Part of “CHAPTER 119 – CLINICAL USE AND ABUSE OF ANDROGENS AND ANTIANDROGENS“

In sexually immature, eunuchoidal patients, androgen therapy stimulates the development of normal male secondary sexual characteristics and somatic growth (see Chap. 115). These effects of androgens are less dramatic in older eunuchoidal
patients and adult hypogonadal men. androgen replacement therapy for patients with delayed puberty who have not achieved full adult height is complex and should be undertaken with great care (see Chap. 92).75 Overzealous androgen therapy, although it results in virilization and increased long bone growth, can lead to premature closure of the epiphyses of long bones, resulting in a compromise of the final, achievable adult height. Furthermore, it is difficult clinically to differentiate patients with constitutional delay of puberty, who require only temporary androgen replacement to induce pubertal changes, from those with permanent idiopathic hypogonadotropic hypogonadism, who require lifelong androgen treatment to stimulate puberty and to maintain sexual functioning.

Boys with constitutional delay of puberty present with short stature and delayed pubertal development relative to their peers, and demonstrate delayed height and bone age relative to their chronologic age. Although these boys eventually undergo puberty spontaneously without treatment, studies suggest that delay or omission of therapy may permanently affect acquisition of peak bone mass and have profound, long-lasting psychological effects, considerations that argue for early androgen treatment of constitutional delay of puberty.76