Testosterone Use in Adolescent Males: Current Practice and Unmet Needs.

Area of Science:

• Pediatric Endocrinology
• Adolescent Medicine
• Pharmacology

Background:

• Testosterone replacement therapy (TRT) is commonly used for adolescent males with constitutional delay of growth and puberty (CDGP) or hypogonadism.
• New testosterone formulations are available for adults, prompting a review of options for adolescents.

Purpose of the Study:

• To review current evidence and options for TRT in adolescent males.
• To identify unmet needs in TRT for this population.

Main Methods:

• PubMed search for English-language articles on testosterone therapy, androgens, adolescence, and puberty in humans.

Main Results:

• Short-term use of testosterone enanthate (TE) or oral testosterone undecanoate is safe and effective for inducing puberty and growth in males with CDGP.
• Emerging evidence supports transdermal testosterone for inducing and maintaining puberty.
• Long-term safety and efficacy data for TRT in adolescents are not established.
• Current TRT regimens lack evidence-based guidelines and optimal monitoring strategies.
• Only TE and testosterone pellets are FDA-approved for adolescent males in the US.
• New adult formulations are difficult to titrate for adolescent use.

Conclusions:

• TRT in adolescent males is limited by a lack of long-term safety and efficacy data and few approved options.
• Further research is needed to determine optimal routes, doses, durations, and timing for TRT in adolescents.