What are the methods to continue progression of stalled Tanner (sexual maturity) stage in males?

From the Guidelines

Males with stalled Tanner stage progression should be considered for hormone replacement therapy with testosterone 1, typically initiated at a dose of 50-100mg intramuscularly every 4 weeks, with gradual titration upwards as needed.

Treatment Options

• Testosterone replacement therapy: may be appropriate in deficient patients following accepted endocrine guidelines, with careful consideration of potential benefits and risks 1.
• Human chorionic gonadotropin (hCG) therapy: may be considered to stimulate testicular growth and development, although specific dosing and administration guidelines are not provided in the available evidence.
• Aromatase inhibitors: such as anastrozole, may be used to block the conversion of testosterone to estrogen, potentially enhancing the effects of testosterone therapy, but this is not directly supported by the provided evidence.

Monitoring and Evaluation

It is essential to monitor Tanner staging annually, beginning at 10 years of age, and consider endocrine evaluation if onset of puberty is delayed beyond age 12 to 13 years 1.

Important Considerations

• Specialist referral: is advisable in cases of suspected testosterone deficiency or delayed puberty, to avoid delayed referral and potential impairment of growth, metabolic health, bone mineral accretion, and quality of life 1.
• Individualized treatment: decisions should be made based on each patient's specific needs and medical history, taking into account the potential benefits and risks of treatment 1.

From the FDA Drug Label

CLINICAL PHARMACOLOGY Endogenous androgens are responsible for normal growth and development of the male sex organs and for maintenance of secondary sex characteristics Androgens have been reported to increase protein anabolism and decrease protein catabolism. Androgens are responsible for the growth spurt of adolescence and for eventual termination of linear growth, brought about by fusion of the epiphyseal growth centers. In children, exogenous androgens accelerate linear growth rates, but may cause disproportionate advancement in bone maturation The action of HCG is virtually identical to that of pituitary LH, although HCG appears to have a small degree of FSH activity as well. It stimulates production of gonadal steroid hormones by stimulating the interstitial cells (Leydig cells) of the testis to produce androgens

The methods to continue progression of stalled Tanner (sexual maturity) stage in males may include:

• Exogenous androgens such as testosterone (IM) to accelerate linear growth rates and stimulate production of secondary sex characteristics 2
• Human chorionic gonadotropin (HCG) to stimulate production of gonadal steroid hormones and promote testicular descent and development of secondary sex characteristics 3 Note that these methods may have varying effects and potential risks, and should be used under medical supervision.

From the Research

Methods to Continue Progression of Stalled Tanner Stage in Males

The progression of Tanner stage in males can be influenced by various factors, including hormone levels and treatment therapies. The following methods have been studied:

• Androgen Treatment: Androgen therapy, such as testosterone enanthate or cypionate, can be used to induce pubertal progression in boys with delayed or slow puberty 4, 5. The treatment typically involves intramuscular administration of testosterone every 3 to 4 weeks, with initially low doses that are progressively increased over several months or years.
• Testosterone Formulations: Different testosterone formulations, such as testosterone undecanoate, have been compared in terms of their effectiveness in inducing pubertal progression 5. The study found that both testosterone enanthate and testosterone undecanoate had similar effects on pubertal progression.
• Dihydrotestosterone (DHT) Treatment: DHT, a non-aromatizable androgen, has been used to treat short stature and delayed puberty in adolescent males 6. The study found that DHT treatment increased height velocity, but decreased growth hormone and insulin-like growth factor-I levels.
• Growth Hormone and Insulin-like Growth Factor-I: The relationship between androgen treatment and growth hormone and insulin-like growth factor-I levels has been studied 6. The study found that testosterone treatment increased growth hormone and insulin-like growth factor-I levels, while DHT treatment decreased these levels.

Considerations for Treatment

When considering treatment for stalled Tanner stage in males, it is essential to take into account the potential risks and benefits of different therapies. For example:

• Risk of Male Infertility: Testosterone replacement therapy can suppress the hypothalamic-pituitary-gonadal axis, leading to secondary spermatogenic failure and infertility 7. Clinicians should be aware of this risk and consider alternative treatments, such as clomiphene or human chorionic gonadotropin (hCG), for patients who wish to preserve fertility.
• Monitoring of Hormone Levels: Regular monitoring of hormone levels, including testosterone, growth hormone, and insulin-like growth factor-I, is crucial to ensure effective treatment and minimize potential side effects 4, 6.