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Testosterone therapy in children and adolescents: to whom, how, when?

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Abstract

Male production of testosterone is crucial for the development of a wide range of functions. External and internal genitalia formation, secondary sexual characteristics, spermatogenesis, growth velocity, bone mass density, psychosocial maturation, and metabolic and cardiovascular profiles are closely dependent on testosterone exposure. Disorders in androgen production can present during all life-stages, including childhood and adolescence, and testosterone therapy (TT) is in many cases the only treatment that can correct the underlying deficit. TT is controversial in the pediatric population as hypoandrogenism is difficult to classify and diagnose in these age groups, and standardized protocols of treatment and monitorization are still lacking. In pediatric patients, hypogonadism can be central, primary, or a combination of both. Testosterone preparations are typically designed for adults’ TT, and providers need to be aware of the advantages and disadvantages of these formulations, especially cognizant of supratherapeutic dosing. Monitoring of testosterone levels in boys on TT should be tailored to the individual patient and based on the anticipated duration of therapy. Although clinical consensus is lacking, an approximation of the current challenges and common practices in pediatric hypoandrogenism could help elucidate the broad spectrum of pathologies that lie behind this single hormone deficiency with wide-ranging implications.

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Fig. 1: Classification of male hypogonadism in the pediatric population.

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Acknowledgements

We thank all the reviewers for comments that greatly improved the manuscript.

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Authors and Affiliations

  1. Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA

    Maria Camila Suarez A.

  2. University of Miami Miller School of Medicine, Miami, FL, USA

    Joseph M. Israeli

  3. Sackler School of Medicine, Tel Aviv, Israel

    Eliyahu Kresch

  4. Department of Urology, Lenox Hill Hospital, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA

    Leon Telis

  5. Department of Pediatric Urology, Nicklaus Children’s Hospital, Miami, FL, USA

    Daniel E. Nassau

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  1. Maria Camila Suarez A.
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Contributions

M.C.S.A. conceptualized the outline, contributed to the critical review of the literature, participated in drafting primary manuscript, and created tables and figures of review. J.M.I. and E.K. contributed to the critical review of the literature and participated in drafting of the primary manuscript. L.T. discussed the content and was the secondary manuscript writer. D.E.N. revised the manuscript critically for the intellectual content, final edits, and gave final approval of the version to be submitted.

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Correspondence to Daniel E. Nassau.

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Suarez A., M.C., Israeli, J.M., Kresch, E. et al. Testosterone therapy in children and adolescents: to whom, how, when?. Int J Impot Res 34, 652–662 (2022). https://doi.org/10.1038/s41443-021-00525-5

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