Pediatric Contrasexual Pubertal Development

Pediatric contrasexual pubertal development is a condition where a male or female child develops characteristics of the opposite gender.

What is Pediatric Contrasexual Pubertal Development?

Puberty (between the ages of 10 and 14 for girls and between the ages of 12 and 16 for boys*) begins when a child’s hormone levels dramatically increase, causing physical and hormonal changes.

During puberty, children with contrasexual development will exhibit features typically present in the opposite gender.

  • Girls (virilization) can develop a deep voice or facial hair.
  • Boys (feminization) mainly develop breasts (gynecomastia). 

Contrasexual development can also interrupt puberty milestones, including growth.

*Age of puberty is middle childhood to teenage years as defined by the Center for Disease Control (CDC).

What are the signs and symptoms of Pediatric Contrasexual Pubertal Development?

Symptoms of contrasexual pubertal development differ between males and females.

Females (virilization)

  • Facial hair
  • Excess of pubic hair
  • Unusually large muscles
  • Deep voice
  • Irregular menstruation (periods)
  • Rapid growth

Symptoms in males

The main symptom of contrasexual pubertal development is the development of breast tissue (gynecomastia).

What are the causes of Pediatric Contrasexual Pubertal Development?

There are several causes of contrasexual pubertal development, which can differ between males and females.

Females (virilization)

There are several reasons there may be hormonal changes in females, including:

  • 21-hydroxylase deficiency – this inherited disorder affects the adrenal glands that produce hormones; females with this condition produce too much androgens (male sex hormones).
  • Acromegaly – a disorder that is the result of too much growth hormone.
  • Congenital adrenal hyperplasia – an inherited disorder that affects the adrenal glands due to a lack of necessary enzymes.
  • Cushing’s syndrome (disease) – a rare condition that occurs when there is too much cortisol (stress hormone).
  • Excess testosterone – the adrenal glands will produce too many androgens (testosterone) if there is a tumor in the gland or if the adrenal gland is enlarged.
  • Hyperthyroidism – the gland that regulates metabolism (thyroid) can alter hormones.
  • Hyperprolactinemia – a disorder that is result of too much prolactin (amino acid responsible for milk production).
  • Medications – steroids, antibiotics, chemotherapy or heart medications.
  • Ovarian or adrenal gland tumors – benign (non-cancerous) or malignant (cancerous) tumors can block or change hormone production.
  • Polycystic ovary syndrome (POS)– this hormonal condition causes enlarged ovaries and cysts.

Males (feminization)

There are several reasons there may be hormonal changes in males, including:

  • Liver or kidney failure – hormonal changes in response to medicines and dialysis
  • Malnutrition or starvation – poor nutrition causes testosterone to drop, but estrogen remains constant
  • Medications – steroids, antibiotics, chemotherapy or heart medications
  • Street drugs and alcohol – such as marijuana, heroin and amphetamines
  • Tumors – on the testes, adrenal glands or the pituitary glands