Androgen Deficiency in the Adolescent Male

Abstract

Puberty in the adolescent male is a period of physical, mental, and psychological growth. Puberty commences in the male adolescent at approximately ages 9–14 years. There are some young males that experience delayed puberty and may benefit from androgen replacement therapy. Androgen deficiency in the adolescent is rare and may be transient or permanent. Transient delayed puberty is referred to as constitutional delay of growth and puberty (CDGP) and is characterized by slow growth rate and delay in the tempo of puberty. Permanent hypogonadism may be hard to differentiate from CDGP, but it is caused by an abnormal hypothalamic-pituitary-gonadal axis where the end result is androgen deficiency and delayed puberty. The goals of androgen replacement therapy in the adolescent male should be to promote the following: linear growth, secondary sexual characteristics, accrual of adequate bone mineral content, and acquisition of normal muscle mass. The use of testosterone has been shown to be effective and safe in adolescents in promoting puberty with physical as well as psychological benefit. The most commonly used form of testosterone in adolescents is testosterone enanthate or cypionate and is administered IM. Side effects are rare and most adolescents with transient delayed puberty will be able to wean off of testosterone replacement, while those with permanent hypogonadism need to be treated for life.