Testosterone Therapy and Its Monitoring in Adolescent Boys with Hypogonadism: Results of an International Survey from the I-DSD Registry

Abstract

It is unclear whether testosterone replacement therapy (TRT) in adolescent boys, affected by a range of endocrine diseases that may be associated with hypogonadism, is particularly common. The aim of this study was to assess the contemporary practice of TRT in boys included in the I-DSD Registry. All participating centres in the I-DSD Registry that had boys between 10 and 18 years of age and with a condition that could be associated with hypogonadism were invited to provide further information in 2019. Information on 162 boys was collected from 15 centres that had a median (range) number of 6 boys per centre (1.35). Of these, 30 (19%) from 9 centres were receiving TRT and the median (range) age at the start was 12.6 years (10.8–16.2), with 6 boys (20%) starting at <12 years. Median (range) age of boys not on TRT was 11.7 years (10.7–17.7), and 69 out of 132 (52%) were <12 years. TRT had been initiated in 20 of 71 (28%) boys with a disorder of gonadal development, 3 of 14 (21%) with a disorder of androgen synthesis, and all 7 (100%) boys with hypogonadotropic hypogonadism. The remainder who did not have TRT included 15 boys with partial androgen insensitivity, 52 with non-specific XY DSD, and 3 with persistent Müllerian duct syndrome. Before starting TRT, liver function and blood count were checked in 19 (68%) and 18 boys (64%), respectively, a bone age assessment was performed in 23 (82%) and bone mineral density assessment in 12 boys (43%). This snapshot of contemporary practice reveals that TRT in boys included in the I-DSD Registry is not very common, whilst the variation in starting and monitoring therapy is quite marked. Standardisation of practice may lead to more effective assessment of treatment outcomes.

The Roles of Androgens in Humans: Biology, Metabolic Regulation and Health

“…The main focus of the initial TRT was largely to restore hormonal functionality of adolescents (and adults) with endocrine or reproductive disorders [ 471 ], but it was extended (often out of the clinical milieu) to “return” the libido and youth memories of sexual functionality to old men [ 472 ]. The prevention or correction of sarcopenia is an important application that is also being actively developed [ 301 ].…”

Recent advancement in the treatment of boys and adolescents with hypogonadism

“… 105 Therefore, androgen replacement is needed to induce the development of secondary sex characteristics, growth spurt and bone mass accrual typical of puberty. 106 The classic protocol of IM testosterone administration is used, starting at 50 mg every 4 weeks when bone age is at least 12 years-old, with progressive increases to reach 250 mg every 4 weeks approximately 3 years later. The same considerations are applicable to patients with primary hypogonadism not related to DSD but severely affecting testicular androgen secretion, such as testicular regression syndrome.…”