How much impact does a small penis have on a man’s life?

For many men, the size of the penis is a very sensitive issue. Positive qualities such as influence and strength are related to a large penis, but a small penis can lead to a decrease in self-esteem. However, the size and width of the penis vary from region to region, so the concerns of men often do not make sense and there is no need to lengthen the genital area, which is not the case with the so-called micropenis. This is a small penis due to recurrent testosterone deficiency or testosterone resistance, resulting in poor physical development. Micropenis can be treated by surgery in adolescence or later with testosterone replacement therapy.

What exactly is a micropenis?

A small penis that is less than 7 cm long when stiff is called a micropenis. However, this value applies only to adults, since it is to be expected that the genitals of adolescents are still developing physically and functionally. Therefore, when diagnosing a small penis in children and adolescents, a chart can be used to objectively estimate the length of the penis at any age. If the length of the patient's genital area is less than 2.5 standard deviations from the median for the age group, the diagnosis of "micropenis" is made. To determine the length of the penis, measure the distance between the pubic symphysis and the tip of the penis from the back of the penis. The dorsal side ("back of the penis") is the side of the penis that can be seen from the front when it is not erect.

How common is a micropenis?

There are few studies on the prevalence of micropenis in the general population. It is estimated that 1 to 2 in 100 men have a micropenis, but there appears to be a regional difference. A study in Colombia found that only 19 out of 100,000 men have a micropenis. To describe the prevalence of small penises in the population, it is necessary to distinguish the true micropenis from the "buried penis" caused by severe overweight (obesity). In the latter form, most of the genitals disappear into the abdominal fat tissue, which makes the men appear to have a much smaller penis externally. However, this is referred to as a cosmetic problem, as it is not actually a micropenis from a physical point of view. In recent years, it has been diagnosed more frequently in newborns. According to several studies, this is due to the effect of foreign substances and hormonal preparations (androgens, estrogen mimetics).

Where does the micropenis come from?

The cause of a micropenis is a maldevelopment of the penis before or after birth. The causes of this developmental disorder vary in nature. About half of all diagnosed micropenises are caused by a dysfunction of the pituitary gland or the hypothalamus. As a result, the testes are insufficiently stimulated (hypogonadotropic hypogonadism) and therefore cannot produce enough testosterone to allow normal development of the reproductive organs. It appears that growth hormones such as somatotropin are also important in stimulating testosterone production, but the lack of testosterone may simply be due to inadequate testicular function (hypergonadotropic hypogonadism). About 25% of micropenises are caused by this type of testosterone deficiency and the genitals of the affected person are actually large enough at birth. Over time, the micropenis develops gradually, accompanied by a significant reduction in body growth. Only 15% of cases can be attributed to partial androgen resistance ("partial androgen insensitivity syndrome", PIAS). The body receives sufficient testosterone, but due to defects in the corresponding receptors, the hormone is unable to exert its effect. People affected by this phenomenon are born with below-average physical prerequisites. The remaining 10% of cases cannot be explained medically and are therefore classified as idiopathic micropenis.

What problems can a micropenis cause?

In principle, you can live with a micropenis without any restrictions. In some cases, however, sexual intercourse may be impaired. In addition, a visually below-average penis can lead to bullying, especially among children and adolescents. However, if a micropenis is the result of a syndrome, other symptoms of the syndrome may affect quality of life. However, focused research has not been able to document the relationship between a micropenis and lack of intelligence.

How to treat a micropenis?

Micropenises are usually hereditary. Therefore, they are usually diagnosed early and can be treated with hormones. For this purpose, the affected person is injected with testosterone into the muscles so that over time a penis can develop that is long enough. In addition to testosterone propionate and testosterone anthate, the very effective dihydrotestosterone is also injected depending on the situation, with the amount injected depending on the age and stage of development of the man or boy. During puberty, the amount of testosterone administered increases four- to eightfold. If a micropenis is later discovered after the penis has grown, hormone supplements can no longer be used to treat the genitals, but other methods must be used to heal the penis. Of course, you can find many penis enlargement options online. However, there is usually no evidence of their effectiveness. For example, a penis pump can increase an erection, but there is no evidence that the lengthening lasts longer. The only really effective treatment for small penis after puberty is surgery, which can be performed on an outpatient basis and minimally invasive under local anesthesia. Cutting the anterior frenulum lengthens the erect penis by 2 to 4 cm, and doubling the penis length is also possible in the non-erect state. For example, transplantation of the patient's own thigh fat can make the penis thicker, but surgery is not always appropriate and must be carefully considered (risky). If the sufferer is in severe pain, psychiatric care may provide better treatment than surgery.  
Medically evaluated by: Dr. Emily Wimmer Physician Dr. Emily Wimmer has been one of our German physicians since 2015. In 2009, she completed her studies in human medicine at the University of Lübeck. She then worked in the Department of Hematology and Oncology at MedUni Vienna and as an assistant physician in Hamburg and investigator at the Hamburg Institute for Health Services Research in Dermatology, respectively. Since 2020, she has also been working part-time in the practice of Dr. Jürgen Kolbeck in Hamburg.

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