title: Testosterone exposure in childhood: discerning pathology from physiology.
abstract: BACKGROUND
  Testosterone (T) drives normal male sexual development both in utero and at puberty. Aberrant T exposure manifests as virilization of a female fetus, contrasexual precocity in girls, and isosexual precocity in boys. Evidence of pathologic T exposure warrants a prompt evaluation.
  
  
  METHODS
  The authors introduce the topic of T exposure in children by reviewing its physiology in the fetus and during childhood and adolescence. Pathologic conditions leading to virilization of a female fetus as well as androgen-mediated gonadotropin-independent precocious puberty in both genders are then discussed. The authors finish by noting exogenous T exposure in children and adolescents, focusing specifically on secondary exposure to topical T preparations.
  
  
  CONCLUSIONS
  Contrasexual precocity in a girl or sexual precocity in a boy should prompt evaluation for causes of gonadotropin-independent pubertal changes. Initial biochemical evaluation includes a bone age, T, 17-hydroxyprogesterone, androstenedione, dehydroepiandrosterone sulfate (DHEA-S) and high sensitivity gonadotropin levels. The provider must query exposure to topical androgen-containing preparations as unintentional secondary exposure to topical T must be considered. Hyperandrogenism is temporally related to exposure of topical T and removal of exposure results in a marked decrease in serum T as well as resolution or stabilization of the signs and symptoms.
authors.affiliation: Children's Hospital of Wisconsin, Medical College of Wisconsin, Division of Endocrinology, Department of Pediatrics, 9000 W. Wisconsin Ave PO Box 1997, MS C520, Milwaukee, WI 53201, USA. scabrera@mcw.edu
authors.forename: Susanne M
authors.initials: SM
authors.lastname: Cabrera
authors.forename: Alan D
authors.initials: AD
authors.lastname: Rogol
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D011629:Puberty, Precocious / Q000139:chemically induced* / Q000473:pathology; D012741:Sexual Maturation / Q000187:drug effects / Q000502:physiology; D013739:Testosterone / Q000009:adverse effects*
chemical_list: D013739:Testosterone