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Short-term adverse effects of testosterone used for priming in prepubertal boys before growth hormone stimulation
Andrea Albrecht1, Theresa Penger1, Michaela Marx1
1Paediatric Endocrinology, Department of Paediatrics and Adolescent Medicine, University Hospital of Erlangen, Erlangen, Germany.
Insights
Priming prepubertal boys with testosterone before growth hormone tests is generally safe, with a low 2.7% side effect rate including priapism and testicular pain. Doses and testosterone levels did not correlate with adverse events.
Area of Science:
- Pediatric Endocrinology
- Pharmacology
- Clinical Trial Analysis
Background:
- Prepubertal children often receive sex steroid priming before growth hormone (GH) provocative testing.
- Controversy exists regarding optimal priming protocols (age, drug, dose, timing).
- Safety data on testosterone priming for GH testing is limited.
Observation:
- 188 short-statured prepubertal boys received testosterone enanthate priming before GH testing.
- Doses administered were 50 mg (n=136), 125 mg (n=51), and 250 mg (n=1).
- Serum testosterone levels were measured in 99 boys on the day of the GH test.
Findings:
- Overall adverse event rate was 2.7% (5 out of 188 boys).
- Reported side effects included priapism and testicular pain.
- No correlation found between testosterone dose, serum testosterone levels, and adverse outcomes.
Implications:
- Parents and patients should be informed of potential side effects like priapism and testicular pain.
- Testosterone priming appears to have a low overall risk profile for GH testing.
- Current evidence suggests dose and serum levels do not predict adverse events.
Background:
Despite the fact that priming with sex steroids in prepubertal children before growth hormone (GH) provocative tests is recommended, there is an ongoing controversial discussion about the appropriate age of the children, the drug used for priming, the dose and the period between priming and the GH test. Interestingly, there is no discussion on the safety of this procedure. To date, only little data have been available on the possible side effects of priming with testosterone.
Methods:
We analyzed the outcome in 188 short-statured prepubertal boys who had been primed with testosterone enanthate (n=136: 50 mg; n=51: 125 mg, and accidentally one boy with 250 mg) 7 days prior to the GH test. Serum testosterone levels were measured on the day of the GH test in 99 boys.
Results:
Overall, only five boys developed adverse side effects. Two boys (dose 125 mg) showed severe low-flow priapism and had to undergo decompression of the corpora cavernosa. One boy suffered from self-limiting priapism and testicular pain (dose 50 mg). Two patients reported testicular pain (each dose 50 mg). The single patient with 250 mg testosterone did not show any adverse effects. The total side effect rate was 2.7%. The serum testosterone levels of the boys with side effects were not different from the testosterone levels of the boys without any side effects.
Conclusions:
Parents and patients should be informed about the possible side effects of priming with testosterone such as priapism and testicular pain. However, the overall side effect rate is low. We found no correlation between the outcome and the testosterone dose used and/or the level of serum testosterone.
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