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Brachet and colleagues
discuss 3 case reports of children under the age of 3 who presented for
evaluation of rapid height gain, premature development of pubic hair, and
clitoral or penile enlargement. In each case the growth velocity was documented
to be increased, and the 2 girl’s behavior was described by the parents as
“tomboyish”. In each of the cases the plasma testosterone level was elevated
while the LH, FSH, and DHEAS were low or undetectable; the bone age was advanced
in each of the children. Careful history revealed in each case, a father who
had been using testosterone lipogel 10% daily as an “anit-aging hormone therapy”.
The testosterone gel was applied either to the legs, neck, or chest. In one
case, the child’s mother was found to have hirsutism, irregular menses and a
high plasma testosterone level as well. In each case, the father’s
discontinuation of the use of the testosterone lipogel was associated with reduction
in the child’s plasma testosterone level. In one case the clitoris returned to
normal size. However, no clitoral regression was observed at 1 year follow-up
in the second girl.
The authors
discuss the use of topical testosterone as an “anti-aging therapy” and the
potential for testosterone exposure of family members through skin to skin
contact or even indirectly though household linens. They stressed the
importance of specifically asking abut the parental use of topical agents when
evaluating children with androgen excess.
Brachet C, Vermeulen J, Heinrichs C.
Children's virilization and the use of a testosterone gel by their fathers. Eur
J Pediatr. 2005;164:646-647.
Editor’s Comment: This is an interesting case report and while case
reports are not usually abstracted for GGH, the information presented in this
manuscript is exceedingly important and can be of high interest to pediatric
endocrinologists. Although it is reasonable to ask about hormone exposure when
taking a history from parents of children with early signs of virilization,
questions concerning parental use of virilizing agents are usually limited to evaluation
of children born virilized. It is clearly important that these questions be
asked in every evaluation of androgen excess in young children. Such careful
history taking could clearly simplify diagnostic evaluations and treatment
plans in these children.
William L. Clarke, MD
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Current GGH - Vol. 24 No. 1
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