Though normal antlers are branched and bilaterally symmetrical, male white-tailed deer (Odocoileus virginianus) sometimes develop malformed antlers because of various reasons. As management for antler quality has grown more popular in recent years, there has been concern that spike-on-one-side (SOOS) antler configuration has a genetic cause. We hypothesized that the majority of SOOS antlers are the artifact of injuries to the antlerogenic periosteum region. We collected 71 SOOS specimens over 2 hunting seasons (2010-2011 and 2011-2012) in Alabama, USA, and identified probable cause for malformed antler development. We confidently assigned cause to 62% of specimens, and frequency of skull and/or pedicle trauma increased with age classes (yearling, 2.5-yr-old, and 3.5-yr-old M). It was difficult to determine the reason that yearling males developed SOOS antler traits (30%), but ease of prescription increased with male age (76% for 3.5-yr-old M). Based on the physiology of skull and/or pedicle versus skeletal injuries, we recommended different culling strategies for yearling versus adult male white-tailed deer according to management objectives. Ó 2013 The Wildlife Society.