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What age should males experience spermarche by

My son is on GH for GHD.  Also did 2.25 yrs anastrozole since bone age was slightly ahead.  Now only on GH.  Age 15.5, bone age 13.5-14.  Has all the puberty markers for tanner 4: pubic hair now starting a line to navel. Has to shave a couple times per week but only few hairs in beard area, voice deeper but no prominent adams apple yet.  A year ago at endo appt we were told he didnt have to endure anymore testicle size checks.  I assume that means they are near adult in size.  After being off anastrozole i had them check his testosterone.  Igf-1 in range but high with z score 1.9.  GH dose increased from 2.8 to 2.9 6 days per week.  T was only 62.  No bottom of range is given for 15 year olds although if I look at tanner 4 range he was under the low limit of 160.  Free T is 9.9.  Once he gets to 16 the ranges all say T should be above 160.  He has confided in me that he has had no nocturnal emissions or spermarche.  I have read sper,arche can be tied more to bone age than anything else.  Since his bone age is a bit behind, would not having the “equipment downstair” functioning yet be normal since his bone age is 13.5-14 rather than be tied to all the tanner 4 markers and testicle size?  When should i be concerned about if he is T deficient and hasnt had spermarche yet?
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Avatar universal
Hi! The best possible answer can give you only your endocrinologist, who knows your son the best. Just remember: there is no "normal" in medicine! There is only statistically median value, which also means that the individualy normal range can be very far away from this statistical median value. What I am trying to tell you is, is that it could be normal to have a spermarche at the age of 16 or even later, especially if taking growth hormones. One more aspect: if one mastubates, nocturnal emissions are unlikely. So maybe you could ask him whether your son does that and whether orgasm is achievable and anything at all comes out? If orgasm is possible, right afterwards he may obtain a urine sample and send it to laboratory for microscopic diagnostic to determine the presence of sperm in it. There is a condition called retrograde ejaculation, where seprm flows the wrong way- towards urinary bladder.
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