Hypospadias

Urethral development occurs between weeks 8-14 of gestation through androgen-dependent fusion of the urethral folds over the urethral plate. Dihydrotestosterone (DHT), converted from testosterone by 5-alpha reductase in genital skin, drives this closure from proximal to distal. Hypospadias results from insufficient DHT signaling due to genetic mutations (SRD5A2, AR gene variants), placental insufficiency reducing hCG-driven fetal testosterone, or environmental endocrine disruptors. Posterior hypospadias may indicate broader anomalies of sex development (46,XY DSD). The clinician evaluates severity, prescribes pre-operative testosterone therapy for severe cases, manages post-operative complications, and coordinates long-term urological follow-up including fertility implications.