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Topical use also demands parental compliance for the child to receive appropriate dosages (22). Regardless, randomized studies directly comparing topical and intramuscular androgen administration http://www.selleckchem.com/products/dabrafenib-gsk2118436.html do not show any differences in penile growth between the routes (4, 21). In the systematic review, intramuscular administration seemed to have fewer adverse events than topical (10). In particular, it was noted that topical administration was associated with more skin irritation and genital pigmentation. Dosage and schedule Typical doses and scheduling of androgens vary within the literature. Some authors use intramuscular T doses adapted to patient��s size with substantial effects on penile growth by using doses of 2?mg/kg/dose for two to three doses (2, 15, 19, 24) or 100?mg/m2 (8, 18). Alternatively, fixed doses of T at 25?mg/dose IM once monthly for 3?months binedaline have also been used with no significant adverse effects such as delay in bone age (11, 14). Similar effects can be achieved with topical 10% T propionate cream applied twice daily (23). If topical DHT is used, its concentration typically ranges from 2.5 to 3% applied daily for up to 3?months (7, 18). While hCG may be administered at 250?IU/dose in patients younger than 1-year-old or 500?IU/dose in patients 1�C5?years old, it is typically given as 1500?IU every 2?days for a total of six doses (6, 8, 18). Time from PHS to operation When reported, the time from PHS to operation ranged from 2?weeks to 24?months (2, 8, 24). Some studies skipped doses if certain measures were achieved such as notable increases in penile length or glans circumference (11). It has been reported that serum T levels return to normal range a week after being stopped and penile growth disappears during the first year following treatment (22, 24). Gorduza et al. gave monthly IM injections and stopped when penile length was equal or >35?mm (8). In their study, boys who underwent PHS Talazoparib manufacturer more than 3?months prior (21.7%). Adverse Effects Reported adverse effects such as appearance of pubic hair, aggressive behavior, and increased erections have been reported but are transient and resolve post therapy (4, 6�C8, 21). Kaya et al. reported that after topical DHT, 13 of 37 boys experienced pruritus, erythema, and penile pigmentation that normalized after PHS was withdrawn (7). Koff and Jayanthi described dose-related emesis in 1 of 12 boys receiving intramuscular T, leading to cessation of PHS (6). Most studies report no intraoperative complications with a focus on the absence of excess bleeding (2, 21). In the systematic review, no persistent side effects due to PHS were reported (9).