Micropenis in Children and Adolescents: A Narrative Review

PURPOSE: To summarize current evidence on the etiology, diagnostic approach, management strategies, and outcomes of micropenis in children and adolescents. MATERIALS AND METHODS: A narrative review was performed using PubMed/MEDLINE (October 2025) with the search terms (Micropenis OR Microphallus OR "Small Penis") AND (Children OR Youth OR Adolescents). From 707 records screened, 36 studies were selected based on methodological quality and relevance to clinical practice. RESULTS: Micropenis is a clinical sign frequently associated with underlying endocrinopathies, particularly Congenital Hypogonadotropic Hypogonadism (CHH). Accurate diagnosis relies on standardized Stretched Penile Length (SPL) assessment, recently optimized by the Stretched Penile Length INdicator Technique (SPLINT). Use of population-specific SPL nomograms is critical for diagnostic reliability. Testosterone therapy remains the primary treatment modality and demonstrates greatest efficacy in early infancy, promoting significant penile growth and generally favorable functional outcomes. Spontaneous catch-up growth during puberty has been reported in select cases. Current evidence supporting surgical interventions in children and adolescents is limited, heterogeneous, and associated with inconsistent long-term results; thus, surgery should not be considered first-line therapy. High-quality long-term outcome data and randomized placebo-controlled trials are lacking. CONCLUSIONS: Standardized SPL measurement and appropriate nomogram use are essential for accurate diagnosis. Early hormonal therapy, especially in CHH-associated micropenis, appears to yield optimal functional and psychosocial outcomes. Expectant management may be appropriate in selected clinical scenarios. Surgical techniques remain controversial, with insufficient evidence to recommend routine use. Further well-designed prospective studies, including randomized placebo-controlled trials, are needed to define long-term outcomes and guide clinical decision-making.