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Male pubertal development and the role of androgen therapy

Nature Clinical Practice Endocrinology & Metabolism volume 3, pages 338–344 (2007)Cite this article

Abstract

In boys, the hormonal changes that accompany normal puberty are well defined, as are the physical signs of pubertal development and the kinetics of the growth spurt. Most androgens are derived from the testes, although adrenal androgens may also contribute; testosterone can also be aromatized to estrogen to exert important effects during puberty. Androgens, but especially their conversion to estrogens by aromatase, have a major role in the dramatic changes in linear growth, secondary sexual characteristics, and changes to bone, muscle and fat distribution that occur during puberty. Androgen therapy for delayed puberty should permit full normal pubertal development and thereby also address some of the associated psychosocial problems. Adolescent boys with conditions of permanent hypogonadism (hypogonadotropic or hypergonadotropic) or transient hypogonadotropic hypogonadism (constitutional delay of growth and puberty) can benefit from testosterone therapy. Long-term testosterone therapy should be given for hypothalamic or pituitary gonadotropin deficiency, or for primary hypogonadism such as for adolescents with Klinefelter syndrome, if endogenous testosterone levels drop or levels of luteinizing hormone rise. Intramuscular administration every few weeks is effective, but newer cutaneous forms, for example, gels or patches, also show promise in permitting adolescent males to reach adult body composition.

Key Points

  • Constitutional delay of growth and puberty (CDGP) is a common form of (transiently) delayed pubertal development in males

  • Testosterone therapy increases growth and leads to lean body mass accrual in boys with primary or secondary hypogonadism

  • Adolescent males with CDGP benefit from short-term administration of testosterone

  • Long acting testosterone esters are the primary form of androgen replacement therapy in adolescents, but newer cutaneous forms are beginning to be used in this group

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Author information

Authors and Affiliations

  1. EJ Richmond is the Chief of the Pediatric Endocrinology Unit at the National Children's Hospital, San José, Costa Rica; he is also Professor at the School of Medicine, Pediatrics and Pediatric Endocrinology in the University of Costa Rica, San José.,

    Erick J Richmond

  2. he is also Professor at the School of Medicine, Pediatrics and Pediatric Endocrinology in the University of Costa Rica, San José.,

    Erick J Richmond

  3. AD Rogol is Professor of Clinical Pediatrics in the Department of Pediatrics, University of Virginia, Charlottesville, VA, USA.,

    Alan D Rogol

Authors
  1. Erick J Richmond
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  2. Alan D Rogol
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Corresponding author

Correspondence to Alan D Rogol.

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Competing interests

EJ Richmond declared he has no competing interests. A Rogol is a consultant to Solvay Pharmaceuticals, Inc., the manufacturer of Androgel®.

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Richmond, E., Rogol, A. Male pubertal development and the role of androgen therapy. Nat Rev Endocrinol 3, 338–344 (2007). https://doi.org/10.1038/ncpendmet0450

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