Puberty is the period to attain adult secondary sexual characteristics and reproductive capability. It involves the reactivation of pulsatile hypothalamic gonadotropin-releasing hormone secretion from its relative dormancy in childhood, on the background of an intact hypothalamic-pituitary-gonadal axis.
Both primary gonadal dysfunction and abnormalities of the hypothalamic-pituitary axis result in hypogonadism and delayed puberty. With better treatment in childhood cancers and other chronic conditions, the survival has improved dramatically. However, many of them suffer from various endocrine late effects including deficits in gonadal function, related to the underlying condition or its treatment. As a result, the number of patients requiring pubertal induction has also increased.
The goal of pubertal induction is to mimic the normal timing and progression of physical and social development at different pubertal stages, while minimizing risks. Treatment strategies should aim to achieve adequate feminization for girls or virilization for boys, to optimize pubertal growth spurt, and to attain normal body composition with optimal bone mass accrual. Implication on future fertility should also be considered. All these should be balanced with age-appropriate psychosocial and emotional maturity. Nowadays, a wide range of treatment options are available. In this session, we will discuss the merits and disadvantages of the different options, based on currently available evidence.
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