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

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."