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How Testis Develops
Causes of small Testis
Investigations & Diagnosis
Response of treatment
Side effects of treatment
How Testis Develops: In all male child testis is small. It remains small until the onset of genital development i.e. puberty which usually starts at age of 14 years. At this time L.H. & F.S.H. hormone is secreted from pituitary gland in brain. These hormone act as Germ cell & Sertoli cells in testis leading to there growth. This enlargement is size continues upto 18 years, ultimately reaching size of 12 to 25 ml. Other hormones which control testis size are growth hormone IGF-1 & others.
Cause of small Testis: There are many causes of small testis. These are as follows :-
Hypogonadotropic Hypogonadism: Hypogonadism, Hypothyroidism,
Testosterone deficiency, hyperprolactinema, Hypogonadotropic hypogonadism
(hypothalamic or pituitary deficiency) Hypogonadotropic states: Hypothalamic
– pituitary deficiency: Idiopathic GnRH deficiency, Kallman syndrome,
Prader-Willi syndrome, Laurence-Moon-Biedl syndrome , Hypothalmic
deficiency, pituitary hypoplasia, Trauma, post surgical, postoradiation,
Tumour (Adenoma, craniopharyngioma, other), Vascular (pituitary infraction,
carotid aneurysm), Infiltrative (Sarcoidosis, histiocytosis, tuberculosis,
fugal infection, hemochromatosis) Autoimmune hypophysitis, drug-induced
hyperprolactinemia, Untreated endocrinopathies , Glucorticoid excess,
Hypopituitarism, Cushing disease, Addison disease.
(6)Vanishing Testis Syndrome
(7) Dysmorphic Syndrome
(8) Post Mumps Orchitis.
Consequences of Small Testis :
When testis is small it denotes that testis is not fully developed thus it will not be having normal function also.
The two functions of fully
developed testis are:
Investigation & Diagnosis:
For proper diagnosis of cause of small testis we do following tests.
Other tests depending on likelihood of other
: After finding the cause appropriate treatment started in form
hormone replacement therapy. The treatment s as follows:
2) Gonadotropin Releasing hormone therapy is
effective in many cases of underdeveloped testis even when gonadotropin
therapy has failed in normalizing testicular size & function.
4) Growth Factor Therapy
5) Male Hormone Replacement: Treatment with male hormone testosterone is available as oral tablets, skin patch, skin gels or injection is given with very good results.
The various preparation of testosterone & route of administration are:
1) Oral preparation that is available in capsule form. It need to be given one to three capsule daily.
These have no side effects.
2) Transdermal Testosterone given as testosterone gel preparations. It need to be applied any part of skin once a day.
It is very effective & has no side effects.
3). Transdermal Testosterone scrotal patch are also available which are very effective even if used in small doses. It is very effective & has no side effects.
4) Sublingual Testosterone cyclodextrin is now available which is very fast acting & very effective is fast & bettergenital organ secondary genital character development. It is used as one tablet daily to be kept under the tongue for few minutes. It has no side effect and it is very effective
5) Local application of D.H.T. gel available as Andractim gel is a new preparation for male hormone replacement.
6) Injection Testosterone esters these includes Testosterone enanthate & testosterone cypionate given intramuscular injections every 10 to 14 days.
7) Long acting testosterone as testosterone bucilate given once in 4 months.
8) Testosterones implants are now available which once injected remain effective for up to six months.
Response: Once we start the treatment testis starts enlarging in size. After start of treatment testis starts enlarging in three months time. With in one year time testis enlarges to normal size. Its function also normalizes in most patients.
Side Effects: As this treatment consist of replacement of defective hormones. These hormones are given in physiological replacement doses as prescribed in our scientific text books. Thus this treatment does not have any side effects.
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