Efficacy of Topical Testosterone in Management of Scrotal Hypoplasia and Agenesis

Background Scrotal hypoplasia or agenesis may possess difficulty during orchidopexy or end with social anxiety around excessively small scrotal size when compared to peers, and where there may be concerns regarding the future sexual life.

Objective Any conservative modality applicable to ameliorate scrotal underdevelopment partially or completely will be useful either solely or before reconstructive surgery.

Study design Seventeen children (3–8 years) were diagnosed with bilateral scrotal hypoplasia (SH) in 5 unilateral in 7, bilateral scrotal agenesis (SA) diagnosed in 4 cases, and unilateral in one. Testicles are either undescended, ectopic, or normal. All cases managed by Testogel 1% topical testosterone for 4 weeks. Clinical assessment by measurements of the scrotal skin surface area (scrotal length multiplied by width) and scrotal corrugations counting. Inguinal and renal ultrasound done for all cases and karyotyping for cases of agenesis and cases with bilateral undescended testicles. Total and free testosterone, LH, FSH, and AMH hormones were assisted before treatment, weekly, and one week after therapy. Data analyzed and evaluated, difference of means used to test for statistically significant differences between scores of scrotal development.

Results Free and total testosterone elevated in the 1st week of treatment but restored to normal or higher levels in 60% of cases at the 2nd week. Satisfactory response (Increasing numbers of scrotal rugae or scrotal surface area by 30–50% above the pretreatment status) obtained in 85% and 60% of unilateral and bilateral SH, but only a partial response (10–20% increase) was gained in 40% of cases with agenesis. No major adverse effect was appreciated.

Discussion Response of some cases of SH to topical testosterone indicates presence of remnants of labioscrotal folds with testosterone receptors (Bell et al., 1971).1 Testosterone replacement therapy can improve the signs and well-being of a hypogonadal male by restoring serum testosterone concentrations to physiologic levels. In this study, the mean average testosterone concentration one week after application of testogel was 13.47 ± 2.45 and 12.12 ± 2.5 within 2nd, 4th week, and after cessation of treatment. Anti-Mullerian hormone is significantly low in 12 cases; mainly in cases of SA (P-value <0.001).

Conclusion Short-term topical testosterone proved to be effective in a considerable percentage of cases of either bilateral or unilateral scrotal hypoplasia; with a subsequent increase in scrotal surface area and number of rugae, it may substitutes the indication for surgical reconstruction. Long-term follow-up is a limitation of this study.
Authors: Omar Al Samahy, Doa Othman, Dalia Gad, M.A. Baky Fahmy, Pediatric Surgery, Al Azhar Faculty of Medicine for Girls, Egypt

Source: Omar Al Samahy, Doa Othman, Dalia Gad, M.A. Baky Fahmy, “Efficacy of topical testosterone in management of scrotal hypoplasia and agenesis,” Journal of Pediatric Urology, 2021, ISSN 1477-5131, https://doi.org/10.1016/j.jpurol.2021.02.014.