Purpose of Review <p>To review the use of testosterone and other androgens for various diagnoses in pediatric urology including hypospadias, bladder exstrophy and micropenis. This review focuses on the biometric effects of prepubertal androgens exposure has on male genitalia, long- and short-term side effects of this administration, various routes of administration and effects on surgical outcomes.</p> Recent Findings <p>Preoperative androgen administration is common in pediatric urology when treating patients with hypospadias, bladder exstrophy, bilateral anorchia and micropenis. The most common route of administration is intramuscular (IM). Although some patients with hypospadias have androgen resistance, most will experience significant growth in penile length, circumference and glans width and there is no significant difference between IM and topical testosterone or topical DHT administration. Side effects like increased appetite, fussiness/aggressiveness, and pubic hair growth often occur in the short term, however are typically mild and self-resolve. There appear to be no long-term effects on penile length or overall height specifically in hypospadias patients that received testosterone in infancy/prepubertally. Literature on how androgen stimulation effects surgical outcomes for hypospadias patients is mixed, however more recent publications suggest that testosterone use preoperatively in select patients is safe and can decrease surgical complications.</p> Summary <p>Testosterone is used in the treatment paradigm of various urologic diagnoses, namely hypospadias, micropenis and bladder exstrophy. Its biometric effects on penile growth, regardless of the route of administration, are significant and well established. Although there is certainly a role for its use in patients with these specific diagnoses, future research efforts must focus on more granular data collection to answer the question of who is to benefit most from treatment.</p>