Can testosterone therapy increase height in children?

Testosterone Therapy and Height in Children

Testosterone therapy does not increase height in children and can actually lead to premature epiphyseal closure, potentially reducing final adult height. 1

Mechanism of Action and Effects on Growth

Testosterone and other androgens have significant effects on bone maturation and growth:

• In children, exogenous androgens initially accelerate linear growth rates, creating a temporary growth spurt
• However, testosterone simultaneously causes disproportionate advancement in bone maturation 1
• This premature fusion of epiphyseal growth centers terminates the growth process earlier than would naturally occur
• The net result is often compromised final adult height, particularly in younger children 1

Evidence from Clinical Studies

The FDA drug label for testosterone clearly warns about its effects on growth:

• "In children, androgen treatment may accelerate bone maturation without producing compensatory gain in linear growth" 1
• "This adverse effect may result in compromised adult stature" 1
• "The younger the child the greater the risk of compromising final mature height" 1

Studies examining testosterone use in tall stature further confirm this effect:

• High-dose testosterone treatment has been historically used to reduce final height in excessively tall boys 2, 3
• In one study, testosterone reduced predicted adult height by 7.26 cm after just 6 months of treatment 2
• Another study showed adult height reduction of 5.4 cm with the best height-reducing results (8 cm) achieved in the youngest treatment group 3

Growth Hormone vs. Testosterone for Height Issues

For children with growth concerns, growth hormone (GH) therapy—not testosterone—is the appropriate treatment for certain conditions:

• GH therapy is indicated for children with persistent growth failure (height below 3rd percentile and height velocity below 25th percentile) 4
• In children with idiopathic short stature, GH therapy can increase adult height by approximately 4-6 cm 5
• GH stimulates growth in prepubertal children with various conditions, with studies showing increased height velocity of 3.88 cm/year compared to controls 4

Clinical Implications and Recommendations

When evaluating treatment options for height concerns in children:

• Testosterone should not be used to increase height in children as it accelerates bone maturation and can compromise final adult height 1
• Testosterone treatment requires careful monitoring of bone age every 6 months if used for other indications 1
• For children with documented growth failure, growth hormone therapy (not testosterone) should be considered after addressing other potentially treatable causes 4
• The FDA explicitly warns that testosterone "has not been shown to be safe and effective for the enhancement of athletic performance" and should not be used for such purposes 1

Pitfalls and Caveats

• Parents may mistakenly believe testosterone will increase their child's height due to the initial growth acceleration
• This temporary growth spurt is misleading as it's followed by premature growth plate closure
• The younger the child at time of testosterone exposure, the greater the risk of compromised final height 1
• Any consideration of hormone therapy for growth should involve careful assessment of bone age and growth potential
• Testosterone has numerous other potential adverse effects including hypercalcemia, edema, and in adolescents, potential effects on the prostate 1

In summary, testosterone therapy is contraindicated for increasing height in children as it accelerates epiphyseal closure and can permanently reduce final adult height.