ESPE Abstracts

Background: Virilization of young children after topical androgen use by their fathers through skin contact is well-known. The long-term consequences of such exposure at very young age are not well known.

Objective and hypotheses: The aim is to report the occurrence of spermarche in a young boy and central precocious puberty in a young girl as late consequences of interpersonal transfer of testosterone gel.

Method: Testosterone contamination was evidenced in a 4-year-old boy presenting with penile enlargement and pubic hair development (serum testosterone: 1.07 μg/l) and in a 3.5-year-old girl presenting with pubic hair development and acne (serum T: 1.66 μg/l). Bone age was accelerated with respectively 14 and 27 months. A suppressed LH response to GnRH was documented. In both children testosterone levels were unmeasurable after discontinuation of the exposure.

Results: Regular semen staining in the underpants was observed in the boy at the age of 8 years (4 years after testosterone exposure). Genital examination showed a penis size of 8 cm and testes of 5 ml. Hormonal testing showed normal prepubertal values of gonadotropins (basal and after GnRH) and testosterone. Bone age was 11 years. Ultrasound evidenced an enlarged prostate and seminal vesicles. Breast development was seen in the girl at the age of 6.2 years (3 years after exposure). Pubertal staging was A2P3M3. Genital examination showed a clitoral size of 1 cm. LH increased up to 22.1 U/l after GnRH. Bone age was 9.5 years. Ultrasound evidenced an enlarged uterus.

Conclusion: Penile and clitoral enlargement as well bone age advancement can persist, while early spermarche and pubertal development can develop some years after testosterone exposure in children at a young age. Attentive clinical surveillance of these children is thus needed for several years.