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Human Reproduction Update Advance Access published online on May 3, 2006
Human Reproduction Update, doi:10.1093/humupd/dml018
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© The Author 2006. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org
Received January 3, 2006
Revised March 13, 2006
Accepted March 27, 2006

Article

The sensitivity of the child to sex steroids: possible impact of exogenous estrogens

Lise Aksglaede 1, Anders Juul 1, Henrik Leffers 1, Niels E. Skakkebæk 1, and Anna-Maria Andersson 1 *

1 University Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark

* To whom correspondence should be addressed.
Anna-Maria Andersson, E-mail: anna{at}rh.dk


  Abstract

The current trends of increasing incidences of testis, breast and prostate cancers are poorly understood, although it is assumed that sex hormones play a role. Disrupted sex hormone action is also believed to be involved in the increased occurrence of genital abnormalities among newborn boys and precocious puberty in girls. In this article, recent literature on sex steroid levels and their physiological roles during childhood is reviewed. It is concluded that (i) circulating levels of estradiol in prepubertal children are lower than originally claimed; (ii) children are extremely sensitive to estradiol and may respond with increased growth and/or breast development even at serum levels below the current detection limits; (iii) no threshold has been established, below which no hormonal effects can be seen in children exposed to exogenous steroids or endocrine disruptors; (iv) changes in hormone levels during fetal and prepubertal development may have severe effects in adult life and (v) the daily production rates of sex steroids in children estimated by the Food and Drug Administration in 1999 and still used in risk assessments are highly overestimated and should be revised. Because no lower threshold for estrogenic action has been established, caution should be taken to avoid unnecessary exposure of fetuses and children to exogenous sex steroids and endocrine disruptors, even at very low levels.

Keywords: anabolic growth promoters/endocrine disruptor/estradiol/prepubertal children/threshold level.
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