Testicular volume of 4 mL is not an appropriate marker of pubertal onset in a subset of boys born small for gestational age

We identified a subgroup of boys born SGA in whom hormonal changes typical of initial puberty (serum LH ≥0.35 IU/L and AMH decline ≥30%) occurred before a clinical diagnosis of pubertal onset (TV 4 mL) was evident. These results indicate that TV 4 mL is not a reliable clinical sign of pubertal onset in all boys born SGA, and that other biomarkers, such as serum LH and AMH, may need to be assessed.