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Journal of Pediatric Endocrinology and Metabolism

Editor-in-Chief: Kiess, Wieland

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Virilization in two pre-pubertal children exposed to topical androgen

Danielle Nelson1 / 2 / Danièle Pacaud2 / David Stephure2

1Department of Pediatrics, Section of Community Pediatrics, University of Calgary, Calgary, Canada

2Department of Pediatrics, Section of Pediatric Endocrinology, University of Calgary, Calgary, Canada

Corresponding author: Josephine Ho, Faculty of Medicine, Department of Pediatrics, Section of Pediatric Endocrinology, University of Calgary, Alberta Children’s Hospital, 2888 Shaganappi Trail NW, Calgary, T3B 6A8, Canada, Phone: +1-403-955-7819, Fax: +1-403-955-5001, E-mail:

Citation Information: Journal of Pediatric Endocrinology and Metabolism. Volume 26, Issue 9-10, Pages 981–985, ISSN (Online) 2191-0251, ISSN (Print) 0334-018X, DOI: 10.1515/jpem-2013-0127, May 2013

Publication History

Published Online:


Androgen replacement therapy for male hypogonadism may be prescribed utilizing intramuscular, oral or more recently, topical formulations. With topical formulations, there is a risk of person-to-person transmission if appropriate precautions are not taken. We describe two cases of virilization in pre-pubertal children following passive transfer of paternal topical testosterone. A 21 month old male was referred with a 6 week history of pubic hair, phallic growth, and linear growth spurt. Genital examination revealed Tanner stage 2 pubic hair and Tanner stage 3 phallic development, which was discordant with the pre-pubertal testicular size (2 mL bilaterally). A 3 year 8 month old girl was referred for a 2 month history of increasing pubic hair development. Examination revealed Tanner stage 2 pubic hair and Tanner stage 1 breast development. Both of these patients had fathers who had been diagnosed with hypogonadism and were being treated with topical androgen gel therapy, which they applied to their arms and chest before bed. In addition, both patients often slept with their parents resulting in skin-to-skin contact. Investigations were consistent with gonadotropin independent virilization with both patients demonstrating elevated testosterone levels. Testosterone levels returned to normal pre-pubertal levels with no further development of secondary sexual characteristics following discontinuation of exposure to topical testosterone. Precautions must be taken to prevent person-to-person transfer of topical steroids. With the increasing popularity of topical steroids for the treatment of low testosterone, it is imperative that these therapies be prescribed and utilized judiciously to prevent harm, specifically gonadotropin-independent virilization.

Keywords: testosterone; topical; virilization

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