Precocious Puberty Secondary to Topical Testosterone Transfer: A Case Report

Abstract

Testosterone replacement therapy is the standard of care for androgen deficiency syndrome, and patients and physicians can choose among depot injectable, subcutaneously implanted pellet, transdermal patch, topical gel, and buccal tablet dosage forms. Topical gels have become popular and, although unintentional secondary transfer to a spouse or child is a known hazard, physicians and patients may underestimate the risk. We report a case of precocious puberty in a 10-month-old male secondary to transfer of topical testosterone from his father, who was treated for primary hypogonadism. Once the father's therapy was changed from a topical to a buccal dosage form, the symptoms in his son receded. The potential for secondary exposure to testosterone-and its consequences-may be underappreciated by patients and by health care providers not involved in managing testosterone replacement therapy. The patient's lifestyle (e.g., contact with children, physical limitations, daily schedule) should be part of the discussion when selecting a method of testosterone replacement therapy.