An inexpensive and edible aid for the diagnosis of puberty in the male: multispecies evaluation of an alternative orchidometer

Increasing testicular volume—a useful index of puberty in the male—is measured with an orchidometer, a graded series of ovoid beads on a string.¹ This instrument is reliable, but at £28.50 ($43.00) it is prohibitively expensive, and it is usually unobtainable when needed.²

Deeply concerned by the national shortage of orchidometers, two of us (PB and GW) made a serendipitous discovery that led to this study. Briefly, Teasers and Truffle, two chocolates in the Celebrations assortment (Mars UK, Slough), are uncannily similar in size and shape to the 8 ml orchidometer bead (figure). This observation presented a timely opportunity to cut clinic waiting times and costs, two problems that continue to dog the NHS. We therefore compared the conventional orchidometer with its chocolate surrogates, focusing on the key properties of reliability, durability, and palatability.

Participants, methods, and results

Five paediatricians (three male, two female) were blindfolded and given, in random order, a Teaser or an 8 ml orchidometer bead in a Teaser wrapper and asked to size the other beads as larger or smaller than the reference. (Real testicles were not used because the image of the medical profession is already bad enough.) Participants were 100% accurate in sizing the beads against both the Teaser and the reference.

To simulate typical outpatient conditions in Liverpool, Teasers (n=6) and an 8 ml orchidometer bead (n=1) were hit smartly with a 454 g hammer and carried in a pocket (by PB) into a sauna. The orchidometer bead survived both tests whereas the Teasers yielded to a single blow of the hammer and ruined a perfectly good bathrobe.

The ability to rescue staff weakened by hunger at the end of a long clinic is an important bonus for any item of medical equipment. Intuitively, chocolate has more potential in this respect than the Swedish birch of the conventional orchidometer. Regrettably, GW was unable to persuade PB that proving this point could be important for her career; accordingly, S and P were recruited to the research team. Teasers (n=5) and Truffles (n=5; all unwrapped) and 10 orchidometer beads were scattered randomly 30-40 cm away from P and S, who had recently been fed (Burns Canine Maintenance; Burns Pet Nutrition, Kidwelly, Dyfed; about 600 kcal) so that there would be some chance of seeing what was happening. About 17 seconds later all that remained were 10 orchidometer beads and some saliva. We regard this as evidence that Teasers and Truffles are more palatable than conventional orchidometer beads.

Comment

A testicular volume greater than 8 ml can be judged just as accurately with a Teaser or Truffle as with the conventional orchidometer. Moreover, the alternative orchidometer had the advantage of edibility, although its working life would probably be short. A testicular volume of 8 ml corresponds to the 50thcentile at 13 years of age¹; thus puberty is proceeding satisfactorily if the testes progress from smaller than to the same size as and finally bigger than a Teaser.

We believe that we have found a viable substitute for the time honoured but outrageously overpriced orchidometer. We do not wish to diminish the contribution of Prader, father of the orchidometer, nor to impoverish the wood turners who craft its beads with such skill.³ However, the low cost of our alternative orchidometer (6p (10¢)) must endear itself to healthcare systems that are strapped for cash.

Finally, we reject any allegation that this paper is another gratuitous attempt by dogs to get themselves on to Medline.⁴,⁵ We do, however, acknowledge that this research was basically a load of balls.

Figure.

Conventional 8 ml orchidometer bead (top) and Teaser in wrapped and unwrapped state (bottom)