pediatrics
Male Hypogonadism in Children
Symptoms and Signs of Male Hypogonadism in Children
 and sperm production are affected. (For presentation in adulthood, see Symptoms and Signs .) If androgen deficiency or defects in androgen activity occur during the first trimester (<12 weeks gestation), differentiation of internal wolffian ducts and external genitals is inadequate. Presentation may range from ambiguous external genitals to normal-appearing female external genitals. Androgen deficiency during the second and third trimesters may cause a microphallus and partially or completely undescended testes. Androgen deficiency that develops early in childhood has few consequences, but if it occurs when puberty is expected, secondary sexual development is impaired. Such patients have poor muscle development, a high-pitched voice, inadequate phallic and testicular growth, a small scrotum, sparse pubic and axillary hair, and absent body hair. They may develop gynecomastia and grow to eunuchoidal body proportions (arm span exceeds height by 5 cm; pubic to floor length exceeds crown to pubic length by>5 cm) because fusion of the epiphyses is delayed and long bone growth continues. 