Apologies, I’ll post again.  New keyboard here...

Flutamide is a weak anti-androgen. 

http://www.cancerbacup.org.uk/info/flutamide.htm

It hasn’t really been tested that extensively in children.  Normal children’s androgen levels are a lot lower than adults androgen levels.  So although it may be ok to use in adults, one has to wonder if even though it is a weak androgen, if given at too high a dose in a child, whether it can over suppress androgen or completely suppress androgen in children.  Not something I would want to mess around tweaking really.  Not when  Doctor’s are so lax at tweaking cortisol in these children on it’s own nevermind introducing another drug. 

Children are meant to have androgens---just in lower amounts than they occur in CAH.  Totally blocking or lowering them substantially in the presence of continuous high cortisol levels (well high when compared to the androgen levels which have been suppressed or lowered) would be just as likely to cause weight gain and insulin resistance than if you were to simply over treat a child with cortisol and suppress androgen.    When we over treat a child with cortisol we do exactly the same thing.  We suppress androgens too much and that is why growth is suppressed. 

Children on conventional treatment are exposed to androgens where the cortisol falls low enough in their blood serum to effect release of androgens.  So they get a good dollop every few hours and this helps to have a growth spurt.  Children on those drugs are going to be exposed to less androgen because flutamide may do all the things that is stated in that study but it is also an anti-androgen and could be (well probably is) suppressing androgens too much.  They are either using too high a dose of flutamide.  Too high a dose of cortisol for the levels of androgens present after flutamide has been given OR, flutamide is not good for children full stop because of there being more difficulty controlling what the dose should be in children on it than just conventional treatment--cortisol. 

Doctor’s cannot make up the minds what exactly the correct "normal" blood ranges s are where androgens are concerned at the best of times these days (and I believe these alter with age of the child so it isn’t as simple as aiming for between 500-1000 ng/dl obviously) in conventional treatment.  So there is even scarcer or smaller chances that they will get this treatment right IMO.  That’s because at the very least kids on conventional treatment children get a good rise and fall in androgens and cortisol.  Like ying and yang one balance sout the side-effects of the other throughout the day.   Children kids on this treatment however, are being maintained at the same level of androgen and same level of cortisol over a 24 hour period, and they are not able to recover from the dose of crotisol given by having a spurt of androgen over an hour or two or vice versa because both hormones are being maintained at the same amount.  In other words it is like being in limbo growth wise basically.    Every day is ground hog day...