Androgen replacement in children with constitutional delay of puberty: thecase for aggressive therapy

Puberty describes the complex physiological transition between childhood an d adulthood. Dramatic physical changes occur, most notably the development of secondary sexual characteristics and the pubertal growth spurt. During t he adolescent growth spurt, growth velocity increases from pre-pubertal rat es of 4-6 cm per year to as much as 10-15 cm per year. Accompanying the inc rease in gonadal steroids is an increase in amplitude of growth hormone sec retory bursts. Evidence suggests that adequate growth hormone and gonadal s teroids are both necessary for the attainment of a normal pubertal growth v elocity, and the complex interplay between these two hormonal axes is under intense investigation. Delayed onset of puberty, or constitutional delay o f growth and adolescence, is a common phenomenon presenting particularly in boys. Physiologically, it represents an extension of the normal pre-pubert al hypogonadotropic hypogonadal state. Without intervention, these children will spontaneously undergo puberty and often reach their genetic height po tential, but their delay compared with that of their peers is often of conc ern to the children and their families. Recent evidence suggests long-term physiological benefits of early androgen replacement therapy in these boys, including maximizing attained bone mineral density. Androgen replacement t herapy in male adolescents with constitutional delay of growth and adolesce nce is beneficial psychologically as well as physiologically and should be initiated promptly.