Background: Clinical findings in children with premature adrenarche (PA) correlate only partly with circulating levels of adrenal androgens. It is not known whether the prepubertal low circulating concentrations of testosterone (T) and dihydrotestosterone, together with those of adrenal androgens, are capable of activating the androgen receptor. Methods: This cross-sectional study was performed at a university hospital. Circulating androgen bioactivity was measured in 67 prepubertal children with clinical signs of PA and 94 control children using a novel androgen bioassay. results: Circulating androgen bioactivity was low in the PA and control children. In the subgroup of children (n = 28) with serum T concentration over the assay sensitivity (0.35 nmol/l) and a signal in the androgen bioassay, we found a positive correlation between androgen bioactivity and serum T (r = 0.50; P < 0.01) and the free androgen index (r = 0.61; P < 0.01) and a negative correlation with serum sex hormone-binding globulin concentration (r = −0.41; P < 0.05). conclusion: Peripheral metabolism of adrenal androgen precursors may be required for any androgenic effects in PA. However, the limitations in the sensitivity of the bioassay developed herein may hide some differences between the PA and control children. t he reticular zone (zona reticularis (ZR)) of the adrenal cortex starts to develop from small focal islets in early childhood (1). Later on, continuous ZR begins to produce weak androgen precursors, mostly dehydroepiandrosterone (DHEA) and its sulfate (DHEAS), and this phenomenon is referred to as adrenarche. During adrenarche, increasing androgenic activity leads to greasiness of the skin and hair, comedones/acne, adult-type body odor, and finally to the development of axillary and pubic hair. Though not uniformly used, adrenarche may be defined as premature (premature adrenarche (PA)) if these clinical signs are evident together with elevated serum levels of adrenal androgens before the age of 8 y in girls or 9 y in boys (2).In both normal-timed and PA, the clinical signs of androgen activity do not correlate well with the circulating levels of DHEA, DHEAS, or androstenedione (A4) (2,3). In peripheral tissues such as the skin, DHEA and DHEAS interconvert via hydroxysteroid sulfotransferase and steroid sulfatase (4), but DHEAS desulfonation in the liver is controversial (5). DHEAS is biologically inactive, and DHEA is only a weak androgen receptor (AR) agonist (6), but they are present in the serum of PA subjects in excess concentrations.The effects of androgens are mediated via the AR, resulting in the activation of target gene transcription (7). Whereas testosterone (T) and dihydrotestosterone (DHT) are potent AR agonists, the affinity of adrenal androgen precursors to AR is weak (6,8), and prereceptor level conversion to more potent androgens is needed for the full activation of AR. In peripheral tissues, DHEA is converted to the most potent androgen, DHT, through A4 and T. The main enzymes responsible for this intracrine co...