This study investigates the management of small genitalia in children, a condition that can cause considerable concern for both patients and caregivers, often necessitating evaluation for potential endocrinological or anatomical abnormalities. Various treatment strategies, such as hormone therapy and topical applications, have been explored to promote growth. The objective of this study is to assess the safety and efficacy of different therapeutic interventions, including hormonal injections, topical testosterone creams, and alternative treatments, in pediatric patients over a multi-year follow-up period

Children diagnosed with small genitalia were identified from a prospectively maintained database and categorized into treatment groups based on their prescribed regimen. Therapeutic interventions included intramuscular injections of human chorionic gonadotropin (hCG) (Choriomon 5000 IU), topical testosterone therapy (5% testosterone cream), and desmopressin (Minirin) for cases presenting with both small genitalia and nocturnal enuresis. Regular follow-up visits were conducted to monitor treatment responses, with assessments including serial penile measurements, Doppler ultrasound evaluations, and hormonal profiling, specifically measuring luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels. Adverse events were carefully documented, and the efficacy of each intervention was analyzed by tracking longitudinal changes in genital size and hormonal markers.

All treatment groups demonstrated improvements in genitalia size and hormonal parameters, with the most pronounced growth observed in patients receiving hormonal-based therapy. Notably, those treated with intramuscular human chorionic gonadotropin (hCG) or topical testosterone exhibited significant increases in penile length and hormonal normalization over time.  Treatment adherence varied, with some instances of discontinuation due to caregiver concerns, patient discomfort, or preference for non-invasive options, ultimately impacting the consistency of long-term outcomes. Regular follow-up and counseling were essential in optimizing adherence and ensuring sustained therapeutic benefits.

The findings suggest that various therapeutic approaches, particularly hormonal-based treatments, are effective in promoting genitalia growth and improving hormonal parameters in children with small genitalia. The significant response observed in patients receiving testosterone therapy highlights its role as a primary intervention for this condition. Minimal side effects and good overall tolerability reinforce the safety of these treatments, though adherence challenges were noted, emphasizing the need for individualized management and caregiver education. The observed variations in long-term outcomes underscore the importance of consistent follow-up and tailored treatment strategies to optimize effectiveness.

Hormonal and topical therapies are effective and well-tolerated options for managing small genitalia in children. The results indicate that early initiation of treatment, regular monitoring, and adherence to prescribed regimens are crucial for achieving the best outcomes. Future research is needed to compare the long-term effectiveness of various treatment modalities and to assess the psychological impact on affected children.