Replacement of Male Mini-Puberty

Dimitrios T. Papadimitriou; Dionysios Chrysis; Georgia Nyktari; George Zoupanos; Eleni Liakou; Anastasios Papadimitriou; George Mastorakos


J Endo Soc. 2019;3(7):1275-1282. 

In This Article


During therapy, all infants increased their height velocity. None of the infants had local or systemic adverse events or reactions. At the end of therapy, 24 hours after the last injection, median LH increased from undetectable before treatment to high normal (4.45, 4 to 7.22 IU/L), median FSH increased from undetectable before treatment and reached supranormal levels (83, 60.3 to 132 IU/L), inhibin-b increased from subnormal before treatment (27.8, 9 to 42 pg/mL) and reached normal levels (365, 252 to 650 pg/mL), and AMH increased from subnormal (1.5, 0.9 to 2.2 ng/mL; 11, 6.65 to 15.4 pmol/L) and reached 150 (112.4 to 249.3) ng/mL (1071.4, 802.8 to 1780.7 pmol/L). Median testosterone increased from just detectable (0.02, 0 to 0.14 ng/mL; 0.07, 0 to 0.48 nmol/L) to completely normal levels (3.3, 1.8 to 4.3 ng/mL; 11.4, 6.2 to 14.90 nmol/L).[25] Stretched penile length increased from a median of 2 cm (1.5 to 2.5 cm) to 3.8 cm (3.2 to 4.5 cm). Although penile length normalized in all patients, we decided to "optimize" penile length (meaning to reach the 50th percentile for age) in three patients with additional treatment with IM injections of testosterone enanthate at the dose of 50 mg/mo for 3 months around the age of 2 years (i.e., at the end of the first physiologic phase of penile growth). During therapy all testes descended to the scrotal position by the end of the first month in three patients, the second month in four patients, and the third month in three patients. Testes measured 1.5 mL (1.0 to 2.5 mL) with a Pradder orchidometer and had a completely normal ultrasonography by an experienced pediatric radiologist. In two patients, one with septo-optic dysplasia and one with aplastic pituitary, one of the two testes regressed in the low inguinal area; both patients were successfully treated surgically by an experienced pediatric urologist before 1 year of age. After 3 to 10 years of annual follow-up (two patients reached 10 years post treatment, one patient reached 9 years, two patients reached 6 years, one patient reached 5 years, two patients reached 4 years, and two patients reached 3 years), in all cases testes are still in the scrotal position; the testes slightly regressed in size at 1.0 mL (0.5 to 2.0 mL, reports from the last annual visit) but are still measurable with a Pradder orchidometer. No patient has reached the presumed age of entering puberty according to their growth pattern, and none has presented signs of spontaneous pubertal maturation.