Delayed puberty (DP) is a common condition caused by the deficient production or action of gonadotropin-releasing hormone, gonadotropins, or androgens. It is often quite concerning to patients and can affect psychosocial well-being of patients. This review addresses developments in the diagnosis and treatment of male DP, highlighting some clinical tips and tricks in a question (Q) and answer (A) format.
The author searched electronic databases from 1966 to November 2015, including PubMed, MEDLINE, EMBASE, EBCSO Academic Search Complete, Cochrane Systematic Reviews Database, and Google Scholar using the following keywords: male, boys, adolescent, delayed puberty, diagnosis, and treatment.
Clinically, DP can be diagnosed in boys who lack testicular enlargement or secondary sexual development by 14 years or who do not progress to Tanner stage V 4.5 years after the onset of puberty. Constitutional delay of growth and puberty (CDGP) is the most common cause of DP. Initial workup should include a thorough history, physical examination, and targeted investigations. No single test is considered foolproof for differentiation between CDGP and hypogonadotropic hypogonadism (HH). Klinefelter’s syndrome may present with a lack of pubertal progress rather than delayed onset. Spontaneous puberty may start in patients with CDGP; otherwise HH should be reconsidered. Reversal and relapse may occur with HH. Induction of spermatogenesis may be an issue in some cases.
A range of options now exists for the management of DP. Current therapies have room for innovation in both pharmacological and assisted reproduction. The treating physician should be aware of new advances in the diagnosis and therapy.