5-Alpha-Reductase Deficiency Medication

Updated: Nov 11, 2016
  • Author: Anna H Isfort, MD; Chief Editor: Robert P Hoffman, MD  more...
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Medication

Medication Summary

Because of recent data, reconsidering the past policies of raising children with 46,XY, such as those with 5-alpha-reductase type 2 deficiency (5-ARD) with ambiguous genitalia and small phalli as females may be appropriate.

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Hormone therapy

Class Summary

Testosterone therapy has been reported to increase penile size and cause virilization in some patients with 5-alpha-reductase type 2 deficiency, and may be used in prepubertal males prior to surgical intervention, or at pubertal onset. Some males with 5-alpha-reductase type 2 deficiency respond with an increase in penile size when 2% dihydrotestosterone (DHT) cream is applied as reported internationally and in research settings. Maximum penile enlargement is achieved after 6 months of treatment. Treatment with DHT is not currently FDA approved for use in the United States.

Children reared as girls require estrogen replacement therapy in adolescence. Progestins are not required due to the absence of a uterus.

Testosterone enanthate or cypionate (Delatestryl)

Promotes and maintains secondary sex characteristics in males with androgen deficiency. Limited data suggest that testosterone therapy may increase penile shaft length and circumference, increase erectile potency and ejaculatory volume, increase facial hair and muscularity, and improve a sense of well-being in patients with 5-alpha-reductase deficiency. The goal of adult dosing is to get the DHT level into the normal range.

Dihydrotestosterone, DHT cream 2%

Promotes and maintains secondary sex characteristics in androgen-deficient males.

Estrogens, conjugated (Premarin)

Used as hormone replacement in patients reared as female. Promotes development of secondary sex characteristics.

Ethinyl estradiol (Estinyl)

Used as hormone replacement in patients reared as female. Promotes development of secondary sex characteristics.

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