Virilization in two pre-pubertal children exposed to topical androgen.
Level 4 - case-series / case-control
Case report / case series of two patients
PubMed 23729604 · doi:10.1515/jpem-2013-0127
What was done
Clinical evaluation and endocrine investigations of two pre-pubertal children (a 21-month-old male and a 3-year-8-month-old female) who developed signs of premature virilization after passive skin-to-skin exposure to paternal topical testosterone gel.
What was found
The 21-month-old boy presented after 6 weeks of pubic hair, phallic enlargement, and linear growth spurt with Tanner stage 2 pubic hair, Tanner stage 3 phallic development, 2 mL bilateral testicular volume, and elevated testosterone. The 3-year-8-month-old girl presented after 2 months of pubic hair development with Tanner stage 2 pubic hair, Tanner stage 1 breast development, and elevated testosterone. Both fathers used topical androgen gel on their arms and chest before bed and frequently co-slept with the children. Following discontinuation of exposure, serum testosterone normalized to pre-pubertal levels and secondary sexual development ceased.
Why it matters
Topical testosterone replacement therapy carries a direct risk of accidental pediatric transfer during routine close contact and co-sleeping, causing peripheral precocious puberty.
Limits
Descriptive report of only two cases with no control group or systematic screening. Exact transdermal exposure amounts were not quantified, and long-term outcomes such as bone age acceleration or final adult height were not reported in the abstract.
Cited by
- supports Topical testosterone creams can accidentally transfer to children through skin or residue contact, causing secondary virilization.