Pharmacological Induction of Puberty

Delayed puberty (DP) defines a lack of pubertal onset or progression beyond the expected age-range of occurrence. It can result from different disorders affecting the hypothalamus-pituitary-gonadal axis. It can impact adversely on psychosocial well-being and peer relationships in the short term and, when caused by permanent causes, is associated with infertility and high-rates of depressive illness and psychosexual difficulties persisting into adulthood. The most frequent form of DP (constitutional delay of growth and puberty, CDGP) is self-limited and may need no intervention. However, CDGP cannot always be readily distinguished from organic hypogonadotropic hypogonadism (HH), which requires drug treatment. The core aims of treatment in both sexes are: (i) achieving development of secondary sexual characteristics according to genetic potential; (ii) promoting an appropriately timed growth spurt; (iii) promoting positive psychosexual development; in females also (iv) achieving adequate uterus dimensions and volume for future child-bearing. Different pubertal induction regimens have been described in the literature, largely reflecting local clinical experience drug availability rather than outcomes of clinical trials. Herein, we assemble an in-depth and updated review of the literature regarding the therapeutic options for inducing puberty, bearing in mind the heterogeneity of this population and underlining differences in therapeutic timing and goals.