National Center for Advancing and Translational Sciences Genetic and Rare Diseases Information Center, a program of the National Center for Advancing and Translational Sciences

Testotoxicosis



Other Names:
Precocious puberty, male limited; Sexual precocity, familial, gonadotropin-independent; Pubertas Praecox; Precocious puberty, male limited; Sexual precocity, familial, gonadotropin-independent; Pubertas Praecox; Familial Testotoxicosis (subtype) See More
Categories:

Testotoxicosis is a form of gonadotropin-independent precocious puberty in which boys experience early onset and progression of puberty. The disease generally presents between 2 and 4 years of age. Patients have accelerated growth, early development of secondary sexual characteristics and reduced adult height. Testotoxicosis is caused by an activating mutation of the luteinizing hormone receptor (LHCGR) gene, which leads to increased levels of sex steroids in the context of low luteinizing hormone. The condition may be sporadic or transmitted as a dominant trait. It is only expressed in males.[1][2][3][4] Treatment consists of reducing hyperandrogenism in children (sexual maturation, stature), with ketoconazole or a combination of antiandrogens and aromatase inhibitors.[4]
Last updated: 2/29/2012

This table lists symptoms that people with this disease may have. For most diseases, symptoms will vary from person to person. People with the same disease may not have all the symptoms listed. This information comes from a database called the Human Phenotype Ontology (HPO) . The HPO collects information on symptoms that have been described in medical resources. The HPO is updated regularly. Use the HPO ID to access more in-depth information about a symptom.

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Medical Terms Other Names
Learn More:
HPO ID
80%-99% of people have these symptoms
Accelerated skeletal maturation
Advanced bone age
Early bone maturation
[ more ]
0005616
Male infertility 0003251
Precocious puberty
Early onset of puberty
Early puberty
[ more ]
0000826
Tall stature
Increased body height
0000098
30%-79% of people have these symptoms
Abnormal hair morphology
Abnormality of the hair
Hair abnormality
[ more ]
0001595
Acne 0001061
Long penis
Enlarged penis
0000040
5%-29% of people have these symptoms
Attention deficit hyperactivity disorder
Attention deficit
Attention deficit disorder
Attention deficit-hyperactivity disorder
Attention deficits
Childhood attention deficit/hyperactivity disorder
[ more ]
0007018
Macroorchidism
Large testis
0000053
Oligospermia
Low sperm count
0000798
Percent of people who have these symptoms is not available through HPO
Decreased testicular size
Small testes
Small testis
[ more ]
0008734
Precocious puberty in males
Early onset of puberty in males
0008185
Sex-limited autosomal dominant 0001470
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Last updated: 7/1/2020

Decisions regarding treatment for patients with testotoxicosis are complex.[3] Treatment typically consists of reducing hyperandrogenism in children (sexual maturation, stature) with ketoconazole or a combination of antiandrogens and aromatase inhibitors.[3][4] Recently, the use of combination therapy with bicalutamide (a potent antiandrogen agent) and anastrozole or letrozole (third-generation aromatase inhibitors) was reported to yield encouraging short-term results, including slower growth rate.[5][6] 
Last updated: 2/29/2012

The complications associated with testotoxicosis are related to early sexual and physical maturation. Other complications are psychological and related to the early sexual and physical maturation. In general, prognosis is excellent with proper treatment.[3]
Last updated: 2/29/2012

If you need medical advice, you can look for doctors or other healthcare professionals who have experience with this disease. You may find these specialists through advocacy organizations, clinical trials, or articles published in medical journals. You may also want to contact a university or tertiary medical center in your area, because these centers tend to see more complex cases and have the latest technology and treatments.

If you can’t find a specialist in your local area, try contacting national or international specialists. They may be able to refer you to someone they know through conferences or research efforts. Some specialists may be willing to consult with you or your local doctors over the phone or by email if you can't travel to them for care.

You can find more tips in our guide, How to Find a Disease Specialist. We also encourage you to explore the rest of this page to find resources that can help you find specialists.

Healthcare Resources


Related diseases are conditions that have similar signs and symptoms. A health care provider may consider these conditions in the table below when making a diagnosis. Please note that the table may not include all the possible conditions related to this disease.

Conditions with similar signs and symptoms from Orphanet
Differential diagnoses include other causes of precocious puberty associated with low levels of gonadotropins such as adrenal tumors, testicular Leydig cell tumors (ruled out by testicular ultrasound since they can be of small size), human chorionic gonadotropin (HCG)-secreting tumors, congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency, CAH due to 11-beta-hydroxylase deficiency, central precocious puberty (with detectable LH levels that can be stimulated by gonadotropin-releasing hormone (GnRH) or GnRH agonists) (see these terms), and occult exposure to androgens.
Visit the Orphanet disease page for more information.

Research helps us better understand diseases and can lead to advances in diagnosis and treatment. This section provides resources to help you learn about medical research and ways to get involved.

Clinical Research Resources

  • ClinicalTrials.gov lists trials that are related to Testotoxicosis. Click on the link to go to ClinicalTrials.gov to read descriptions of these studies.

    Please note: Studies listed on the ClinicalTrials.gov website are listed for informational purposes only; being listed does not reflect an endorsement by GARD or the NIH. We strongly recommend that you talk with a trusted healthcare provider before choosing to participate in any clinical study.

These resources provide more information about this condition or associated symptoms. The in-depth resources contain medical and scientific language that may be hard to understand. You may want to review these resources with a medical professional.

Where to Start

In-Depth Information

  • Medscape Reference provides information on this topic. You may need to register to view the medical textbook, but registration is free.
  • The Monarch Initiative brings together data about this condition from humans and other species to help physicians and biomedical researchers. Monarch’s tools are designed to make it easier to compare the signs and symptoms (phenotypes) of different diseases and discover common features. This initiative is a collaboration between several academic institutions across the world and is funded by the National Institutes of Health. Visit the website to explore the biology of this condition.
  • Online Mendelian Inheritance in Man (OMIM) is a catalog of human genes and genetic disorders. Each entry has a summary of related medical articles. It is meant for health care professionals and researchers. OMIM is maintained by Johns Hopkins University School of Medicine. 
  • Orphanet is a European reference portal for information on rare diseases and orphan drugs. Access to this database is free of charge.
  • PubMed is a searchable database of medical literature and lists journal articles that discuss Testotoxicosis. Click on the link to view a sample search on this topic.

Questions sent to GARD may be posted here if the information could be helpful to others. We remove all identifying information when posting a question to protect your privacy. If you do not want your question posted, please let us know. Submit a new question

  • My uncle, my brother, and one of my brother's sons have testotoxicosis. My son is also affected. I took my son to an endocrinologist and he treated my son with ketoconazole. Treatment was stopped when my son was 11 years old. He continued to grow until the age of 13. Now he is 14 and is 5'7".  We are in the process of going back to the doctor that treated my son to get an x-ray of his hand to see if the growth plates have grown together. Has ketoconazole been proven to work successfully in boys with testotoxicosis? See answer



  1. Reiter EO, Norjavaara E.. Testotoxicosis: current viewpoint. Pediatr Endocrinol Rev. 2005; http://www.ncbi.nlm.nih.gov/pubmed?term=16361981. Accessed 2/29/2012.
  2. Brito VN, Latronico AC, Arnhold IJ, Mendonca BB. Update on the etiology, diagnosis and therapeutic management of sexual precocity. Arq Bras Endocrinol Metabol. 2008; http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-27302008000100005&lng=en&nrm=iso&tlng=en. Accessed 2/29/2012.
  3. Ferry RJ, Fenton CL, Poth MPM. Precocious Pseudopuberty. eMedicine. 2009; http://emedicine.medscape.com/article/923876-overview. Accessed 2/29/2012.
  4. Carel JC. Testotoxicosis. Orphanet. 2005; http://www.orpha.net/consor/cgi-bin/OC_Exp.php?lng=EN&Expert=3000. Accessed 2/29/2012.
  5. Lenz AM, Shulman D, Eugster EA, Rahhal S, Fuqua JS, Pescovitz OH, Lewis KA. Bicalutamide and third-generation aromatase inhibitors in testotoxicosis. Pediatrics. 2010; http://www.ncbi.nlm.nih.gov/pubmed/20713483. Accessed 2/29/2012.
  6. Reiter EO, Mauras N, McCormick K, Kulshreshtha B, Amrhein J, De Luca F, O'Brien S, Armstrong J, Melezinkova H. Bicalutamide plus anastrozole for the treatment of gonadotropin-independent precocious puberty in boys with testotoxicosis: a phase II, open-label pilot study (BATT). J Pediatr Endocrinol Metab. 2010; http://www.ncbi.nlm.nih.gov/pubmed/21158211. Accessed 2/29/2012.