with multiple comorbidities exists, but what remains to be
determined are the optimal treatment modalities and target
testosterone levels in elderly men requiring TST.
Conﬂicts of interest:
L. Lipshultz has been a clinical trials participant,
consultant, and speaker for Auxilium and a clinical trials consultant and
speaker for Endo. The other authors have nothing to disclose.
Vigen R, O’Donnell CI, Baron AE, et al. Association of testosterone
therapy with mortality, myocardial infarction, and stroke in men
with low testosterone levels. JAMA 2013;310:1829–36.
Basaria S, Coviello AD, Travison TG, et al. Adverse events associated
with testosterone administration. N Engl J Med 2010;363:109–22.
Shores MM, Matsumoto AM, Sloan KL, Kivlahan DR. Low serum
testosterone and mortality in male veterans. Arch Intern Med 2006;
Shores MM, Smith NL, Forsberg CW, Anawalt BD, Matsumoto AM.
Testosterone treatment and mortality in men with low testosterone
levels. J Clin Endocrinol Metab 2012;97:2050–8.
Coviello AD, Kaplan B, Lakshman KM, Chen T, Singh AB, Bhasin S.
Effects of graded doses of testosterone on erythropoiesis in healthy
young and older men. J Clin Endocrinol Metab 2008;93:914–9.
Basaria S, Dobs AS. Risks versus bene±ts of testosterone therapy in
elderly men. Drugs Aging 1999;15:131–42.
Ranjith Ramasamy, Jason R. Kovac, Jason M. Scovell, Larry I. Lipshultz*
Department of Urology, Baylor College of Medicine, Houston, TX, USA
*Corresponding author. 6624 Fannin Street, #1700, Houston,
TX, 77030, USA.
Re: Penis Size Interacts with Body Shape and Height to
Influence Male Attractiveness
Mautz BS, Wong BB, Peters RA, Jennions MD
Proc Natl Acad Sci U S A 2013;110:6925–30
Using computer-generated images, biologists found that 105
heterosexual Australian females aged 26.2
6.8 yr rated
images of males with smaller penises less attractive than
those with larger ones. Each female rated the attractiveness
of 53 figures, a subset of the 343 generated by creating seven
different flaccid penis lengths, seven heights, and seven
shoulder-to-hip ratios. Height ranged from 1.63 m to 1.87
m, and flaccid penis lengths ranged from 5 cm to 13 cm. When
the researchers controlled for body shape, a larger penis size
had a greater effect on attractiveness for taller males. Accord-
ing to these biologists, a large penis is a likely fitness-related
attribute, which can be used by females, including human
ones, to pursue repeated intercourse with a particular male.
This small study, published in the prestigious
the National Academies of Sciences of the United States of
, provides limited evidence that male attractiveness
assessed by females is influenced by flaccid penis size. Sexual
attractiveness was rated using computer-generated images
rather than real persons. Unfortunately, penile length and
girth were not distinguished, and the researchers did not
explain where the length was measured from. Obviously, their
findings are not applicable to females of different backgrounds
or cultures. The ancient Greeks, for example, believed that a
small penis was not only more attractive but also more
serviceable in reproduction, since its semen would suffer less
heat loss. They represented satyrs with huge penises as a sign
of their ugliness
Because human males have covered their genitals with
clothing for most of their history, it is not clear what
opportunities females would have had to exert their
preferences with regard to flaccid penis sizes. However,
according to Costa and coworkers
, preference for a large
penis may be associated with higher rates of vaginal
orgasms. Scientific research that has relied on direct
questioning of females has yielded mixed results: Depend-
ing on the study, females prefer longer penises or thicker
penises or think size is unimportant when selecting a
the bigger, the better
seems to be the main motto,
but with regard to attractiveness, there are really much
more important factors than penis size, such as being
receptive to a partner’s needs
. For the individual female,
however, experience with several men is the only way to
learn how important flaccid and erect penis sizes actually
are for her. In my country, as far as I know, females prefer a
Conﬂicts of interest:
The author isaspeaker forLillyandGlaxoSmithKline.
McLaren A. Impotence. A cultural history. Chicago, IL: University of
Chicago Press; 2007.
Costa RM, Miller GF, Brody S. Women who prefer longer penises are
more likely to have vaginal orgasms (but not clitoral orgasms):
implications for an evolutionary theory of vaginal orgasm. J Sex
Francken AB, van de Wiel HB, van Driel MF, Weijmar Schultz WC.
What importance do women attribute to the size of the penis? Eur
Van Driel MF. Manhood. The rise and fall of the penis. London, UK:
Reaktion Books; 2009.
Mels F. van Driel
Department of Urology, University Medical Centre Groningen,
Groningen, The Netherlands
EUROPEAN UROLOGY 65 (2014) 843–848