Children’s Vitilization by Testosterone Gel
© 2006 Prime Health Consultants, Inc.
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.
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