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Can too much testosterone make a preschooler aggressive?

July 3, 2012

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.