Prenatal Virilization Associated with Paternal Testosterone Gel Therapy

Abstract

Transdermal testosterone gels are used in the treatment of hypoandrogenism of males. Virilization due to exposure to testosterone gels has been reported in children resulting in a US Food and Drug Administration (FDA) warning about secondary exposure to these products. At present, we are unaware of prenatal virilization associated with unintentional testosterone gel exposure. We report prenatal virilization in a female infant due to secondary maternal exposure to the father's testosterone gel. We also describe postnatal virilization of the child's twin sister.

Oral Enclomiphene Citrate Stimulates the Endogenous Production of Testosterone and Sperm Counts in Men with Low Testosterone: Comparison with Testosterone Gel

“…Testosterone gels can overcome some of the said problems if men apply the gel correctly and are compliant with daily application. There are concerns with cross contamination of partners or children . The new use of enclomiphene citrate has been described to a considerable extent .…”

Topical dihydrotestosterone to treat micropenis secondary to partial androgen insensitivity syndrome (PAIS) before, during, and after puberty – a case series

“…At higher doses, subtle and reversible (on cessation) adverse effects have been reported, including local itch/irritation for the first 2 weeks of therapy, suppression of the hypothalmamicpituitary-gonadal axis, decreases in HDL cholesterol, and increases in alkaline phosphatase (10). Additionally, as with other topical androgen preparations, patient education must include warnings about the risk topical DHT poses to close contacts, in particular children and women, following direct contact with contaminated skin (20).…”

Testosterone exposure in childhood: discerning pathology from physiology

“…Child sat on step-fathers bare legs Father: non-FDA 'sports skin tonic' containing 4-androstenediol (50 mg/ml) for body-building, discontinued 2 months prior to presentation Father: 4-androstenediol (50 mg/ml) spray for body-building Mother and father: compounded T cream for body building and libido Father: compounded T cream for energy 2005 [77] 2.5-year-old female with Cl, PH, " GV, acne Father: 10% liposomal T gel to legs as 'anti-aging' hormone therapy 2007 [79] 16-month male with PH, penile enlargement with frequent erections, 2 ml testes Father: T gel to shoulders, chest, and back for # libido. Child co-slept with parents 2010 [108] 30 weeks premature infant females with posterior urethral opening at birth life onward, many of which are still being actively discovered and researched. The common embryologic precursors of internal and external sexual development as well as the presence of androgen receptors and 5-a-reductase translates into the potential for virilization of the 46,XX fetus.…”