This can be a tender topic to talk about, and the jury is out on whether or not it is a parent’s choice to make for a child. At Cosmetex 2015, we had an opportunity to have an indepth discussion with Professor Colin Moore from Australian College of Cosmetic Surgery, about treating boys at a young age who have been diagnosed with a micropenis.
PLASTIC SURGERY HUB: We are here chatting today to Professor Colin Moore who is trained Pediatric Surgeon and a Cosmetic Surgeon. He is known for his contribution to the field of penis enlargement, also known as phalloplasty. We’re going to talk to him today about modern day hormone injections that are available to young boys that have what’s known as a micro penis, and are specifically designed to increase the size of their penis. So thank you so much for taking time to talk to us again Dr Moore.
PROFESSOR COLIN MOORE: You are welcome, Trish.
PLASTIC SURGERY HUB: So, just some answers to some questions from our readers. How many young boys have you seen for small penises that are brought in by their concerned parents over the years?
PROFESSOR COLIN MOORE: Over the years, many hundreds. At the present time I probably see 4 to 5 a year. There are two groups. There are patients with true micro penises which is a fairly rare event. Technically, this is a penis that is small in infancy and does not respond to hormone stimulation. In fact, that’s the diagnostic test par excellance. If you’ve got a small willy, a wee willy if you like… we inject it with testosterone in a small dose and if it responds, then it’s not a micro-penis. Now there are many kids who are just a bit beyond a micro penis size, nonetheless small or their penis is buried in a big fat pad – these ones will respond to hormone injections. Essentially what we’re doing is we’re stealing a little bit of the growth that would occur at puberty. We used to think that that would be lost at the next growth of puberty – but we now know that what in fact we’re doing is shifting the base line; so that if the small penis was subjected to puberty, and we look along the growth curves that it would be ‘x’ length. We take some of that with the hormones in infancy and it’s added on at the other end, so they do in fact have a bigger phallus after puberty than they would otherwise have had.
PLASTIC SURGERY HUB: Ok, right.
PROFESSOR COLIN MOORE: So they sometimes need three courses and each course is over three months. And I like to leave at least six months between the courses. So, we do better the younger we get them but you can still have a crack at it as they’re approaching puberty and the doses are well described and the regimes are well described and it is well established in pediatric surgical practice.
PLASTIC SURGERY HUB: Ok. And, do you think it’s ok for parents to make the decisions on behalf of their sons to give them hormone treatment to in order to increase the size of their penis when they’re older?
PROFESSOR COLIN MOORE: I absolutely do. Most parents make well intended decisions about their children. But the penis, and in particular the penis size, is such an important part of the male psyche. If you try to do this after puberty, it doesn’t work. So, it’s got to be done while the child is legally and technically an infant. It’s got to be done pre-puberty and it’s got to be done a year or so before puberty to produce a result. So yes, I think they do have the right and they should.
PLASTIC SURGERY HUB: Ok, so I was going to ask you how many injections are necessary to treat a small penis and how quickly can you see the results.
PROFESSOR COLIN MOORE: Well, you’ll usually see a result after the first injection. We do them at monthly intervals. I come in, I measure them, photograph them, they get their first injection. Now this is an injection into muscles somewhere on the bottom. Then they go away and we let the hormone, which is a depot testosterone type injection and they come back in a month. Now, if we’re going to get a response we’ll get some response in that month but it’s a progressive and incremental response. So you repeat the dose at one month, again at two months and the course may be three or may be four months, and you then measure that and you send them away for six months. They come back and if the size is satisfactory and the parents think it is ok, and that’s all we do. But if they still think that it’s a bit small, then we can run a second and even a third course if we have to.
PLASTIC SURGERY HUB: So, it’s not actually injected into the penis, it’s injected intramuscular.
PROFESSOR COLIN MOORE: There’s two ways of delivering: you can do testosterone creams which you actually rub into the penis – this is an uncontrolled dose and we used to see pubic hair in some of the kids with these creams. And it doesn’t go away which is the distressing part. So we’ve mostly switched over to injections. We can control the dose, and seeing them every month the first sign of pubic hair you back off – cut the dose back.
PLASTIC SURGERY HUB: Ok, right.
PROFESSOR COLIN MOORE: The other thing you sometimes see is there’s a bit of aggression which is a precursor of what’s going to happen to puberty.
PLASTIC SURGERY HUB: Sure, so it’s the testosterone effect?
PROFESSOR COLIN MOORE: Yup!
PLASTIC SURGERY HUB: Ok. And in previous years, hormone injections, although shown to have some contribution towards increased penis size, they were identified as not being able to restore an average size penis in the recipient. So how has the hormone treatment changed or become more effective today, and does it give results in all boys who undertake the treatment?
PROFESSOR COLIN MOORE: I’ve been using this technique both in its current form and its precursor form since the late 1960’s? The early failures were because people were not using enough. They were terrified that they were going to close bone ends too soon; because all the longitudinal growth on bones occurs around the big joints. And there are plates you can identify in the bones called growth end plates. And these are the things that close off in puberty which determines your height. And the fear was that we would close them off early. Well, that’s not proved to be correct.. if you stay within the range of doses that we use.
PLASTIC SURGERY HUB: Ok, right. So you’ve really got to go to someone who knows what they’re doing.
PROFESSOR COLIN MOORE: Yes, absolutely.
PLASTIC SURGERY HUB: If that’s the path you’re going to go down..
PROFESSOR COLIN MOORE: Absolutely.
PLASTIC SURGERY HUB: Well, thank you so much for talking to us today. If this is a problem in your family and you are looking for a practitioner you can jump onto our website; you can contact Professor Moore himself or you can send us an email to firstname.lastname@example.org.