Penile Size Enhancement After Hypospadias Repair
There is no established hormonal therapy to increase penile size in adults who have previously undergone hypospadias repair, and surgical augmentation options carry significant risks with limited evidence supporting their use in this population.
Hormonal Therapy Considerations
Testosterone in Post-Hypospadias Adults
Testosterone therapy is NOT indicated for penile enlargement in adults with prior hypospadias repair. The evidence for preoperative testosterone use is limited to children undergoing initial hypospadias surgery, not adults seeking size enhancement after completed repairs 1, 2, 3, 4.
Preoperative testosterone (2 mg/kg testosterone enanthate monthly for 2 months) has demonstrated efficacy in children before primary hypospadias repair, increasing penile length by 22-36% and circumference by 16-29% 2. However, this represents tissue preparation for surgery in developing anatomy, not adult penile augmentation 3.
Critical distinction: The hormonal responsiveness seen in prepubertal children with hypospadias does not translate to post-pubertal adults with completed repairs and mature penile anatomy 1, 4.
Why Hormones Don't Work Post-Repair
Adult penile tissue after hypospadias repair has completed sexual maturation and lacks the androgen-responsive growth potential present in childhood 5.
Hormonal agents (GnRH agonists, antiandrogens) are contraindicated in persons who have completed growth and sexual maturation unless treating specific conditions like stuttering priapism, and these agents actually suppress rather than enhance penile size 5.
Surgical Augmentation Options
Available Surgical Techniques
Modified penile augmentation using dermal-fat grafts has been reported in post-hypospadias adults (ages 18-24), achieving average increases of 1.53 cm in flaccid girth and 1.67 cm in flaccid length 6.
This technique involves girth enhancement via free dermal-fat graft and length enhancement through suprapubic skin advancement with ligamentolysis, using specialized tunneling instruments to avoid neo-urethral trauma 6.
Critical Surgical Risks and Limitations
The American Urological Association considers penile lengthening surgeries risky, noting that most men seeking such procedures have normal-sized penises 7.
Post-hypospadias anatomy presents unique challenges: previous urethral reconstruction creates scarring that increases risk of urethral injury, fistula formation, and neurovascular bundle damage 8, 6.
Avoid repeated endoscopic procedures for any complications, as these are unlikely to succeed and may compromise future reconstructive options 8.
Evidence Quality Concerns
The single study on post-hypospadias augmentation 6 involved only 15 patients with 6-month follow-up—insufficient to establish long-term safety or efficacy.
No randomized controlled trials exist comparing surgical augmentation techniques in post-hypospadias patients 1, 4.
Clinical Counseling Approach
Essential Patient Education
Most men seeking penile enlargement have normal-sized penises and would benefit more from counseling than intervention 7.
The average glans length is approximately 4 cm, providing a clinical reference point for realistic expectations 7.
Correlation between subjective perception of penile size and objective measurements is limited; comprehensive evaluation should precede any intervention 9.
Psychosocial Considerations
Penile size concerns significantly affect masculine self-image, sexual satisfaction, and relationship quality, warranting thorough psychological assessment 9.
In Peyronie's disease patients (a different population but relevant for understanding size concerns), 54% report relationship difficulties and persistent depressive symptoms related to penile changes 9.
Practical Recommendations
When to Consider Intervention
- Surgical augmentation might be considered only in adults with:
- Objectively documented micropenis (stretched penile length <9.3 cm in adults)
- Significant functional impairment
- Realistic expectations after comprehensive counseling 6
Mandatory Preoperative Evaluation
Do not proceed without excluding underlying pathology such as penile tumors or other rare conditions that may affect penile dimensions 9.
Assess for concurrent erectile dysfunction, as this may require different management strategies 5.
Pitfalls to Avoid
Never dismiss patient concerns as purely psychological without thorough evaluation, as underlying pathology may be present 9.
Do not use potent topical steroids if lichen sclerosus is suspected, as this can cause cutaneous atrophy and complicate future surgery 8.
Avoid promising specific dimensional outcomes, as individual tissue response varies significantly 6, 4.