Androgen therapy in hypogonadal adolescent males.
ABSTRACT Androgen treatment represents a main aspect of clinical management of boys with hypogonadism from adolescence onwards. Androgen replacement therapy is required to induce secondary sexual characteristics and adult male body composition, to optimize the accrual of bone mineral content and muscle mass, and to promote physical and social well-being. Testosterone is the only sex steroid hormone suitable for treatment in hypogonadal boys as it fulfils all the physiological requirements. However, the optimal regimens for androgen replacement therapy during adolescence remain to be defined. The new testosterone formulations (patch, gel, transbuccal and long-acting) have been designed for use in adults and the available dosages are probably too high to induce and manage puberty in adolescents properly. The aim of this paper is to provide practical indications for androgen treatment in male adolescents with hypogonadism.
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ABSTRACT: This review deals with the relationship between obesity in male adolescents and gonadal function. The article is structured in two main paragraphs; the first one is about population studies that have assessed puberty timing and its mode of onset in relation with body weight to evaluate if and how the latter can influence the gonadal function in this phase of life. These studies analyze issues such as increased BMI and early onset of male puberty, gender differences, secular trend toward early onset of puberty in males, effects of a different body composition on male puberty and consequences of a different stage of childhood obesity on the onset of male puberty. The second paragraph examines the possible mechanisms through which, obesity may alter the timing of puberty in young males, including the role of SHBG, leptin, insulin resistance, ghrelin, GH-IGF-1 axis, AR polymorphisms, primary testicular dysfunction, retinol binding protein 4 (RBP-4) and liver function abnormalities. However, despite the numerous studies in the literature, the etiology of gonadal disfunction in obese adolescents on puberty remains uncertain.Journal of endocrinological investigation 06/2014; · 1.65 Impact Factor
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ABSTRACT: This review of disorders of sex development (DSDs) in boys and men will outline the conditions that may lead to this phenotype, present some guidance on how to evaluate and investigate affected cases and then review the medical and surgical management and subsequent outcome. DSDs are a wide range of relatively rare conditions which need multidisciplinary input. The underlying cause is clearer in girls with DSDs, but the actual diagnosis remains unclear in the majority of boys with DSDs. There is a need to improve the diagnostic yield and develop standardized methods for assessing, describing and investigating DSDs as well as for reporting outcome. This will lead to improved clinical management and genetic counselling.Current opinion in endocrinology, diabetes, and obesity 04/2012; 19(3):190-6. · 3.77 Impact Factor
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ABSTRACT: The medical term disorders of sex development (DSDs) is used to describe individuals with an atypical composition of chromosomal, gonadal and phenotypic sex, which leads to differences in the development of the urogenital tract and reproductive system. A variety of genetic factors have been identified that affect sex development during gonadal differentiation or in specific disorders associated with altered androgen biosynthesis or action. The diagnosis of DSDs in individuals and the subsequent management of patients and their families requires a targeted and structured approach, involving a multidisciplinary team with effective communication between the disciplines. This approach includes distinct clinical, imaging, laboratory and genetic evaluations of patients with DSDs. Although treatment of patients with DSDs can include endocrine and surgical options, many patients have concerns that arise from past incorrect treatments that were founded on the traditional binary concept of the sexes. To dispel these concerns, it is necessary to create centres of expertise for DSDs that include physicians, surgeons, psychologists and specialists in diagnostic procedures to manage patients and their families. Additionally, the inclusion of trained peer support in the multidisciplinary DSD team seems to be integral to the supportive management of patients with DSDs. Most importantly, dealing with DSDs requires acceptance of the fact that deviation from the traditional definitions of gender is not necessarily pathologic.Nature Reviews Endocrinology 07/2014; · 11.03 Impact Factor