Hormone treatments aid boys with a 'little' way to go

By Bruce Emond

JAKARTA (JP): Size does not matter. Well, try arguing that point with a 24-year-old man with a penis shorter than a match.

Talk about penis size sounds like the stuff of boisterous locker-room ribbing, but psychiatrist and sex counselor Dr. Naek L. Tobing said undersized genitals, particularly in the most serious condition called micropenis, could lead to serious emotional problems in adulthood.

"If the penis is extremely small, two centimeters or so, it would be physically impossible to have intercourse. I often feel sorry for my patients when I first examine them."

Causes of the condition vary in each child.

"Some of the causes we know, others we don't. Some types of medication, including for asthma, include substances which may constrict blood flow to the penis, resulting in infrequent erections and probably affecting the size. There also seems to be a tendency for overweight boys to have smaller organs."

Little research has been done on the subject in Indonesia, and Naek uses a chart compiled by U.S. researchers Schoenfeld and Beebe in his practice. In their determination, a length of 3.8 centimeters is small for a nine year old; 9.3 centimeters is a micropenis for an adult male. Naek said he subtracted 10 percent from these figures, based on Indonesians' generally smaller physiques and body frames.

"It seems that a lot of men in Indonesia have small penises. If it was relatively small during childhood, then it's likely to be relatively small in adulthood."

The treatment uses gonadotropic drugs, which stimulate activity in the gonads, and consist of hormones taken from the urine of pregnant or menopausal women.

Naek said it was only possible to help the boys if there were no "signs of masculinization", such as pubic hair, and if their voices had not broken. "It's usually difficult if they are older than 13. The best age for treatment is 11."

Some of his case histories include a 14-year-old with a two- centimeter-long penis and the 24-year-old suffering from delayed puberty whose organ measures 3.7 centimeters. Both patients can be helped because they have yet to pass through puberty.

Naek said the 24-year-old man was suffering from depression when he first saw him.

"He was very angry, very desperate, with an inferiority complex. He didn't want to go out or call people on the phone, because they would assume from his high voice that he was a woman."

Following the treatments, the length of the man's penis increased to 5.5 centimeters. He eventually got married.

Naek said most patients experienced at most a 30 percent increase in the length of their penises, but his focus was on helping them to function sexually.

"If a penis is about five centimeters when it's flaccid, then it would be about seven centimeters erect. That's enough for intercourse."

The goal is not to create super-endowed men, he added.

"It's for their confidence. It's only natural for people to want to have a body which makes them believe in themselves. My job is to classify if they have a small penis or a micropenis, to determine what treatment is needed."

Something wrong

"Umi" first suspected something was wrong with her son when he was about nine years old.

"I have always been very open with my children, bathing with them, talking to them about everything, and I did notice that his penis seemed a bit small compared to his older brothers," she said at Naek's practice in Kebayoran Baru, South Jakarta.

She thought that circumcision would lead to growth in the organ, but it did not. "I asked my husband to take a look, to not be obvious about it, but to see what he thought. He agreed that it seemed small for his age."

Umi sought help from Naek, who examined the child and determined that his organ was small for his age. He recommended a series of hormone injections plus topical application of the drugs.

Umi said she was open with her son, now 10, about the treatment.

"I told him that it might help, or it might not, but whatever way he was perfect because God made him this way. He listened to me and understood."

He has already experienced some development, which has created a few new problems.

"His grandmother, my mother, came over and he started to pull down his shorts, saying, 'look, grandma, I'm getting bigger'. I've had to remind him that in Islam there are parts of the body we need to keep covered, and that this is a private matter and we don't need to tell everyone about it."

Naek said middle-class parents, usually with a smaller number of offspring to take care of, were more open about the subject.

"With family planning, people are having two or three kids, and they want those kids to be really healthy, to be as perfect as they can be. In the past, when there were big families, parents really didn't think about something like the penis size of their sons."