title: Objective use of testosterone reveals androgen insensitivity in patients with proximal hypospadias.
abstract: OBJECTIVE
  We report preoperative testosterone stimulation based on glans width measurements in patients with midshaft and proximal hypospadias, revealing androgen resistance in those with proximal hypospadias.
  
  
  METHODS
  Patients had maximum glans width measured preoperatively. Those <14 mm initially received 2 mg/kg testosterone cypionate intramuscularly for two to three doses, with the aim of increasing glans width ≥ 15 mm. Not all patients achieved targeted growth, and some were subsequently treated with escalating doses of testosterone.
  
  
  RESULTS
  5/15 midshaft patients had two to three doses of 2 mg/kg testosterone, with all increasing glans width to ≥ 15 mm. 29/47 proximal patients had testosterone, with 13 (57%) not reaching desired glans width. Six of these and another six patients had escalating doses from 4 to 32 mg/kg testosterone, with 11 then achieving targeted glans width. Relative androgen resistance was found in 19/29 (66%) proximal cases, including all treated patients with perineal hypospadias.
  
  
  CONCLUSIONS
  39/62 (63%) patients met objective criteria for preoperative testosterone stimulation based on glans width <14 mm, which is less than the average normal newborn glans diameter. Evidence of relative androgen resistance was found in 19 (49%), all with proximal hypospadias.
authors: Department of Pediatric Urology, University of Texas Southwestern, Dallas, TX, USA.
authors: Warren T
authors: WT
authors: Snodgrass
authors: Department of Pediatric Urology, University of Texas Southwestern, Dallas, TX, USA.
authors: Carlos
authors: C
authors: Villanueva
authors: Mayo Clinic, Rochester, MN, USA.
authors: Candace
authors: C
authors: Granberg
authors: Department of Pediatric Urology, University of Texas Southwestern, Dallas, TX, USA. Electronic address: nicol.bush@childrens.com.
authors: Nicol Corbin
authors: NC
authors: Bush
mesh_terms: D000293:Adolescent; D013734:Androgen-Insensitivity Syndrome / Q000150:complications* / Q000175:diagnosis*; D000728:Androgens; D002648:Child; D006801:Humans; D007021:Hypospadias / Q000150:complications* / Q000601:surgery; D008297:Male; D010413:Penis / Q000187:drug effects; D013739:Testosterone
chemical_list: D000728:Androgens; D013739:Testosterone
keywords: Androgen resistance; Glans width; Hypospadias; Testosterone