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Delayed secondary sexual development
I am a 29 year old Caucasian male living in the UK. I am also a family physician, but given my relative lack of expertise in this particular area I wanted to post this problem to get the opinions of others including physicians.
For as long as I can recall, I have been bothered about the rate of my secondary development. This has had a fairly profound effect on me psychologically and, in all honestly, I'm not sure why I waited until now to ask about this.
My mother was not a late bloomer, my father may well have been given what he has said before (but he is not particularly forthcoming about these matters). I know that he certainly had developed normally by the time he was my age.
I probably got my first downy blonde pubic hair when I was about 14. By the time I left high-school, (17) I had only a very fine downy hair on my upper lip, and virtually no detectable axillary hair. I did not have hairy legs or arms. My height was average until mid-highschool; I then became a bit below average and have ended up at 5ft 8.5 inches. I suspect this is probably within the range to be expected from my father who is 5ft 10-ish and mother who is 5ft 3.5inches. My genital development, I believe, is probably normal too.
Througout University I hardly had to shave. I guess to make me feel more grown up, I tended to shave every few days with just a dry razor (not particularly good for my skin!) even though I could have gotten away without shaving. Even now, I really struggle to grow anything resembling a sideburn and the main concentration of my facial hair is on my upper lip and chin, with a very small sparse amount of it (both dark brown, similar to my pubic hair, and blonde) on my cheeks. This actually makes it sound much more than it truly is:- it is hardly visible except on close inspection. In the past 6 months I have developed a small amount (but definitely more than I had) of downy hair on my chest which starts blonde and some of which has become a little darker over time. Again, this is only visible on very close inspection.
I have become so bothered with my appearance that it was a real factor in my developing depression over the past few years. It has had a fair impact on my life with me avoiding dating/going to pool/beach/gym etc, and generally feeling inferior to other guys in my peer group who are developed. A number of people - strangers and less immediate family - have blurted out how young I look. My depression fortunately is much improved and is now stable over the past 12 months, but my physical development issues are still present.
I eventually decided the time had come to see my own family doctor and get some bloods done. The following are the results (bear in mind these are UK units/reference ranges in brackets):-
Renal function – normal
Liver function –
Alkaline phosphatase 126 IU/L (30-120)
Bilirubin – normal
AST – 74 IU/L (5-42)
ALT – 217 IU/L (5-60)
Cholesterol (total) 5.8 mmol/L (3.1-5.2)
Thyroid function – normal
Sex hormone profile -
FSH – 2.1 U/L (0.7 – 11.1)
LH – 2.6 U/L (1.3 – 70)
Prolactin – 220 microU/L (60 – 360)
Progesterone <2 (3 – 7)
Estradiol 218 pmol/L (0 – 206)
Testosterone 29.8 nmol/L (10 – 36)
SHBG 35.0 nmol/L (6 – 45)
Free Androgen Index 85.1% (36 – 156)
I have already had my liver function looked at, and given I don’t drink alcohol, it has been put down as hepatic steatosis. I am a little over-weight, but not obese, and my gastroenterologist thinks this is the reason for my deranged Liver function. My liver ultrasound was normal.
I am wondering if the raised estradiol levels could have any effect on delaying/counteracting my sexual development. I know it is marginal. Are the estradiol levels coming from my body fat; I can hardly believe this as there are plenty of males my age who are heavier and have still developed normally.
My family doctor has simply said the results were fine … end of story. I on the other hand think that I’d still like an answer to this problem. It gets extremely frustrating seeing others 10 or more years my junior who are more physically developed.
Does anyone have any experience of this, or wish to offer opinions on what I should do next/ how to take this further (given the fact that any secondary referrals have to go through my family doctor here in the UK). Am I over-reacting?
Cheers, in anticipation.
For as long as I can recall, I have been bothered about the rate of my secondary development. This has had a fairly profound effect on me psychologically and, in all honestly, I'm not sure why I waited until now to ask about this.
My mother was not a late bloomer, my father may well have been given what he has said before (but he is not particularly forthcoming about these matters). I know that he certainly had developed normally by the time he was my age.
I probably got my first downy blonde pubic hair when I was about 14. By the time I left high-school, (17) I had only a very fine downy hair on my upper lip, and virtually no detectable axillary hair. I did not have hairy legs or arms. My height was average until mid-highschool; I then became a bit below average and have ended up at 5ft 8.5 inches. I suspect this is probably within the range to be expected from my father who is 5ft 10-ish and mother who is 5ft 3.5inches. My genital development, I believe, is probably normal too.
Througout University I hardly had to shave. I guess to make me feel more grown up, I tended to shave every few days with just a dry razor (not particularly good for my skin!) even though I could have gotten away without shaving. Even now, I really struggle to grow anything resembling a sideburn and the main concentration of my facial hair is on my upper lip and chin, with a very small sparse amount of it (both dark brown, similar to my pubic hair, and blonde) on my cheeks. This actually makes it sound much more than it truly is:- it is hardly visible except on close inspection. In the past 6 months I have developed a small amount (but definitely more than I had) of downy hair on my chest which starts blonde and some of which has become a little darker over time. Again, this is only visible on very close inspection.
I have become so bothered with my appearance that it was a real factor in my developing depression over the past few years. It has had a fair impact on my life with me avoiding dating/going to pool/beach/gym etc, and generally feeling inferior to other guys in my peer group who are developed. A number of people - strangers and less immediate family - have blurted out how young I look. My depression fortunately is much improved and is now stable over the past 12 months, but my physical development issues are still present.
I eventually decided the time had come to see my own family doctor and get some bloods done. The following are the results (bear in mind these are UK units/reference ranges in brackets):-
Renal function – normal
Liver function –
Alkaline phosphatase 126 IU/L (30-120)
Bilirubin – normal
AST – 74 IU/L (5-42)
ALT – 217 IU/L (5-60)
Cholesterol (total) 5.8 mmol/L (3.1-5.2)
Thyroid function – normal
Sex hormone profile -
FSH – 2.1 U/L (0.7 – 11.1)
LH – 2.6 U/L (1.3 – 70)
Prolactin – 220 microU/L (60 – 360)
Progesterone <2 (3 – 7)
Estradiol 218 pmol/L (0 – 206)
Testosterone 29.8 nmol/L (10 – 36)
SHBG 35.0 nmol/L (6 – 45)
Free Androgen Index 85.1% (36 – 156)
I have already had my liver function looked at, and given I don’t drink alcohol, it has been put down as hepatic steatosis. I am a little over-weight, but not obese, and my gastroenterologist thinks this is the reason for my deranged Liver function. My liver ultrasound was normal.
I am wondering if the raised estradiol levels could have any effect on delaying/counteracting my sexual development. I know it is marginal. Are the estradiol levels coming from my body fat; I can hardly believe this as there are plenty of males my age who are heavier and have still developed normally.
My family doctor has simply said the results were fine … end of story. I on the other hand think that I’d still like an answer to this problem. It gets extremely frustrating seeing others 10 or more years my junior who are more physically developed.
Does anyone have any experience of this, or wish to offer opinions on what I should do next/ how to take this further (given the fact that any secondary referrals have to go through my family doctor here in the UK). Am I over-reacting?
Cheers, in anticipation.
Yeah, cheers, I have seen sick euthyroid. You can have some who is sick euthyroid who has abnormal results but clinically they aren't hypo/hyper. Just because of temporary concurrent illness.
Dr Peatfield says if all tests are abnormal but the patient seems fine with sick euthyroid - that infact the patient does sooner or later become ill and will need treatment
What is more commonly seen is that all tests are normal but the patient is obviously ill. This may be called Euthyroid Hypometabolism. This is why I mentioned getting RT3 tested in my previous post because T4 doesn't convert properly into T3 and the tissue levels are infact low. This situation can occur with growth hormone deficiency, nutritional failures and low adrenal function
There is also Thyroid Hormone Resistance...
It is also intriguing how in the states any tsh over 2 is considered suspicious for primary hypothyroidism while here they just drop you anywhere in the range and most labs aren't very sensitive anyway. I am near 4 usually but have been more than double this in the Endocrine clinic with normal "frees" that my body can't use - of course I have to tell my GP all this and the only way to really get things done is go private
I find it interesting when Mega felt normal his tsh was 0.6 and is now 2.5 and I have had this reading once also. Again it is a terrible test in general
What is more commonly seen is that all tests are normal but the patient is obviously ill. This may be called Euthyroid Hypometabolism. This is why I mentioned getting RT3 tested in my previous post because T4 doesn't convert properly into T3 and the tissue levels are infact low. This situation can occur with growth hormone deficiency, nutritional failures and low adrenal function
There is also Thyroid Hormone Resistance...
It is also intriguing how in the states any tsh over 2 is considered suspicious for primary hypothyroidism while here they just drop you anywhere in the range and most labs aren't very sensitive anyway. I am near 4 usually but have been more than double this in the Endocrine clinic with normal "frees" that my body can't use - of course I have to tell my GP all this and the only way to really get things done is go private
I find it interesting when Mega felt normal his tsh was 0.6 and is now 2.5 and I have had this reading once also. Again it is a terrible test in general
hi everyone i was gonna post my own question about this same subject matter but i seen this post and im in the same situation. of course im a teenager. but iv been having trouble developing myself. im 16 and still have no body hair and my penis and testes are not fully grown. anyone know what could be wrong with me. what causes puberty to happen. hormones right. hey bud goodluck with your problem.
Hi there
At 16 I wouldn't worry yourself about hormones just yet, you sound like a late developer and this is the case for many; especially being male. I know it isn't easy with peer pressure etc but you will probably have a raging sex life in the next year or so onwards when that testosterone spikes with everything else
Take care mate
At 16 I wouldn't worry yourself about hormones just yet, you sound like a late developer and this is the case for many; especially being male. I know it isn't easy with peer pressure etc but you will probably have a raging sex life in the next year or so onwards when that testosterone spikes with everything else
Take care mate
i agree with the prevous poster that your E2 is out competing your testosterone. An aromatase inhibitor would not be out of the question for improved devlopment.
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