Exogenous Hyperandrogenism in Children due to Unintentional Exposure to Topical Androgens

Background. The usage of topical androgens has become increasingly popular in recent years due to their availability and ease of use at home. However, a lack of awareness about the precautions to be taken when using topical gels can lead to unintended secondary exposure of third parties, including the risk of developing exogenous hyperandrogenism in children. Case Reports describe 5 patients (3 boys and 2 girls) who were examined for signs of precocious sexual development (PSD): pubic hair, enlargement of the penis or clitoris, accelerated growth, and advanced bone age. All patients showed isolated increases in blood testosterone levels, low values of gonadotropic hormones, and other indicators of the steroid profile. During a repeated proactive survey of parents, it was revealed that the patients’ fathers were using transdermal forms of testosterone and were not following the precautions to avoid exposing their children to these products. After eliminating the exogenous exposure to androgen, all patients’ blood testosterone levels returned to prepubertal levels. During follow-up, two patients developed gonadotropin-dependent PSD, necessitating the initiation of triptorelin therapy. Conclusion. These case reports highlight the need for increased awareness among physicians and patients of the potential risk of developing exogenous hyperandrogenism in children with unintentional exposure to transdermal androgens as a result of parental or guardian use of these medications and, consequently, the importance of taking precautions. Thorough collection of family and social history in children with signs of precocious puberty is essential in the timely diagnosis of an exogenous cause of hyperandrogenism and in the selection of examination and treatment.

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