DELAYED PUBERTY IN BOYS
We continue to publish the work of Vladimir Nikolayevich Kosenko, an urologist, a specialist of the highest qualification category and Honoured Doctor of Ukraine.
Young parents, who would like to become happy grandparents and want their sons to be healthy in the future, should definitely pay attention to this essay.
The fact is that after another "reasonable and rational" medical reform, observation of adolescents was transferred to paediatricians, thereby pushing the mandatory visit to an urologist to indefinite period. So, these young men (18 years old and over) seek for the urologist only when the problem cannot be neglected or even corrected in some cases.
We must face the truth that in domestic medicine precious attention is paid to the problem of sexual development disorders in adolescents. It is also important that the detection of this pathology should occur at the age of 12-14, and this is when adolescents are left without sufficient attention.This issue is not completely regulated – who should take care of children with infantile disorders, i.e. delayed puberty. Should itbe paediatricians, geneticists, endocrinologists, gynaecologists, urologists orandrologists?
It turns out that everyone and no one is involved. In addition if we take into account the mental state of the child, his isolation, unwillingness to talk about this topic, then we can understand all the difficulties of identifying this disease.
Male hypogonadism is an insufficient sex hormones saturation of the body and decreased sex glands functioning. The reasons for this problem are very diverse:
-congenital syndromes associated with the pathology of the pituitary gland and hypothalamus;
- abnormalitiesassociated with genetic aberrations (disorders);
- inflammation of the genitals due to trauma;
- constitutional delayed puberty and physical maturation in more than half of cases.
This pathology, if not corrected in a timely manner, can lead to serious deviations in the functioning of other organs and systems, up to impaired reproductive performance. This may become a cause of physical and social disability in young men.The urgency of studying this problem is also determined by the fact that adolescents with impaired puberty constitute a high risk group of borderline mental disorders, up to suicide attempts.
That is why we are asking parents to get away from your own grown-up, terribly important affairs and take a close look at your teenage boys.
Androgenic insufficiency begins to manifest itself at the age of 12 years. The physique is infantile, the limbs are relatively long, the waist is overestimated and the hips are often wider than the shoulders. The deposition of subcutaneous fat on the chest, waist, and lower abdomen just like in the female type is also observed. The muscles are flabby and weak, and his voice is high and childish. Sometimes children of small stature lag behind their peers significantly.
In the mental aspect, attention is drawn to the "eunuchoid type" – timidity, weakness of will, apathy, loneliness, the desire to protect himself from communication with peers, pettiness, selfishness, irritability, tearfulness, vengefulness, cruelty sometimes (animals and insects)...Trying to hide their flaw from others, children strive to show themselves as adults in their understanding – they begin to smoke, drink alcohol, use foul language or tell stories about their courage. At the same time, asthenization, such as constant alertness, exhaustion of attention and rapid fatigue, is expressed.Children are extremely sensitive to their appearance defects – underdevelopment of the genitals, lack of hair growth in the pubis and armpits, high pitched voice, fat deposits, breast augmentation, etc. They experience serious doubts about their further usefulness, the ability to live a sex life and to have children. As a result, a traumatic fixation of attention on his own shortcomings is formed.
The most noticeable is the infantilism of the external genitals – the penis is not more than 5 cm, tiny testicles up to 43 cm, and there is no folding and sagging of the scrotum. Pubic and axillary hair growth is absent or poorly expressed. There is no nocturnal emission, which should begin at 13-14 years of age. All these manifestations are easy to see with the naked eye of the parent.At the same time, I want to note that the clinical assessment of delayed puberty should be made only by a specialist. Therefore, at the first signs of the child's infantilism, your main task as a parent is to take your child and go to see your doctor.
In hypogonadism, it is very important to start the treatment in time. Sensitivity to treatment decreases with age, and the best results can be obtained only between 12 and 16 years of age. Late diagnosis and treatment worsens the long-term prognosis, especially fertility, i.e. the ability to have children.
The question of medical ethics, interaction with parents and mutual understanding with adolescents is very important, since such children form a stable idea of their own inferiority and physical impairment. These psychoemotional deviations must not be allowed to progress and become entrenched in the mind of a teenager.It is necessary to destroy the phantom of inferiority immediately by using repeated phrases, such as it is not terrible, it is ok, this is common, it is easy to treat, and you can give examples from your childhood, even if invented...
Treatment of a teenager with delayed puberty must be comprehensive – medications, herbal medicine, physiotherapy, physiotherapy exercises, medical and psychological correction. The effectiveness of therapy appears after the first month of treatment. You will be surprised to see the shining eyes of your boys, their straightening shoulders and emotional confidence. The character will change right before our eyes – children become calmer and aggressiveness goes away. They become open for communication and can already stand up for themselves. This is what, dear parents, should convince you to bring the work started to the end, because the shortest course of treatment makes 2.5 - 3 months.
In nutrition, canned and smoked meat products must be excluded and special attention should be paid to purified drinking water, the consumption of fish in different guises, and legume side dishes, such as beans, peas, soybeans, walnuts, honey, etc.
For a long-term prognosis, I would like to emphasize the need for early diagnosis and treatment once again. It is likely that many cases of hypogonadism in adult men with decreased sexual function, infertility, and various kinds of neuropsychiatric diseases have their roots in childhood. However, the striking success in the treatment of delayed puberty can be expected in adolescence only.
To be continued……..