pediatrics
Male Hypogonadism in Children
Treatment of Male Hypogonadism in Children
Surgery as needed Hormone replacement Cryptorchidism is corrected early to obviate concerns about cancer developing in later adulthood and to prevent testicular torsion. For secondary hypogonadism, any underlying pituitary or hypothalamic disorder is treated. Overall, the goal is to provide androgen replacement starting with a low dose and progressively increasing the dose over 18 to 24 months. Treatment is started at an appropriate age for normal onset of puberty, often around 12 years of age. Adolescent boys with androgen deficiency should be given long-acting injectabletestosteroneenanthate or cypionate 50 mg every 2 to 4 weeks; the dose is increased up to 200 mg over 18 to 24 months. A transdermal patch or gel may be used instead as boys get older. Treatment choice can be determined based on patient preference, but injections are preferred as doses are being increased. Treatment of Kallmann syndrome with hCG can correct cryptorchidism and establish fertility. Puberty is typically induced usingtestosteroneinjectable or gel. GnRH therapy has been previously shown to help endogenous sex hormone secretion, progressive virilization, and even fertility. In isolated LH deficiency,testosterone, via conversion toestrogenby aromatase, induces normal epiphyseal closure. Patients with Prader-Willi syndrome may be treated with human growth hormone. Several studies have shown this treatment is beneficial. Constitutional delay of puberty can be treated with a 4- to 6-month course oftestosterone. After the course is complete, treatment is stopped andtestosteronelevels are measured several weeks or months later to differentiate temporary from permanent deficiency. Iftestosteronelevels are not higher than the initial value and/or pubertal development does not proceed after completion of this treatment, a second course of low-dose treatment can be given. If endogenous puberty has not begun after two courses of treatment, the likelihood of permanent deficiency increases, and patients need to be reevaluated for other causes of hypogonadism. 