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Pajares reported that 29% of the patients who had precocious puberty elicited by secondary androgen exposure had no regression of symptoms. This was characterized by persistently enlarged penile size, presence of pubic hair, and advanced bone age de- spite normalized androgen levels; 47% of patients had only partial regression of these symptoms. 4 Our report highlights the importance of obtaining a detailed family history in the workup of a patient with early puberty. Obtaining this information will guide the provider in establishing the diagno- sis earlier and individualizing the care, as well as avoiding unnecessary and expensive diagnostic tests. Furthermore, it should be emphasized that pubertal assessment by the parent is not a reliable measure of exact sexual maturation of the child; therefore, the genital examination must be part of annual health supervision visits for every child to determine the stage of puberty. 5 Although eight years have passed since the FDA enforced black box warnings on topi- cal testosterone products, there continue to be incidences of virilization like the one discussed above. These cases suggest lack of education and understanding of exposure prevention, as well as lack of adherence. Secondary testoster- one exposure remains overlooked by the medical community, and as a result, primary care provid- ers and specialists are not as cognizant of this public health concern as they shou ld be. Consid- ering the potentially irreversible adverse effects of prolonged testosterone exposure in a growing and developing child, it is of paramount importance to have a detailed conversation between the patient and prescribing provider to illuminate the best ad- ministration option of testosterone—a conversa- tion that takes into account the patient’s family life, schedule, and living arrangements. Conclusion Secondary androgen exposure should al- ways be high on the differential diagnosis in cases of sexual precocity, particularly in a family with multiple affected members. A thorough physical examination and family history can guide the pro- vider in formulating a diagnostic plan that might avoid unnecessary testing. An open and continued dialogue between the patient and physician would ensure that the recommended mode of treatment meets the patients’ needs and can accommodate the patients’ lifestyle and home life while limiting secondary exposure to children. References 1. Surampudi P, Swerdloff RS, Wang C. An update on male hypogonadism therapy. Expert opin- ion on pharmacotherapy. 2014;15(9):1247- 1264. doi:10.1517/14656566.2014.913022. 2. Cavender RK, Fairall M. Precocious Puberty Secondary to Topical Testosterone Transfer: A Case Report. J Sex Med. 2011;8(2):622-6. doi: 10.1111/j.1743-6109.2010.02082.x.  3. Kunz, Gregory J., et al. Virilization of young children after topical androgen use by their parents. Pediatrics. 2004, 114(1):282-4. 4. Martinez-Pajares J, Diaz-Morales O, Ramos- Diaz J, Gomez-Fernandez E. Peripheral precocious puberty due to inadvertent ex- posure to testosterone: case report and re- view of the literature. J Pediatr Endocr Met. 2012;25(9-10):1007-1012. doi: 10.1515/ jpem-2012-0124. 5. Rasmussen A, Wohlfahrt-Veje C, Tefre de Renzy-Martin K, et al. Validity of Self-Assess- ment of Pubertal Maturation. Pediatrics. 2014; 135(1). doi: 10.1542/peds.2014-0793. Planned Parenthood Great Plains is seeking a “back-up” physician who would agree to handle complications from medication abortion (which are rare), as required by Arkansas law. Without such a physician, medication abortion is likely to be banned throughout the entire state. This position does not involve providing abortion services, but it is crucial to preserving abortion access. We are committed to ensuring Arkansas women have access to critical care. To learn more about the position, including compensation and anticipated time commitments, please send us an email at [email protected] or call [phone]. NUMBER 3 SEPTEMBER 2018 • 65