Treatment
10
Table 6. Tanner Stages of Breast Development and Male
External Genitalia
e description of Tanner stages for breast development:
1. Prepubertal
2. Breast and papilla elevated as small mound; areolar diameter increased
3. Breast and areola enlarged, no contour separation
4. Areola and papilla form secondary mound
5. Mature; nipple projects, areola part of general breast contour.
For penis and testes:
1. Prepubertal, testicular volume <4 mL
2. Slight enlargement of penis; enlarged scrotum, pink, texture altered, testes 4–6 mL
3. Penis longer, testes larger (8–12 mL)
4. Penis and glans larger, including increase in breadth; testes larger (12–15 mL),
scrotum dark
5. Penis adult size; testicular volume >15 mL.
Adapted from Lawrence AA. Arch Sex Behav. 2003;32(4):299–315.
Table 7. Baseline and Follow-Up Protocol During
Suppression of Puberty
Every 3–6 mo Anthropometry: height, weight, sitting height, blood
pressure, Tanner stages
Every 6–12 mo Laboratory: LH, FSH, E2/T, 25OH vitamin D
Every 1–2 y Bone density using DXA
Bone age on X-ray of the le hand (if clinically indicated)
Abbreviations: DXA, dual-energ y X-ray absorptiometry; E2, estradiol; FSH, follicle stimulating
hormone; LH, luteinizing hormone; T, testosterone
Adapted from Hembree WC et al. J Clin Endocrinol Metab. 2009;94(9):3132–3154.
