pediatrics
Delayed Puberty
Treatment of Delayed Puberty
Hormone therapy Ifboysshow no sign of pubertal development or of skeletal maturation beyond 11 to 12 years by age 13 or 14, they may be given a 4- to 6-month course of low-dosetestosteroneenanthate ortestosteronecypionate 50 to 100 mg IM once/month. These low doses induce puberty with some degree of virilization and do not jeopardize adult height potential. After the course is complete, treatment is stopped and after several weeks or monthstestosteronelevels are measured; an increase to pubertal levels suggests the deficiency was temporary rather than permanent. dose is increased over an 18- to 24-month period towards adult replacement doses (see Treatment ). Ingirls,depending on the cause, hormone therapy may be used to induce puberty or, in some cases (eg, Turner syndrome), may be needed for long-term replacement. Estrogen replacement is given in the form of pills or patches, and the dose is increased over an 18- to 24-month period. Doses are lower than those used in adults, and transdermal patches are generally preferred over pills. Girls can be transitioned to transdermal estrogen patches with cyclic progestin (often worn days 1 to 10 of the calendar month) or to combined estrogen-progestin oral contraceptive preparations for long-term treatment. 