Precocious Puberty (Boys) Referral Guidelines

Clinical Findings

Boys < 9 years

  • Testicular enlargement ( > 4ml or > 2.5 cm)
  • Penile enlargement

Referral Timeframe

URGENT: Call MD on-call to discuss and start treatment.
On-Call Phone #
Day: (512) 628-1830
After Hours: (512) 323-5465

Pre-Referral Workup

  • TSH and T4 or Free T4 by dialysis
  • Bone age
  • Pediatric LH (CPL 2776, Esoterix 500234, Lab Corp 502286)
  • Pediatric FSH (CPL 2700, Esoterix 500192, LabCorp 502280)
  • Pediatric Testosterone (CPL 2833, Esoterix 500286, Lab Corp 500159)

Referral Requirements

  • Growth chart
  • Bone age results- Please have parent bring a copy of film/CD to appointment.
  • Lab results
  • Relevant clinical notes with physical examination including Tanner stage.

Facts to Remember

  • Standard LH, FSH, Estradiol or Testosterone assays are not reliable for children, please use test codes provided.
  • Consider imaging testing such as pelvic ultrasound or brain and pituitary MRI if warranted.
  • In benign premature thelarche, the nipples are not usually dark or enlarged as seen in precocious puberty.
  • Fine downy and non-pigmented short hair is not considered secondary sexual pubic hair.
  • Pubic hair on the suprapubic area is more indicative of precocious puberty than hair on the labial majora or scrotum.