Читать книгу Handbook of Clinical Gender Medicine - Группа авторов - Страница 76

Steroid treatments are mainly based on androgen stimulation to enlarge the penis. There is no consensual protocol on if, when, and how to stimulate GT growth. There are three main possibilities: systemic testosterone (testosterone enanthate), topical DHT, and HCG (human or recombinant). When the GT is under 25 mm in length and 15 mm in width during the first year of life, androgen stimulation is commonly used. Some adverse effects, such as bone growth, should be monitored. It is also acknowledged that androgen treatments might be deleterious to the healing process after reconstructive surgery [30]. A 3-to 6-month gap between stimulation and surgery is recommended. Androgens mainly act on the growth of the GT dorsum and the ventral segment situated proximal to the division of the corpus spongiosum. Tissues located beyond the division of the corpus spongiosum are likely less androgen sensitive. These dysplastic tissues solely used in hypospadias reconstruction may not grow as well as the rest of the penis. This would explain the late urethral inadequacy with some techniques (Duplay, tubularized incised plate). Some surgeons favor the use of dorsal tissues for urethroplasties (onlay urethroplasty) which have a normal response to androgen stimulation.