A 15-year-old boy is brought to the office by his parents due to concerns about his pubertal development.  The patient says, “I am the only one of my friends whose voice has not changed and who does not have any body hair.  I’m tired of being called ‘weak’ in gym class.”  The patient has been fatigued lately, which he attributes to staying up late talking with friends; he otherwise feels well.  He has had no recent headaches, vomiting, or vision changes.  The patient has a good appetite and eats a well-varied diet.  His father is 178 cm (5 ft 10 in) and his mother is 160 cm (5 ft 3 in).  Blood pressure is 116/70 mm Hg and pulse is 78/min.  Weight and height are at the 15th and 3rd percentiles, respectively, unchanged from his last visit 12 months ago.  The patient’s height has increased 4.5 cm (1.8 in) since then.  Physical examination shows a well-appearing, quiet adolescent with no dysmorphic features.  The thyroid is palpable and not enlarged.  There is no gynecomastia.  Cardiopulmonary examination is normal.  The testes are soft and measure 2 mL (Tanner stage I).  The phallus is normal in length.  There is no axillary or pubic hair.  The rest of the physical examination is normal.  Bone age x-ray is consistent with age 13.

Item 1 of 2

Which of the following is the most likely diagnosis in this patient?

Item 2 of 2

When the family is asked if there are any concerns, the patient answers, “I’m worried that my body will never change and I’ll be this way for the rest of my life.  I’m stressed about changing in the locker room in front of my soccer teammates because I don’t think I look like I should at my age.  It makes me want to quit the soccer team.”  Which of the following statements would be the best response to this patient’s concerns?

An 8-month-old boy is brought to the office for a routine visit.  The parents’ only concern is that their son’s “private area looks abnormal,” which his primary care provider has been monitoring.  The patient breastfeeds on demand and eats pureed fruits and vegetables.  He urinates frequently and stools once a day.  The patient rolls in both directions, responds to his name, and transfers objects from one hand to the other.  He was born by cesarean delivery at 36 weeks gestation due to maternal preeclampsia.  The patient was small for gestational age but has gained weight appropriately since birth.  Weight, length, and head circumference track along the 30th percentile.  Physical examination shows an interactive and alert infant.  The abdomen is soft, nontender, and nondistended.  Genital examination reveals a hypoplastic, empty left hemiscrotum, as shown in the image below:

A small mass is palpated in the left inguinal canal and cannot be manipulated into the scrotum.  The right testicle is palpated in the right hemiscrotum, which has normal cremasteric reflex and normal rugae.  The penis is uncircumcised, and the urethral meatus is at the tip of the glans.  Which of the following is the most appropriate next step in management of this patient?