctor
Answered by Dr. Binu Parameswaran Pillai 5 hours later
Brief Answer:
Hello

Detailed Answer:
Hello,
Good day.
I hope I can reply your question. Since I had replied earlier, I was waiting so that any other endocrinologist can pick ur question. Simce none has picked it in last few days, I decided to answer if that's okay with you.

I know your history since I communicated with you before.

To be XXXXXXX if your sperm count is 50 million/ml and if FSH is normal, that means that your sertoli cells are functioning well. If they weren't, then you would have low sperm count and FSH would have been very high.

It is very important to get the testicular volume assessed by the help of an orchidometer.

FSH can increase the testicular volume temporarily, however, on stopping treatment the volume can go down. We resort to this treatment in men with low sperm count who want to father a child. Stem cell treatment is in experiment stage and is not available readily for use.

Regards
Binu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Binu Parameswaran Pillai 2 hours later
I saw a reproductive endocrinologist in Europe. FSH is 5 IU
Count was 50 million and total was 180 million. My wife got pregnant last year; in fact; it was an accident. I had returned from a Diwali trip to see family in XXXXXXX and we had mis calculated her period and so she got pregnant. But she is really fertile.

The reproductive endo (for men) told me I have abnormally small testicles. It is embarrassing so I would like to fix this. It is kind of like having a micropenis but it is the testicles. He asked me to check LH, FSH, inhibin B and AMR level. He told me that if AMR level is high indicates some immature sertoli cells and that FSH treatment could help. But he also said that he fears that since I am already past puberty; and I have a normal FSH, LH; and that Seroli are making sperm; that the Sertoli cells would not proliferate if I give them an Overdose on FSH. What is your opinion on this matter? Also should I add LH to the mix? Or do a FSH only treatment. Can any harm be done if I take FSH other than the cost?
I have HCG (25 vials of 2000IU); 5 vials to 250 mg testosterone euthanate; and a prescription for 3 X 150 IU /WEEK of FSH.
I read somewhere that if you reduce the endogenous testosterone production the Sertoli cells can be tricked into proliferating? One way to do this could be testosterone injections and FSH?

What is your experience in this? I am looking for another opinion.

And how far off is a stem cell cure for men with a partially reduced sertoli leydig cell count? There are so many infertile men in the world; and it is so important in XXXXXXX to have kids; you would think XXXXXXX would lead the stem cell way to cure male infertility.
doctor
Answered by Dr. Binu Parameswaran Pillai 11 minutes later
Brief Answer:
hi

Detailed Answer:
hello,
I agree with your XXXXXXX If you were in UK or USA, they wouldnt have initiated the treatmet. hCG acts like LH. I dont think that is required now. FSH in supraphysiological dose would cause some sertoli proliferation and that would seize once you stop treatment. The are fully functional in your case looking at your fertility and sperm count. AMH may give some idea.

My experience is treating hypogonadotropic hypogonadism ( low LH and FSH) with combination of HcG and FSH. Even in this scenario, success is less than 50%. We wouldnt use this just to increase the size. In men with single testes, our urologists would use artificial testes to put in for cosmetic reasons. As far as i understood, your need is cosmetic rather than functional. Why dont you discuss this aspect as well with your doctor. However, when normal testes is in situ, usually they will not attempt this.

Stem cell treatment is still in experimental stage. Huge research is going on in XXXXXXX as well as abroad in turning stem cells to pancreas cells to treat diabetes and in the treatment of cancers. But as far as i know,in hypogonadism, not much work is going on. I do not know the scenario in west

Regards
Binu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Binu Parameswaran Pillai 14 hours later
Dear Doctor:

So even in adults FSH in a supralarge dose would cause some sertoli cell proliferation while on treatment. After treatment those sertoli cells would continue to live? My understanding is that once sertoli cells are made (after proliferation) they live for a long time. And produce sperm? It is pretty simple ; if there is sertoli cell proliferation; then the testicles would increase in volume; especially once these cells produce sperm? What would be a supra large dose? Would it make any sense to take it with Testosterone; this way the sertoli cells would not be receiving endogenous testosterone and might go into proliferation mode?

So little work is going on in XXXXXXX in infertility and hypogonadism?
My need is not cosmetic; it is because I want to be able to have a child many years from now; and also I think that if there are more sertoli cells the endogenous production of testosterone would increase as more leydig cells may also be created. I am trying to treat my problem which is basically I grew very little from age 6 to 12; as a result I am shorter than I would have been; my testicles are smaller than normal and my penis is smaller than it should have been (still normal). I know you can't help me get taller; but if you have any suggestion on the testicle problem please tell me.

Also perhaps after (or before) FSH treatment (then HCG); so my penis would grow a bit more I could try taking lots of testosterone with SHBG inhibitor (provision and arimadex) so as to get my free androgen index (or bioavailable testosterone) to a level ABOVE my level during puberty? Assuming I had a low testosterone level during puberty; would this work? If i had a high level during puberty I would have to take way to many things to get the level higher and would probably go bald doing so. Any thoughts on this?
doctor
Answered by Dr. Binu Parameswaran Pillai 8 hours later
Brief Answer:
hi

Detailed Answer:
Hi,
Adults with hypogonadotropic hypogonadism with reasonably good testicular volume ( > 10-12 ml) may respond to FSH. But success rate even after 12-15 months of treatment is low. We may have to resort to TESA or MESA ( sperm aspiration) for IVF in those patients. Continuous gnRG infusion by pump is another experimental treatment. (" its just experimental)

The response to FSH is based on the germ cell reserve in the testes. There are few germ cells in adult life. Intratesticular testosterone concentration is nearly 400 times compared to blood levels. This is not acheivable by testo injections. Thats why we give hCG to stimulate leydig cells to produce testosterone. This high concentration of intra testicular concentration is necessary for Sertoli cells to make sperm. All these are complicated and not easily reproducible in adult life. Hence there is low success.Hence excess testosterone treatment may not have any value.

Your penis may not grow any longer if it has reached his XXXXXXX growth potential.

There is huge research on infertility , especially female infertility in XXXXXXX

If you plan for a baby in future, the existing sperm count i good enough. You may also store semen now in a sperm bank just as a precaution.

I am not discouraging you, but discussing the facts.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Binu Parameswaran Pillai 2 hours later
Dear Doctor:

I do not think I am HH. LH 4, 10 (two test); FSH 5; total testosterone 15 nmol/L 450ng/DL); Bio available 60 NG/DL? MY TV is at least 10ML; but I am not sure if more. Success for me is that there are more sertoli cells. You say there are few germ cells in adult life; I think you are saying all sertoli cells are in proliferation mode? How to know? One would think there would be some germ cells left in adult life; just not many?

You said penis may not grow if it has reached XXXXXXX growth potential. How would one know if there is growth potential left? My story is kind of sad. As a child I had a growth hormone deficiency due to a kidney problem. Around 11 years parents took me to doctor to see about growth hormone. My mom was concerned about my height; and synthetic GH now existed. As I child I wanted so much for puberty to arrive because I had a small penis and was chubby. I had suffered some; my brother once told me I had a small penis. I never said anything to my parents because I was ashamed to bring it up and did not know there was any treatment. When the doctor or my mom told me that the GH treatment would delay my puberty I was no longer enthusiastic at all. All I wanted was puberty so my penis would grow. I think I may have said something that discouraged my mom; so she later told my dad that the doctor felt treatment not necessary. Granted back in 1987 they did not give GH to everyone ; as it was new and side effects were still a bit unknown. Of course; little did I know anything about the treatment. Everything would have been so simple back then if I had been more enthusiastic. I am sure if I had said anything the doctor would have explained more about the treatment so I didn't fear the delay of puberty. I have suffered over 25 years because of this.

What causes the penis to stop growing? Is it because it reaches its XXXXXXX growth potential? Or is it because the growth cells run out (like growth plates in bones)? What could cause cell hyperplasia? I fear that by not growing much during five years it did not grow a couple centimeters as a child; which would mean perhaps four centimetres after puberty (errect length). I have some reason to believe my grandpa had a 19Cm errect penis. So what is the potential? What causes the stopping of growth? Is it that the testosterone levels XXXXXXX out? Would having a higher level than puberty help it grow again? Would GH help? Or IGF -1? And how to cause penis localised hyperplasia?
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Follow up: Dr. Binu Parameswaran Pillai 8 minutes later
So the bioavailable testosterone has been low; like 42 to 70 NG/DL; the normal is over 100 to 300 (for 30 to 39 year olds). Honestly, I do not think that I had as much testosterone during puberty as I should have. Also my penis was smaller than it should have been going into puberty due to lack of overall body growth (kidney disease, etc.).
doctor
Answered by Dr. Binu Parameswaran Pillai 3 hours later
Brief Answer:
A honest answer based on my conclusions

Detailed Answer:
Hi XXXX
Good day.
Based on my analysis of your case and after talking to you, i have formed a conclusion.Do you think i could be bit XXXXXXX and critical in my answer now ?
That may not sound very nice to you though. It will be a very honest answer. Is that okay with you?
Binu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Binu Parameswaran Pillai 5 hours later
You can tell me the conclusion but I would appreciate if you tell me a solution if you see one. I would like to know what happened to me when growing up and if anything can be done. Try no to be too critical.just to be clear ; I said it did not grow (an extra 2cm due to lack of growth hormone). After puberty two extra cm=4 EXTRA CM. It is 15cm stretched.
doctor
Answered by Dr. Binu Parameswaran Pillai 4 hours later
Brief Answer:
Hello

Detailed Answer:
Hello,
Good day.
As i have told you earlier, your height is almost with in your genetic potential, ( with in the predicted height).

I didnt say that you have HH for sure. I just mentioned the treatment options in HH. You have a normal sperm count despite having a low testicular volume. You consider that your penile length is small.

If the TV is low, at some point of time, there was an arrest of sertloi cell prliferation or the process started later or you did not have a good minipubery.

Minipuberty is the period around 2-6 months after birth which last for up to 6 months in boys. Around this time, the LH, FSH and testosterone rises to pubertal range and that is the time maximum amount of sertoli, germ cells and leydig cells form. Later they go in to an arrested phase until puberty. If you haven't had a good XXXXXXX puberty, that can lead to a low TV. It is umpossible to have a sperm count of 50 million with a 10 ml testes. Hence i strongly beleive that the volume estimation is wrong.

Other causes of low TV could be due to a partial pituitary transcription factor deficiencies which can cause a form of partial HH. Your LH and FSH are normal. If the testosterone and TV is low, we expect the LH and FSH to rise above normal as a compensatory mechanism. In your case that has not happened. They are looking normal. Absence of appropriate rise of LH/FSH could be due to a partial form of HH.

As a matter of fact, If you have had a kidney damage from reflux uropathy, that would be a permanentt damage due to the reflux disease. Your GFR is > 90 and kidney functions are normal. THIS IS NOT POSSIBLE WITH A SIGNIFICANT KIDNEY DAMAGE. Usually the damage is permanent which leads to scarring etc.

Temporary mild forms of kidney damages can reverse, but then those damages are not severe enough to cause a growth retardation. USually systemic disease induced temporary growth retardation is followed by a catch up growth after recocery from the disease process.

I UNDERSATND THAT YOU HAVE RESEARCHED ABOUT THE REPRODUCTIVE PHYSIOLOGY AND BASED ON THAT, HAVE ARRIVED AT SOME CONCLUSIONS AND FIRMLY BELEIVE IN THAT.

IT IS NOT POSSIBLE TO CHALLENGE YOUR CONCLUSIONS BASED ON A WEB BASED ANALYSIS. I can only argue based on the available results and evidences.

In the minipuberty if enough sertoli cells have not been formed, future development is difficult.

I recommend yourself to go to an institute where there are many endocrinologists/reproductive endocrinologists. Your case is interesting and a panel discussion may be better rather than consulting individual private endocrinologists. Some times, an individual doctor is forced to offer some form of treatment considering the "patient satisfaction" factor , but it may not be evidnce based or scientific always.

I hope you will try to understand my points.

Regards
Binu

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Binu Parameswaran Pillai 5 hours later
My mom was a type 1 diabetic; she took insulin already before getting pregnant. She had some autoimmune disorder which attacked her pancreas cells. I have to say that even as a five or six year old my stretched penis would not have been more than 5cm; though maybe it was 6 ; but I really really doubt that. I think that even for a six/seven/eight year old 5cm is quite small. And I can say it did not really grow until around age 12; when it grew to (I think around 7cm-errect). Then it grew with puberty. When my mom had my older brother she was not yet on insulin. We used to take baths together as kids (me 4 to 6; he was 8 to 10). I do remember his penis was always bigger than mine (mine would be like 2.5cm and his was like 4.5cm). But he was skinnier. I am not sure if such a difference is normal).

It may be that I was little as a little child; and tried to recover from the stress of being in a diabetic womb.

It may also be that in the womb the kidneys did not form as large as normal due to diabetes. But I kind of doubt this because why is the left kidney smaller than the right kidney and at only 9.86cm in length. Bear in mind I grew up eating meat and protein; I think it should be the genetic size of someone from the West (or eating protein diet as a child). Don't kidneys grow partly in function of the protein intake of an infant? Is that true?

However, it is around 9 when I started getting noticeably chubby to overweight by age 12. This continued until a few months after my 13th birthday; which is also when I started to grow. I then became more normal in weight. I look at my picture as a kid and I almost cry seeing them. I had really fat swollen hands which I hear is symptom of renal insufficiency.

But I have to be very honest; I think I had chronic mild forms of kidney damage which needs to be understood in order to try any treatment. A GFR of 95 is not exactly high for a healthy 38 year old male who has a BMI of 23.50. It is borderline kidney disease. I heard that most kidney disease is not even detected until it become level III. And it is possible that I have scars but they are small or healed. Is it really not possible that these would effect growth? These incidents were from age 7 to 12. I am inclined to believe damage was mild enough to reverse but it has left smaller than normal kidneys due to chronic mild damage as a child. Well If almost daily they were temporarily damaged; well after a few years this would effect kidney growth and overall growth? For example; once I was 9; I think this is when early prepuberty starts and penis starts to slowly grow AGAIN; I believe this puts a bit more demand on the kidneys. So that is when Growth hormone deficit became more obvious with chubbiness. Does this theory make any sense? It is also around 9 year old when my doctor noted that I was heavy (like in the 75% ) but only in the 25% for height (per my memory).

Do you know if there is a lot of sertoli cell proliferation also before puberty (around age 11 or so)? Could my growth problem have impacted this? Under Ultrasound my testicle size is 34mm X 24mm X 17mm (each one) (that is just the capsule). It is not genetic because neither my dad or my brother admit to having small testicles. In your opinion, can the above size corresponds to 50 million/ML; total being 178 million? To note: only 43% of sperm were alive; and only 37% were XXXXXXX WHO A +B (within 3 hours). I believe I had abstained for 5 days; I tell you this because this could negatively effect vitality of sperm.

Right now I am pretty sad; because my mom took me to the doctor's to see about growth hormone and I did not insist on treatment. She gave me an opportunity and I did not insist on it. Maybe she was hoping I would have been for the treatment and asked the doctor to examine me and my genitals which he did not . She is no longer alive so it makes my job very hard to find out what happened. Her dad was 5 10 or 5 11; so I kind of think she thought I should be taller. I think I may have also passed from the 25% to 10% in two years. My dad always thought I was little because he was little. He told me that my whole teenage and adult life so I never once questioned anything. But I still do not buy this now because even if I am two inches taller than my dad ; my hands and feet are smaller than my dad's; and pretty small (18.5cm hand length) size 42 shoe (26.5cm). To me this indicates that I had some sort of growth retardation. It is like the entire body was supposed to bigger and my feet and hands would have been similar to my dad's size. Also his voice is somewhat deeper than mine. More importantly, I think at least three fourth (perhaps 80%) of men have a deeper voice than mine. The other thing; is yes I can grow a beard; and I have body hair. But my dad has a ton of body hair so this does not say much. What do you think about the above theories?

I believe that you might be right about having some sort of partial HH because an LH of 4.0 does not make sense when the Bioavailable testosterone is at 70NG/DL. I perhaps had this since I was 9 or so (at least reduced FSH level vs normal). I believe at 9 testicles start to increase fSH a little bit. Also I think I made very little T as a kid due to kidney problem. I know kids have some T. I wonder if it could be related to the programming of HPA during prepuberty (early puberty) and in light of a growth hormone deficiency due to kidney problem.
My total T is currently closer to normal at 464NGDL but that is with an SHBG of 45. It is like the body does not sense the need to make testosterone or when it does SHBG is formed and binds to it. What could have programmed the body to do this?


I am going home to get pictures of me as a very young child and any medical records to see if I really was that little. If I was normal height than I would be pretty sure that I had a kidney problem. If I was little than it is harder to tell.

Perhaps a treatment of testosterone (at some point) to finish puberty. Then FSH and LH? But I do not know the order. I know my case is not easy and I think a panel is best because I need lot's of experience and minds to solve the problem.

If you know an institute to refer me to in XXXXXXX this would be good. Do you work with one? We could poll them. I could probably get the prescriptions filled in France by a local endocrinologist. You could make the findings public; I think that perhaps others could benefit from my experience.




doctor
Answered by Dr. Binu Parameswaran Pillai 4 days later
Brief Answer:
hi

Detailed Answer:
Dear XXXX
Good day and sorry for the delay in reply. Noticed that you have lot of queries.
I will try to answer them one by one.

Overall nutrition helps to improve the growth of every organ including kidneys. If you have had extra protein as a child, it doesnt necessrily make kidneys grow bigger.

Fatty hands are not always sign of kidney disease. In advanced kidney disease there can be fluid retention which cause swollen hands and legs. By that stage, kidney disease is beyond reversible stage.


If you had kidney scars as a child, that is irreversible and you would be in end stage renal disease at this age. Once it reach a stage of scarring, it is no longer mild or reversible. The fact that you do not have hypertension and your kidney functions are good, i dont think you have kidney scars. Please understand that GFR of 95 is healthy and normal.


Yes, sertoli cell proliferation occur in XXXXXXX puberty which is a month after baby is born and lasts until 6 months after birth. If minipuberty was not good, sertoli cell population will be less.

Ultrasound wise, testes apperas to be slightly on lower side, but i it is producing 50 million sperms and if you have had no infertility issues, that means that your sertoli cell population is healthy.

I beleive you have formed strong beleif that your kidneys are bad or damaged as a child and that affected your growth. There is no evidence to beleive that theory and i can only urge you not to beleive so.

You may visit this website and enquire more about a second opinion. you may have to visit UK for that. http://www.lua.co.uk/male-fertility-specialist-london/

I need to saerch for a center in XXXXXXX which can help you. But i beleive that, no one in XXXXXXX will suggest FSH injections to you since you have no infertility issues and you have normal semen analysis as per" WHO" norms.

Regards
Binu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Binu Parameswaran Pillai 26 hours later
Hello. Okay I saw pictures of me age 21 months; i was perhaps 33 inches tall; on beach; my penis was 3.4cm flaccid; and perhaps 2.4 cm from glans to base (perhaps after cool water swim or shower). I was skinny? Is this average size; or may I have been hypogonadic?

My height is as follows
4 YRS 11mos; 43 inches

April 26 86 (10.5 years) 54 inches tall (very chubby)
May 87 11.5 yrs old 56 inches tall (rather chubby)
Oct ,87 (12 Years old) 58 inches tall (I was noticeably a bit slimmer here)
Sep 88 13 years old 60 inches tall (brother was 68") XXXXXXX 89 (13.7 yrs old) I was 63 inches tall. My brother was 69 " (17.7 yrs old).

Is it normal that I only grew 11 inches in 5.5 years? That is hardly 2 inches /year.
Is it normal that I only grew another four inches after age 13.7 years old.

I noticed I grew more during the summer of '87 (after elementary school). I know that after elementary school we had more normal toilets. Based on photos I also noticed that both my dad had a very visible adam's apple (around age 41 even for my dad); and around age 20 for my brother . But my brother's is not visible and he is 42. Mine is not really visible; even when 20 it was barely noticeable. My dad has the deepest voice among the three of us. My brother is in between us. I checked my voice on the piano and it 180 mzhz. Normal male is 80 to 210.

I also noticed my dad has pretty large hands for a guy who was only 65.5 inches.
More importantly his ring finger is perhaps one half of an inch longer than his index finger. My brother his ring finger is around one quarter of an inch longer than his index finger. And mine are equal. What is more alarming is I look at my pictures of when I was young child and my ring finger was quite a bit longer than my index finger (perhaps 25% longer).
I find this odd but this indicates there was a hormonal disruption vs what I was born with and what I grew up with as a toddler. I am saying something altered my growth hormone; testosterone levels greatly. Is is like I grew up with less testosterone and also less during puberty. And less growth hormone?

About height I mentioned it looks like period of May 87 to Oct 87 would be some catch up growth. From kidney problem.
But I think growth plates were wasted as child which is why I only grew 13 inches from age 5 To 11.5.



I do have small kidneys; I know that if there is stress on kidneys can reduce growth. If I did not have kidney problem; what could have caused the above growth patterns and also what could have caused my voice to not be very deep (isn't voice genetic anyway); small testicle size; my height to suffer (paternal XXXXXXX grandfather was at least 5 6-vegetarian-)(maternal grandpa was close to 5 11); height is poor especially compared to being at 55% for height at age 5? My hands also changed so index finger grew more vs ring finger; especially vs when young child.
doctor
Answered by Dr. Binu Parameswaran Pillai 4 days later
Brief Answer:
hi

Detailed Answer:
Dear XXXX
Noted your points.
Between 10.5 yrs and 13.7 yrs, you grew 9 inches ( 22.86 cm). SO on average 7.1 cm in an year. This mentiond that your growth during that period was average. We expect around 8 to 10 cm growth during that peri puberty period. The fact that your final height was in expected range means that, you may have had either constitutional delay in growth and puberty ( CDGP) or you just followed your parent's growth pattern. Possibly your brother's inherited some genes from taller ancestors.

Your hand size comparison is very subjective.

To be XXXXXXX there is no point worrying about what happened in childhood. There isn't much we can do for height gain now. Regarding the testicular volume increase, we have discussed the point many times before. Please meet an XXXXXXX to clear your doubts. I am afraid that even if someone offers you a treatment option to increase testicular volume, it will be largely experimental. Please do enough reaserch yourself before embarking on such a treatment option.

Regards
Binu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Binu Parameswaran Pillai 18 hours later
The thing is that with constitutional delay and growth in puberty ; I was 62 inches or 63 in XXXXXXX 89. 62 is 158cm which at 13 yrs 8 months is around 50%. In CD of growth and puberty; does this mean also that puberty is delayed? I do not think i went through puberty late. In fact; I now wonder why I only grew 5 inches or so after age 13 8 months. Could it be that I did have a problem; which harmed my growth spurt? I did notice even on pictures as late as age 14.5 years old that my ring finger was as long as my middle finger; and longer than my index finger. As a young child my ring finger was quite a bit longer (even longer than middle finger).
I have read that ring finger growth is androgen driven; even during puberty. So it appears i had an androgen deficiency during puberty resulting from a kidney problem and the growth hormone deficiency. I believe it was a kidney problem that caused a growth hormone deficiency (perhaps effecting testicle size); and LH/FSH levels during puberty. As a child I had maxillary hypoplasia (I see in photos my upper lip area is always small from age 5 to 12. I read this is a sign of growth hormone deficiency. In review I have a small adam's apple and my voice is not as deep as my dad or brother. I exclude a congenital reason because i believe my penis size as an infant was normal based on photos.

So if I had incomplete puberty ; would a high dose course of testosterone help?
Might that help lower my voice if I can get the bioavailable level to above the level I experienced during puberty?
doctor
Answered by Dr. Binu Parameswaran Pillai 4 days later
Brief Answer:
Hi

Detailed Answer:
Hi,
Costitutional delay in growth is possible with out delay in puberty. Usually in this, there will be delayed growth. The only conclusive evidence of a growth hormone deficiency is to demonstrate a low GH peak during stimulation tests. The other sins are not specefic.

Testosterone will surely help in virilization ( if you are deficient). But it will reduce the testes volume further on prolonged use. It may also improve the voice quality slightly
Regards
Binu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Binu Parameswaran Pillai 6 hours later
What are the signs of constitutional delay in growth without delay in puberty?Could a kidney problem cause Constitutional delay in growth? How would you treat this before puberty? After puberty?
doctor
Answered by Dr. Binu Parameswaran Pillai 3 hours later
Brief Answer:
Hi

Detailed Answer:
Constitutional delay in growth and puberty ( CDGP) is a normal variation of growth and puberty. CDG can occur in isolation. Mostly there can be a family history. Usually the affected family member would haave reached the target height. In your case too, eventhough there was a delay,, finally your height fell with in the predicted range.

It is a diagnosis of exlusion and management is largely observational after ruling out other treatable causes. However, if puberty is delayed, it can be initiated with short course androgens. This may kick start both growth and puberty. If after puberty, growth alone is affected, it is very unlikely to be due to CDG. We need to rule out other causes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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reproductive endocrinology: 483 ng/ml
fnac examination:
smears examined form bilateral testicular FNA are scantily cellular showing few sertoli cells lying singly scattered against an ammorphous background.
no cells of spermatogenic series identified.
please recommend what to do next?