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Background: PA, traditionally considered a benign process, is now viewed as a harbinger for future aberration such as polycystic ovary syndrome (PCOS) (1, 2). PA is the presence of pubic hair before age 8 yrs in girls, with DHEAS being the predominantly elevated androgen (3). While the role of androgens in bone growth has been well established in vitro (4), correlations between the elevated androgens and advanced bone age (ABA) observed in girls with PA have not been well delineated. The goal of this study was to identify the predominant androgen in a multiethnic cohort of girls with PA and to determine if that androgen was associated with ABA. Methods: A retrospective chart review was conducted on girls aged 5-7 that presented to our clinic between 2002-2010. The review included anthropometric data, androgen profile, bone age (BA), growth velocity and Tanner stage. Age-matched controls were also identified. Hormone concentrations were determined by radioimmunoassay and chromatography following extraction in our institution's endocrine laboratory. Mann-Whitney U tests and Spearman Correlation tests were used for statistical analyses. Results: Our cohort of 40 girls with PA were mostly Hispanic (58%) and African-American (25%) with a mean age of 6.89 +/- 0.80 yrs, BA of 7.83 +/-1.27 yrs, BMI 19.83 +/- 0.75, BMI Z-score 1.26 +/- 0.20, and growth velocity 7.03+/- 0.45 cm/yr. Testosterone was elevated in 60% of girls with PA (defined as >=10ng/dl for pre-pubertal girls) with DHEAS being elevated only in 30% of girls (>=75mug/dl for girls aged 6-8; >=55 mug/dl for girls <5 yr). Girls in the PA group had significantly elevated testosterone (11.55 +/- 4.83 ng/dL; p=0.04) and DHEAS (65.52 +/- 41.84 mug/dl; p=0.04) levels when compared to age-matched controls (n=7). The 17-OHP values in the two groups were not significantly different. 48% girls had an ABA (defined as BA >=1 yr of chronological age). There was a significant correlation between BA and serum testosterone while controlling for BMI (r=0.51, p=0.05). There was no significant association between BA and DHEAS, androstenedione, and 17-OHP.Conclusion: In our cohort of girls, testosterone emerged as the predominant elevated androgen. The adverse long-term effect of hyperandrogenism and consequent PCOS have been well established. Therefore monitoring girls with PA, elevated testosterone and ABA for emergence of aberrations in the hypothalamic gonadal axis may be prudent