Evaluating the four most important salivary sex steroids during male puberty: testosterone best characterizes pubertal development.

Background: During pubertal development in healthy boys, increased levels of different sex steroids occur which are responsible for sexual maturation and physical changes. However, relationships between various sex hormones and pubertal development stages have not been sufficiently studied. Methods: The investigation included 165 normal boys (mean age 12.7 +/- 2.8 years, mean body mass index [BMI] 19.6 +/- 4.2 kg/m(2)). Pubic hair (PH) stages were stratified by Tanner and testicular volume (TV) by means of the Prader orchidometer and assigned to the prepubertal, pubertal and postpubertal development phase. Four different sex steroids (testosterone [TE], dehydroepiandrosterone [DHEA]/dehydroepiandrosterone-sulfate [DHEAS], androstenedione (AE), 17-hydroxyprogesterone [17-OHP]) were measured in saliva by enzyme-linked immunosorbent assay (ELISA) and as serum total steroids by different assays (radioimmunoassay [RIA], chemiluminescence immunoassay [CLIA], electrochemiluminescence immunoassay [ECLIA]). Validation of saliva-based ELISA tests included data related to inter- and intra-assay coefficients of variation (CVs), recovery and linearity. Results: Using Spearman rank correlation, salivary steroids significantly correlated (p <0.001) with pubertal development: TE (TV r = 0.74 and PH stages r= 0.72), DHEA (r= 0.58 and 0.62), AE (r =0.38 and 0.45) and 17-OHP (r =0.42 and 0.43). Correlations between salivary and serum concentrations of steroids were also statistically significant (p <0.001). Binomial logistic regression analysis revealed significant correlations between salivary TE and pubertal maturation during the development phases of prepuberty-puberty and puberty-postpuberty. Inclusion of further salivary steroids did not improve analysis results. Conclusions: Salivary TE permits a good non-invasive characterization of pubertal maturation stages. The consideration of further salivary sex steroids did not improve diagnostic accuracy.