Comparison of Testosterone- Dihydrotestosterone Ratios in Children With Hypospadias to a Control Group at Kenyatta National Hospital

Abstract

BACKGROUND: Hypospadias is a common birth defect occurring in male children. Its worldwide incidence is approximately 1 in 125 live male new-borns. It occurs due to an arrest in the normal development of the urethra, foreskin and ventral part of the penis. The external genitalia of male embryos undergoes masculinization under the influence of testosterone and dihydrotestosterone. Dihydrotestosterone (DHT) is responsible for the complete differentiation of the penis with a male urethra and glans. It is converted from testosterone by the enzyme type 2 5α-reductase. Research done shows that a deficiency of 5α-reductase could be one of the causes of hypospadias. OBJECTIVE: The aim of this study was to compare the Testosterone: Dihydrotestosterone ratio in children with hypospadias to a control group without hypospadias. STUDY SETTINGS AND DESIGN: This was an observational case-control study carried out in the KNH paediatric surgical ward and paediatric surgical outpatient clinic. PATIENTS AND METHODS: The study involved patients with hypospadias and children with inguinal hernias with no other congenital anomalies as the control group. The patients were reviewed, a questionnaire administered and blood drawn. Blood levels of testosterone and dihydrotestosterone were measured at the KNH Biochemistry laboratory and a T: DHT ratio calculated. The control group was paediatric patients with inguinal hernias and no other congenital anomaly. Data collected was analysed using SPSS version 22.0. RESULTS: On the testosterone levels in children with hypospadias and the control group, the study found that there were no statistical differences (p = 0.290). On the dihydrotestosterone levels in children with hypospadias and the control group, the study found that there were no statistical differences (0.304) On the Testosterone: Dihydrotestosterone ratio in children with hypospadias and the control group, the study found that there were no statistical differences (0.130). CONCLUSION: Since there was no statistical difference in the testosterone: dihydrotestosterone ratio between the case and control groups, the study concludes that children with isolated hypospadias may not have a deficiency or defect in the enzyme 5 alpha reductase.