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Efficacy of short-term induction therapy with low-dose testosterone as a diagnostic tool in the workup of delayed growth and puberty in boys

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Abstract

Purpose

Constitutional delay of growth and puberty (CDGP) represents the most frequent cause of delayed puberty in males, sharing some clinical features with growth hormone deficiency (GHD) and isolated hypogonadotropic hypogonadism (IHH). Short-term induction therapy (SIT) has been approved for the induction of puberty in CDGP. We aim to investigate the efficacy of SIT with transcutaneous testosterone gel (TTG) or intramuscular testosterone therapy (IMTT) in a cohort of CDGP subjects, compared to clinical observation. Furthermore, we aim to evaluate the role of SIT as a diagnostic tool to differentiate CDGP from GHD and IHH subjects.

Methods

The retrospective study included 246 male subjects with delayed puberty. The study population was divided into three groups: TTG, IMTT, and control group (CNT).

Results

At 6 months observation, height velocity (HV) was significantly increased in both treated groups compared to CNT group, particularly higher in TTG than IMTT group. A significant testicular enlargement was revealed in both CNT and TTG group compared to IMTT group. Furthermore, LH value was significantly greater in TTG compared to IMTT group. IGF-1 values after SIT rose significantly in both treated groups compared to CNT group. Moreover, almost all GH provocative tests performed after SIT showed a normal GH response.

Conclusion

SIT with TTG appears to be more effective to induce growth spurt, better tolerated and with a more physiological effect on pubertal induction compared to IMTT in CDGP population. Finally, TTG might be a useful tool in the diagnostic work up to discriminate CDGP from GHD or IHH.

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Data availability

The data that support the findings of this study are available on request from the corresponding author, LC.

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Funding

This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.

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Author notes

  1. Stefania Matromattei and Tommaso Todisco have contributed equally to the manuscript.

Authors and Affiliations

  1. Endocrinology Unit, University Pediatric Department, Bambino Gesù Children’s Hospital, IRCCS, P.zza Sant’Onofrio 4, 00165, Rome, Italy

    S. Mastromattei, T. Todisco, L. Chioma, G. Ubertini, M. G. Pattumelli, D. Fintini & M. Cappa

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by SM, TT, LC, GU, MGP and DF. The first draft of the manuscript was written by SM, TT and LC, all authors commented on previous versions of the manuscript. MC, MU and DF reviewed the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to L. Chioma.

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The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This retrospective study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Institutional Review Board of “Bambino Gesù” Children’s Hospital” approved the study protocol.

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Informed consent was obtained from all individual participants included in the study.

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Mastromattei, S., Todisco, T., Chioma, L. et al. Efficacy of short-term induction therapy with low-dose testosterone as a diagnostic tool in the workup of delayed growth and puberty in boys. J Endocrinol Invest 45, 2377–2384 (2022). https://doi.org/10.1007/s40618-022-01879-3

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