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14 April 2000
Doctors Find Muscle-Builder Cream Caused Sex Development In Toddler
by George Atkinson

When a young North Carolina father tried to boost his muscle development artificially, he had no idea he might put his 2-year-old son's health at risk, but that's just what he did.

The man slathered a cream containing the male hormone testosterone on his arms and back for nearly a year, according to University of North Carolina at Chapel Hill School of Medicine physicians who are warning the public to be careful. As father and son roughhoused on a mat where the father exercised, the child absorbed testosterone from the cream through his skin, the doctors found.

Mild acne soon appeared on his face. Pubic hair sprouted. His penis grew. His worried parents sought medical help. "Testing showed that the child had about twice as much testosterone in his bloodstream as the maximum level considered normal for his age," said Dr. Joseph D'Ercole, professor and chief of pediatric endocrinology at UNC-CH.

"Other tests allowed us to rule out other causes of these signs of premature virilization."

A report describing the unusual case appears in a recent issue of the journal Pediatrics. Besides D'Ercole, authors are Drs. Y. Miles Yu, Natavut Punyasavatsu and Deborah Elder, all fellows in pediatric endocrinology at UNC-CH.

Four months after being urged to stop the child's exposure to the testosterone cream, his parents took him back to the doctors for follow-up evaluation, D'Ercole said. Although his penis remained the same, his acne and pubic hair diminished dramatically, and his testosterone level returned to normal for his age.

"The main issue here is that testosterone and other anabolic steroids - male androgenic steroids - are out in the community now, and people are using them to build their muscles and strength," he said. "If children get hold of them they could face some significant problems."

First, children are not ready to develop sexually during the first few years of life, D'Ercole said. Those with premature sexual development can face a variety of serious social problems as well.

"Number two, contact with these hormones could advance their bone maturity very rapidly, which would lead to a short-term increase in their growth rate but eventually they could wind up very short," he said.

A 3-year-old, for example, might grow rapidly for a year or so and be the biggest child in the class but then stop growing and spend his life as a very short adult, the physician said. When growth plates - the parts of bones that lengthen - evolve from cartilage to bone, no more skeletal growth occurs.

"We want to make it clear that we believe the father was not treating his son with testosterone," D'Ercole said. "This was an accident.

"Parents should be aware that androgens in both cream and pill forms are now widespread and that they present a potentially serious health threat to young children. If these substances are left lying around where kids might think they are candy or something else harmless, they could do permanent damage."

Most often, premature puberty in boys results from gonadotropin - a hormone produced by the pituitary gland - prematurely stimulating the testes to secrete androgens, which in turn trigger sexual development.

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