Can too much testosterone make a preschooler aggressive?

The Pediatric Insider

© 2012 Roy Benaroch, MD

Kate wrote in: “My son is 4 and is being labeled as ‘aggressive’. After seeing a reputable psychologist, we have been told he is normal with possibly a little extra testosterone. Is there any medical test to determine if the excess can be balanced?”

Giving the benefit of the doubt to the psychologist, I wonder if maybe he didn’t actually mean “a little extra testosterone.” Maybe that’s just a way of saying “he’s a boy,”, or “he’s all boy.”

Boys, until puberty, make very little testosterone—essentially zero, about as much as girls make. At puberty, of course, there’s a huge surge, and from there testosterone levels stay high until they start to drift inexorably downwards in adult men. If a young boy really had excess testosterone, it would mean there was some tissue somewhere making it, either a tumor of the adrenal gland of a weird piece of testicle tissue somewhere where it isn’t supposed to be. That would be super-rare. And, if there really was excess testosterone sloshing around, you’d see signs of puberty: increased height growth, large testicles and penis, plus body odor and eventually a beard. I’m thinking, probably, that this isn’t what your 4 year old son looks like.

There is no reason whatsoever to do blood tests for testosterone to evaluate behavior issues in preschoolers, and there is no reason to pursue any therapy that claims to “balance” testosterone effects. That’s quackery.

About the aggressive behavior: the best approach to this is behavioral training, which is what a good psychologist should be teaching you. A certain amount of aggression is a normal way for young boys (or girls) to get what they want, and it’s our job as parents to gently (but firmly) guide children to more appropriate ways of dealing with people. While there is no “quick fix”, time invested when children are young pays off big time as they get older—it’s much easier to fix aggression in a four-year-old than in a teenager, and lessons learned now will serve your family very well as your son gets older. If the psychologist you saw didn’t really offer you good strategies to deal with the aggression, go see someone else.

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3 Comments on “Can too much testosterone make a preschooler aggressive?”

  1. ConcernedMother Says:

    My 4-year old son is aggressive and when he started exhibiting body odor and acne we had him tested. The test shows he has testosterone 15 time the normal level for a 5 year old. We have an appointment with an endocrinologist but I have no idea yet what she will recommend. I am curious why you called therapy to balance testosterone effects “quackery”?


  2. Dr. Roy Says:

    Concerned, the post was about a child who exhibited only a behavioral symptom. These children, who have no physical findings) do not have a problem with testosterone levels, and do not need their testosterone levels checked, because they will be normal (when tested correctly.)

    Children who have other physical findings or health issues on their exam may have a problem with excess testosterone or one of many other problems, and appropriate testing and therapy should be done. That’s a different child and a different question.

    Testosterone levels in a 4 year old boy should be quite low, but still span a broad range from .4 – 4.8 pg/mL. You’ll need to work with a board-certified pediatric endocrinologist to figure out what a level outside of that range means.


  3. Julie Ready Says:

    While I’m sure you’re a very intelligent doctor, I’m going to teach you something today. The last thing a mother wants/needs to hear while dealing with an aggressive child who may or may not be uncontrollable, is that it is her job as a parent to guide her child’s behavior.
    As I would tend to agree with you when it comes to “normal” children, when dealing with a child who is exhibiting behaviours that are not normal and possibly deemed as behavioural, she is doing her best and most likely hanging on by a thread. You’re condescending attitude that implies she is not doing her job as a mother only serves to tear her down. Nor build her up.
    She needs help; not judgement.
    Sometimes boys can have higher than normal testosterone levels without having the physical characteristics that you would expect to see. Or there might not be any tumours attributing to the high levels. Sometimes it just happens, and rather than belittling parents, just admit you don’t know what’s wrong and give them links to help them!


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