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What Could Be The Reason For Experiencing Massive Growth Spurt And Tanner Stage?

Posted on Fri, 20 Dec 2013

Question: Hi there. This question is for an endocrinologist or someone with knowledge in this. I am 31 years old now. when i was 14.5 i had following tests: (testes exam) by a pediatric endocrinologist, wrist xray, blood test and thyroid function test. All results were ok. I was told i was in early stages of puberty. For the record, around 8 months after all this, i experienced massive growth spurt and sexual development (tanner stage 3/4) . Question 1: Is it possible for the doctor, at that time, to make deliberate false statments regarding my tests? The reason i ask is that i dont have photographic evidence of my testes when i was 14.5 years old.....all the above info is from doctors notes. Question 2: Even if false statment, does the acheivment of tanner stage 3/4 mean there mustve been prior hormonal activity by several years? hope you can clarify for me. Thanks and best regards.

Answered by Dr. Minal Mohit (18 hours later)

Brief Answer: Seems like normal pubertal development to me. Detailed Answer: Dear XXXX, What best I could get from your history is that you started your pubertal development by 14.5 (14 years and 6 months) years of age. The pubertal spurt progressed over next 8 months and was noticeable significantly in next 8 months i.e. by the time you were 15 years and 2 months. For any boy normal pubertal development starts somewhere around 9 years and is full blown by 14 or say 15 years. For any doctor to examine you and review your reports and comment that you are in early puberty i.e. Tanner stage II is easy and then progression to tanners stage III/ IV in next 8 months is acceptable and is as per anticipation. Answer 1. I don't think the doctor gave any false statement. Answer 2. I think I have already answered your second question, progression of pubertal development from stage II to stage IV takes almost 2 years. So definitely hormonal activity must be present at 14.5 years if full blown puberty has been attained by 15years 2months. Regards! thanks!

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Minal Mohit (1 hour later)

Hello, Thank you for the answer. I want to ask further about the stage of 'early pubertal' ie 4ml testis volume. Does this again mean hormonal activity was present several years prior to this landmark? Best Regards. RF

Answered by Dr. Minal Mohit (35 minutes later)

Brief Answer: Increase in penile length is the first sign. Detailed Answer: Dear XXXX, testicular volume of 4 ml is the exact cut off between stage I and stage II. So, if the testicular volume was previously less than 4 ml and has increased to 4 ml, then definitely puberty has set in, but if testicular volume was 4 ml and has not changed recently then I cannot comment upon tanners staging. Other wise, increase in penile length is the earliest to happen , and the average age is 11.5 years. It is not several years of hormonal activation anyways , the entire pubertal progression occurs over a period of about 2 years. regards!

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Minal Mohit (39 minutes later)

Dear Dr XXXXXXX Thank you for the answer. I read a study that before attainment of 4ml testis ( clinical onset of puberty in boys) around 1.5 years prior to this event gonadtotrophins begin to increase during the night. What i am trying to do, is PROVE there was hormones (however basic) as a second proof to the old doctors' notes. I hope you can help me. I woul very much appreciate it. Kind Regards, RF

Answered by Dr. Minal Mohit (21 hours later)

Brief Answer: I am not sure what are you trying to prove. Detailed Answer: Dear XXXX, you are very right that before the clinically evident early signs of puberty there are hormonal surges in gonadotrophins and that can be studied as a part of puberty work up. It may be anything between 1 and 2 years prior to the clinical signs of puberty, exactly 1.5 years is not something I am aware of. But today when you are 31 years, and I think you are a married man with children and family, why you are trying to prove what happened when you were 14.5 years, what exactly you are trying to prove, I really don't know. What help you are seeking from me I didn't understand. Your doctor told you that you were in early stage of puberty, you had testicular volume 4 ml, you had some gonadotrophin activity documented as you are saying in this follow up. You attained your normal puberty in next 8 months. So where did the doctor go wrong? How did he make a false statement. What are you up to, what do you have in mind, what is actually the problem now? What are you seeking answers for? Dear RF, this forum is to solve your health queries, not meant to prove any other doctor wrong. Again I will tell you medicine has only one rule, and that is, it follows no rules. Regards and take care.

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Minal Mohit (10 hours later)

Thank you Dr XXXXXXX My concern is : What if the doctor, when i was 14.5 years old, after examining testis volume lied about the 4ml , and actually it was say 1.5ml (early childhood size) and then suddenly my hormones went crazy and 8 month later I attained the rapid pubertal progression (which happens at testes 10ml volume) Can you advise if that's possible? To go from 1.5ml to 10ml in 8 months? I just need confirmation . Wishing you all the best. XXXX

Answered by Dr. Minal Mohit (15 hours later)

Brief Answer: Abrupt progression of puberty is unusual. Detailed Answer: Dear XXXX, now if you put up the query as your testicular volume was 1.5 ml at 14.5 years and you attained full blown puberty in next 8 months period, I would say that is a bit unusual. Though the possibility is still not ruled out. If The Gonadotrophins were giving a picture of onset of puberty then in that case even if the testicular volume was less (<4 ml) even then normal pubertal progression might occur. Thanks!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Minal Mohit (23 hours later)

Thank you Dr XXXXXXX I have a final question if i may. i understand testosterone is present in boys early life, especially after birth up to a few months old, and it acts via androgen receptor. My question: In normal healthy baby with no genetic defects, does circulating testosterone interact with androgen receptor at sites such as pituitary gland, bones, gonad etc ? Thanks for your help. Wishing you all the best. Kind Regards Is there any example or proof of testosterone interaction with pituitary gland after birth? Or is it assumption that because testosterone is circulating, it interacts with every site? What if it didn't? Hope you can help Wishing you all the best. Kind Regards, XXXX

Answered by Dr. Minal Mohit (7 hours later)

Brief Answer: Testosterone is the androgen so it will interact. Detailed Answer: Dear XXXX, testosterone is the androgen responsible for male genital development both internal and external. Testosterone is responsible for the descent of testes at birth. So it is the androgen that interacts with androgen receptors at all sites such as pituitary, bones and gonads. Regards! Thank you Dr XXXXXXX for example. Is there any example or proof of testosterone interaction with pituitary gland after birth? Or is it assumption that because testosterone is circulating, it interacts with every site? What if it didn't? Hope you can help Wishing you all the best. Kind Regards, XXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Minal Mohit (21 hours later)

Sorry about that Dr XXXXXXX Its very important for me thats all. in a baby boy without insensitivity syndrome, partial or full. He is completely normal Up to 6 months after birth babies have testosterone. If baby boys have androgen receptors in their pituitary gland, will circulating androgens always bind to it? Or is there any reason in babies , androgens doesnt bind to their pituitary androgen receptors ? Regards XXXX

Answered by Dr. Minal Mohit (42 hours later)

Brief Answer: selective androgen insensitivity i am not aware of Detailed Answer: Dear XXXX, this will be my last response to you. Selective androgen insensitivity i.e. testosterone binding to receptors at one site but not to the other is not something I know of. Sorry and I would request you to close this query, as this is what I am doing from my end. Regards!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Minal Mohit (13 hours later)

Ok. Is androgen receptors present in the baby boy pituitary? Or does it become present later on in childhood? Thanks and Regards