Testosterone exposure in childhood: Discerning pathology from physiology

Children's Hospital of Wisconsin, Medical College of Wisconsin, Division of Endocrinology, Department of Pediatrics , 9000 W. Wisconsin Ave PO Box 1997, MS C520, Milwaukee, WI 53201 , USA +1 414 266 6750
Expert Opinion on Drug Safety (Impact Factor: 2.91). 03/2013; 12(3). DOI: 10.1517/14740338.2013.782000
Source: PubMed


Testosterone (T) drives normal male sexual development both in utero and at puberty. Aberrant T exposure manifests as virilization of a female fetus, contrasexual precocity in girls, and isosexual precocity in boys. Evidence of pathologic T exposure warrants a prompt evaluation.

Areas covered:
The authors introduce the topic of T exposure in children by reviewing its physiology in the fetus and during childhood and adolescence. Pathologic conditions leading to virilization of a female fetus as well as androgen-mediated gonadotropin-independent precocious puberty in both genders are then discussed. The authors finish by noting exogenous T exposure in children and adolescents, focusing specifically on secondary exposure to topical T preparations.

Expert opinion:
Contrasexual precocity in a girl or sexual precocity in a boy should prompt evaluation for causes of gonadotropin-independent pubertal changes. Initial biochemical evaluation includes a bone age, T, 17-hydroxyprogesterone, androstenedione, dehydroepiandrosterone sulfate (DHEA-S) and high sensitivity gonadotropin levels. The provider must query exposure to topical androgen-containing preparations as unintentional secondary exposure to topical T must be considered. Hyperandrogenism is temporally related to exposure of topical T and removal of exposure results in a marked decrease in serum T as well as resolution or stabilization of the signs and symptoms.

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May 27, 2014