Testosterone Use in Adolescent Males

Current Practice and Unmet Needs

Maria Vogiatzi; James P. Tursi; Jonathan S. Jaffe; Sue Hobson; Alan D. Rogol


J Endo Soc. 2021;5(1) 

In This Article


Tens of thousands of adolescent males require TRT annually. In this review we have identified 2 broad areas of unmet needs for these patients. The first involves the absence of data on the impact of TRT, as it is currently implemented, on various health parameters, including quality of life and adult health outcomes. Although androgens have a positive influence on the multiple physiologic processes that mature during puberty, from bone accrual and changes in body composition to cardiometabolic and mental health, the specific TRT regimen that will optimize these parameters and ameliorate the long-term comorbidities associated with hypogonadism for an individual is uncertain and requires assessment in controlled, prospective studies. Lack of TRT guidelines for adolescent males reflects the lack of appropriate data to guide recommendations. The specific needs of adolescent males with chronic illnesses and functional hypogonadism should also be addressed.

The second area of unmet needs involves the scarcity of T formulations that are suitable for use in adolescent males. Many new T formulations have entered the market recently, but all are designed for adults. As a result, their dosing is not very flexible and does not permit easy titration, which is essential for therapy in adolescents. According to World Health Organization guidelines, the ideal formulation should be safe, effective, affordable, convenient, and flexible in dosing, and it should possess a pharmacokinetic profile similar to that observed in pubertal physiology.[130] With TE being the main T option for adolescents, TRT practice in this patient population remains far from this ideal recommendation.