Considerations when treating male pubertal delay pharmacologically

Abstract

Introduction: Delayed puberty , usually affects psychosocial well-being. Patients and their parents show concern about genital development and stature. The condition is transient in most of the patients; nonetheless, the opportunity should not be missed to diagnose an underlying illness. Areas covered: The etiologies of pubertal delay in males and their specific pharmacological therapies are discussed in this review. Expert opinion: High-quality evidence addressing the best pharmacological therapy approach for each etiology of delayed puberty in males is scarce, and most of the current practice is based on small case series or unpublished experience. Male teenagers seeking attention for pubertal delay most probably benefit from medical treatment to avoid psychosocial distress. While watchful waiting is appropriate in 12- to 14-year-old boys when constitutional delay of growth and puberty (CGDP) is suspected, hormone replacement should not be delayed beyond the age of 14 years. When hypogonadism is diagnosed, hormone replacement should be proposed by the age of 12 years. Testosterone replacement has been used for decades and is fairly standardized. Aromatase inhibitors have arisen as an interesting alternative. Gonadotrophin therapy seems more physiological in patients with central hypogonadism, but its efficacy and timing still need to be established.