Introduction: Delayed puberty is a common indication for referral to paediatric endocrine services. Although guidelines exist for management of testosterone replacement in adults, currently it is not clear what the optimum regimen for testosterone therapy is for children or how best to monitor boys throughout treatment.
Aims: To identify the characteristics of testosterone therapy in boys referred for delayed puberty.
Methods: Retrospective review of case notes of all boys treated with testosterone for pubertal delay in one tertiary paediatric endocrine unit from 1 January 20121 April 2017.
Results: Over the study period, 540 clinic appointments were undertaken for review of boys with possible delayed puberty, with 175 new referrals taken during this time. Of these, 46(8.5%) were treated with testosterone (median age (range) 14(1218) years). The most common diagnoses were constitutional delay (n=15.33%); Duchenne Muscular Dystrophy (n=6.13%); hypogonadotrophic hypogonadism (n=6.13%) and panhypopituitarism (n=4.9%). Prior to treatment 30(65%) boys had a bone age X-ray; 12(26%) had liver function tests (LFTs); 7(15%) had an LHRH test; 7(15%) had a haematocrit and 6(13%) had a DXA scan. Five boys (11%) had LFTs checked after treatment; all of whom had raised alkaline phosphatase. The median duration of treatment was 3 (range 212) months. Four boys (9%) were treated with oral testosterone; 1(2%) with oral and IM; 1(2%) with gel and IM and the rest (87%) were treated with IM testosterone alone. Of the 5 boys on oral testosterone, 1(20%) was on oxandrolone; 1(20%) on testosterone undecanoate 40 mg on alternate days and the rest (60%) were on testosterone undecanoate 40mg daily. Of the 41 boys on IM testosterone, 2(5%) were on 1g Nebido; the rest (95%) were on varying doses of Sustanon (median starting dose 100 (range 50250) mg). Three (7%) were started on an increasing dose regimen; the rest (93%) on one static dose. Adverse events were recorded in 9/46(20%); 2(22%) with intolerable aggression and 7(78%) with lethargy.
Conclusions: Induction of puberty with exogenous testosterone is required in nearly 10% of boys referred due to pubertal concerns, with variable initiation and monitoring. Consensus guidelines may be useful to standardise management and ensure best practice.
22 - 24 Nov 2017
British Society for Paediatric Endocrinology and Diabetes