Efficacy and safety of percutaneous administration of dihydrotestosterone in children of different genetic backgrounds with micropenis

Xu, Dan; Lu, Liangsheng; Li, Xi; Cheng, Ruoqian; Zhou, Pei; Bi, Yunli; Ruan, Shuang-sui; Luo, Feihong

doi:10.1515/jpem-2016-0400

Cited by 20 publications

(23 citation statements)

References 17 publications

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“…For example, when the sex is clearly, with a micropenis, early administration of testosterone or dihydrotestosterone cream to increase penile length can be effective. Androgen receptors decrease during adolescence and early adulthood; therefore early use of testosterone allows a better response (15, 16). Sometimes, depending on urethral malformation or ventral curvature, this treatment would be difficult to implement before surgery without discomfort.…”

Section: Endocrinological Aspectsmentioning

confidence: 99%

Controversies on Timing of Sex Assignment and Surgery in Individuals With Disorders of Sex Development: A Perspective

et al. 2019

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Appropriate management of disorders of sex development (DSD) has been a matter of discussion since the first guidelines were published in the 1950s. In the last decade, with the advent of the 2006 consensus, the classical methods, especially regarding timing of surgery and sex of rearing, are being questioned. In our culture, parents of DSD newborns usually want their children to undergo genital surgery as soon as possible after sexual assignment, as surgery helps them to confirm the assigned sex. Developmental psychology theories back this hypothesis. They state that anatomic differences between sexes initiate the very important process of identification with the parent of the same sex. Sex-related endocrinological issues also demand early care. For example, using dihydrotestosterone cream to increase penile length or growth hormone treatment to improve final height require intervention at young ages to obtain better results. Although the timing of surgery remains controversial, recent evidence suggests that male reconstruction should be performed between 6 and 18 months of age. Feminizing surgery is still somewhat controversial. Most guidelines agree that severe virilization requires surgical intervention, while no consensus exists regarding mild cases. Our perspective is that precocious binary sex assignment and early surgery is a better management method. There is no strong evidence for delays and the consequences can be catastrophic in adulthood.

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Section: Endocrinological Aspectsmentioning

confidence: 99%

Controversies on Timing of Sex Assignment and Surgery in Individuals With Disorders of Sex Development: A Perspective

et al. 2019

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“…In undervirilized 46,XY newborns with StAR-D, CYP11A1-D, CYP17A1-D, or POR-D reared as male, sex steroid replacement (T or DHT) might be useful during minipuberty (74). In newborns with CYP11B1-D or CYP17A1-D, if blood pressure control is not achievable by glucocorticoids alone, then appropriate antihypertensives should also be administered.…”

Section: Other Medical Treatmentsmentioning

confidence: 99%

Congenital Adrenal Hyperplasias Presenting in the Newborn and Young Infant

et al. 2020

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Congenital adrenal hyperplasia includes autosomal recessive conditions that affect the adrenal cortex steroidogenic enzymes (cholesterol side-chain cleavage enzyme; 3β-hydroxysteroid dehydrogenase; 17α-hydroxylase/17,20 lyase; P450 oxidoreductase; 21-hydroxylase; and 11β-hydroxylase) and proteins (steroidogenic acute regulatory protein). These are located within the three major pathways of the steroidogenic apparatus involved in the production of mineralocorticoids, glucocorticoids, and androgens. Many countries have introduced newborn screening program (NSP) based on 17-OH-progesterone (17-OHP) immunoassays on dried blood spots, which enable faster diagnosis and treatment of the most severe forms of 21-hydroxylase deficiency (21-OHD). However, in several others, the use of this diagnostic tool has not yet been implemented and clinical diagnosis remains challenging, especially for males. Furthermore, less severe classic forms of 21-OHD and other rarer types of CAHs are not identified by NSP. The aim of this mini review is to highlight both the main clinical characteristics and therapeutic options of these conditions, which may be useful for a differential diagnosis in the neonatal period, while contributing to the biochemical evolution taking place in the steroidogenic field. Currently, chromatographic techniques coupled with tandem mass spectrometry are gaining attention due to an increase in the reliability of the test results of NPS for detecting 21-OHD. Furthermore, the possibility of identifying CAH patients that are not affected by 21-OHD but presenting elevated levels of 17-OHP by NSP and the opportunity to include the recently investigated 11-oxygenated androgens in the steroid profiles are promising tools for a more precise diagnosis and monitoring of some of these conditions.

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“…Therefore, DHT administration results in an increase in serum DHT and a decrease in testosterone and estradiol, following DHT inhibition at the hypothalamic level of the hypothalamic-pituitary-testicular axis (Cailleux-Bounacer et al, 2009;de Lignieres, 1993;Swerdloff et al, 2017). DHT is usually applied topically to the target organ, for example, the external genitalia in boys with micropenis (Becker et al, 2016), and is particularly useful in patients with defects of 5α-reductase (Aydogdu & Swerdloff, 2016;Xu et al, 2017).…”

Section: Formulations Used For Androgen Therapymentioning

confidence: 99%

“…In patients with DSD (Wisniewski et al, 2019), and particularly in those with 5α-reductase deficiency (Bertelloni et al, 2007;Odame et al, 1992;Xu et al, 2017), DHT gels may prove more efficacious. The 2.5% DHT gel is applied around the root of the penis or onto the penile shaft at a dose of 0.1-0.3 mg/kg/day, in two doses 12 hr apart, not exceeding 5 mg/day for a maximum of 3-6 months (Kaya et al, 2008;Xu et al, 2017).…”

Section: Treatment Protocols In Children and Adolescentsmentioning

confidence: 99%

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Androgen Treatment in Adolescent Males With Hypogonadism

Rey

Grinspon

2020

Am J Mens Health

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During adolescence, androgens are responsible for the development of secondary sexual characteristics, pubertal growth, and the anabolic effects on bone and muscle mass. Testosterone is the most abundant testicular androgen, but some effects are mediated by its conversion to the more potent androgen dihydrotestosterone (DHT) or to estradiol. Androgen deficiency, requiring replacement therapy, may occur due to a primary testicular failure or secondary to a hypothalamic–pituitary disorder. A very frequent condition characterized by a late activation of the gonadal axis that may also need androgen treatment is constitutional delay of puberty. Of the several testosterone or DHT formulations commercially available, very few are employed, and none is marketed for its use in adolescents. The most frequently used androgen therapy is based on the intramuscular administration of testosterone enanthate or cypionate every 3 to 4 weeks, with initially low doses. These are progressively increased during several months or years, in order to mimic the physiology of puberty, until adult doses are attained. Scarce experience exists with oral or transdermal formulations. Preparations containing DHT, which are not widely available, are preferred in specific conditions. Oxandrolone, a non-aromatizable drug with higher anabolic than androgenic effects, has been used in adolescents with preserved testosterone production, like Klinefelter syndrome, with positive effects on cardiometabolic health and visual, motor, and psychosocial functions. The usual protocols applied for androgen therapy in boys and adolescents are discussed.

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Efficacy and safety of percutaneous administration of dihydrotestosterone in children of different genetic backgrounds with micropenis

Abstract: Short term and local application of DHT at low doses in patients with micropenis could accelerate penile growth effectively without evident side effects; however, precautions still need be taken due to the paucity of long term study and the lack of ideal DHT dosage.

Cited by 20 publications

References 17 publications

Controversies on Timing of Sex Assignment and Surgery in Individuals With Disorders of Sex Development: A Perspective

Controversies on Timing of Sex Assignment and Surgery in Individuals With Disorders of Sex Development: A Perspective

Congenital Adrenal Hyperplasias Presenting in the Newborn and Young Infant

Androgen Treatment in Adolescent Males With Hypogonadism

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