Delayed puberty and growth hormone injections

[Anonymous]

PP again. I’ve done a lot of research on this too. My son was just diagnosed with growth hormone deficiency and delayed puberty.

When you see an endocrinologist I would ask to make sure he doesn’t have actual growth hormone deficiency. Perhaps you can do blood work and a hand X-ray before your visit.

If he does not but he is still Tanner stage 1 or even 2 at 15.5 I would push for the testosterone shots. There is no reason for him to suffer through this. Research shows they’re very safe and effective and sho in d not stunt his overall height attainment.

FWIW my endocrinologist doesn’t want to do testosterone quite yet as he wants to give the growth hormone shots time to work but I think if my son hasn’t progressed by September or so, we will go that route. He is early stage 2 Tanner.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I’m the PP. forgot to say explicitly that there is a big difference between growth hormone injections and testosterone injections.

Growth hormone is for kids who are deficient in growth hormone and they take it nightly until they’re done growing.

Testosterone is to jump start puberty and kids often get a shot per month for a few months. It’s for constitutional delay of puberty. Sounds like you are talking more about the latter than growth hormone.

OP here- yes, this is specifically what I’m talking about, testosterone shots. I didn’t realize they were different from growth hormone shots, sorry for the confusion. What my pediatrician had mentioned was a few months of injections to kickstart puberty and we are headed to a pediatric endocrinologist in July to explore that further. According to my pediatrician, she thinks he will attain his full height potential at some point but possibly not until college. We are worried about the emotional and psychological implications of this since we see him becoming hyper focused on his lack of growth and increasingly depressed. I am trying to weigh the pros and cons of getting the shots and the risks inherent within vs letting him arrive at puberty naturally but risk having him become mentally unwell. Thanks to all who have responded- it’s a hard topic to research as a lot of the information online is contradictory and confusing, so I really appreciate all of the responses!

Pediatrician here again. I am so relieved! I trust you to make the best choices for your child, but I was worried you were getting advice from someone maybe a bit sketchy. Testosterone makes sense, whereas the GH did not.

Agree with the prior poster that "jump-starting" puberty with a sex hormone (testosterone) can help with the negative psychological effects of CGD without affecting final height.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5556315

Constitutional delay of growth and puberty (CDGP) can cause significant psychological distress in adolescent boys. Although testosterone usage in this group has not been shown to affect the final adult height, the effect on the first year height velocity has not been widely reported.
...
More recent studies and randomised control trials have shown that the use of testosterone in CDGP does not affect the final adult height. Most clinicians, who consider treatment, wait until a chronological age of 14 years and a bone age of 12 years. A short course low-dose depot of intramuscular testosterone has been shown to be a well-tolerated and effective therapy (18). The aim of the above therapeutic interventions has been to bring forward the growth spurt without a decrease in height potential.
...
Our study showed that there is a significant improvement in the first year height velocity in boys with CDGP, treated with a short course of testosterone injections, compared to those not treated. This has an important implication in improving the patient’s self-confidence with his peers and plays an important role in the psychological well being of the patient.

[Anonymous]

DP here. I appreciate these posts. I have a 14 year old in Tanner 1 and we are just starting to get him checked out to make sure it’s just his body on his own natural plan and not something else. Once we rule out any potential issues, we can see if he’s okay to sit tight and wait or if he’s having a very hard time and might benefit from testosterone shots.

[Anonymous]

Great! Glad the thread was helpful, and best wishes to you and OP.

[Anonymous]

NP here, and following the thread but for DD, 14. We are seeing endocrin in June to ensure there is nothing going on other than constitutional growth delay, as IGF and other hormone levels were low on recent bloodwork. (Not sure what Tanner stage she is, probably 1 or 2). Bone scan at age 13 showed bone age of 10.

My question for anyone BTDT or otherwise knowledgeable is whether IGF and other hormone levels would be low if it’s just CGD because the age doesn’t really correlate to the normal levels, or is that suggestive that there may be more to this? Trying to educate myself on different considerations before our appt. FWIW parents were late-ish bloomers (although perhaps not this late) and DD’s nutrition isn’t great so I’m aware those are factors too. Thanks for any info.

[Anonymous]

PP with 16-year-old son diagnosed with hypo-pituitarism. All of his pituitary hormones were present, but on the low side. His bone age was consistently 18 months to 2 years behind throughout his childhood/adolescense. He went to the hospital for a growth hormone stimulation test around age 10, and he took growth hormone injections for about 6 years. He has been taking and will continue taking supplemental thyroid pills. His prolactin levels are practically non-existent, but that does not matter for boys/men. His cortisol is a bit low, but it responded well to the cortisol stimulation test.

[Anonymous]

Anonymous wrote:Has anyone done testosterone injections for constitutional delay of growth in their son? My guy is 15.5 and is 5’4”. No visible signs of puberty. There are no underlying health issues and I’m 5’9” and his dad is 6’0”. My brothers are 6’3. He’s finishing up his freshman year and is one of the smallest in his class. He’s very athletic and is becoming increasingly despondent about his size in terms of how it’s limiting his success in the sports he loves. We are seeing a pediatric endocrinologist in June but I wanted to do some research first and see if anyone here has done growth hormone injections for their son, and what the outcome was. Were there any side effects? How much do they cost? How long was the course of treatment? And was there noticeable growth?
Any insight would be extremely helpful and much appreciated! Thanks in advance for taking the time to respond!

Testosterone at 15.5 to jump start puberty is within the recommended guidelines so I think your approach is reasonable but I think your child's mental distress is worrisome.

It's surprising that he thinks he's one of the smallest in his class. We have a 9th grader who is small and there are a lot of kids who are even smaller at 5'1''-5'3'' in 9th and they do play competitive sports. One of those smaller children we know is a top, county ranked swimmer and another is on an ECNL or MLSNext soccer team. I get it. Height, size and testosterone does make a significant difference in sports performance at this age but it's only temporary and your son needs some perspective. He's probably otherwise healthy and athletic and 5 foot 4 is really not that small overall.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Has anyone done testosterone injections for constitutional delay of growth in their son? My guy is 15.5 and is 5’4”. No visible signs of puberty. There are no underlying health issues and I’m 5’9” and his dad is 6’0”. My brothers are 6’3. He’s finishing up his freshman year and is one of the smallest in his class. He’s very athletic and is becoming increasingly despondent about his size in terms of how it’s limiting his success in the sports he loves. We are seeing a pediatric endocrinologist in June but I wanted to do some research first and see if anyone here has done growth hormone injections for their son, and what the outcome was. Were there any side effects? How much do they cost? How long was the course of treatment? And was there noticeable growth?
Any insight would be extremely helpful and much appreciated! Thanks in advance for taking the time to respond!

Testosterone at 15.5 to jump start puberty is within the recommended guidelines so I think your approach is reasonable but I think your child's mental distress is worrisome.

It's surprising that he thinks he's one of the smallest in his class. We have a 9th grader who is small and there are a lot of kids who are even smaller at 5'1''-5'3'' in 9th and they do play competitive sports. One of those smaller children we know is a top, county ranked swimmer and another is on an ECNL or MLSNext soccer team. I get it. Height, size and testosterone does make a significant difference in sports performance at this age but it's only temporary and your son needs some perspective. He's probably otherwise healthy and athletic and 5 foot 4 is really not that small overall.

I'm not the OP, but just to counter this -- 5'4 seems really small when you haven't started puberty, because you aren't abnormally short necessarily but you look very childish. My son is 14 and 5'4 and definitely not the shortest in his friend group -- he's right in the middle actually -- but the kids who are shorter are further along in puberty, and it shows. There is also the issue of strength for sports, which OP mentioned. Without puberty, a kid can only get so strong....and it is hard to compete with kids halfway through puberty in ANY sport, contact or otherwise. So I completely understand OP's son's distress. He's in high school - probably wants to ask girls to homecoming, etc - and feels he looks like a child. It's not just about height.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Has anyone done testosterone injections for constitutional delay of growth in their son? My guy is 15.5 and is 5’4”. No visible signs of puberty. There are no underlying health issues and I’m 5’9” and his dad is 6’0”. My brothers are 6’3. He’s finishing up his freshman year and is one of the smallest in his class. He’s very athletic and is becoming increasingly despondent about his size in terms of how it’s limiting his success in the sports he loves. We are seeing a pediatric endocrinologist in June but I wanted to do some research first and see if anyone here has done growth hormone injections for their son, and what the outcome was. Were there any side effects? How much do they cost? How long was the course of treatment? And was there noticeable growth?
Any insight would be extremely helpful and much appreciated! Thanks in advance for taking the time to respond!

Testosterone at 15.5 to jump start puberty is within the recommended guidelines so I think your approach is reasonable but I think your child's mental distress is worrisome.

It's surprising that he thinks he's one of the smallest in his class. We have a 9th grader who is small and there are a lot of kids who are even smaller at 5'1''-5'3'' in 9th and they do play competitive sports. One of those smaller children we know is a top, county ranked swimmer and another is on an ECNL or MLSNext soccer team. I get it. Height, size and testosterone does make a significant difference in sports performance at this age but it's only temporary and your son needs some perspective. He's probably otherwise healthy and athletic and 5 foot 4 is really not that small overall.

I'm not the OP, but just to counter this -- 5'4 seems really small when you haven't started puberty, because you aren't abnormally short necessarily but you look very childish. My son is 14 and 5'4 and definitely not the shortest in his friend group -- he's right in the middle actually -- but the kids who are shorter are further along in puberty, and it shows. There is also the issue of strength for sports, which OP mentioned. Without puberty, a kid can only get so strong....and it is hard to compete with kids halfway through puberty in ANY sport, contact or otherwise. So I completely understand OP's son's distress. He's in high school - probably wants to ask girls to homecoming, etc - and feels he looks like a child. It's not just about height.

This. My 14 year old is 5'3" so is shorter but not excessively but looks like a child. He can't build much muscle yet and really feels that lack. He's worried that he hasn't had crushes on girls (or boys, or anyone) when most of his friends are crushing on girls. He's worried that there is something wrong with him.

I'm telling him that he's not in puberty yet so just hold on.

[Anonymous]

You have a lot of options. Call that pediatric endo for a cancellation appointment- get in there!!!

[Anonymous]

Going through this with my son. Our endocrinologist will only give growth hormone shots if there is an issue like a growth hormone deficiency. My son needed to do a growth hormone stimulation test to check for that.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Has anyone done testosterone injections for constitutional delay of growth in their son? My guy is 15.5 and is 5’4”. No visible signs of puberty. There are no underlying health issues and I’m 5’9” and his dad is 6’0”. My brothers are 6’3. He’s finishing up his freshman year and is one of the smallest in his class. He’s very athletic and is becoming increasingly despondent about his size in terms of how it’s limiting his success in the sports he loves. We are seeing a pediatric endocrinologist in June but I wanted to do some research first and see if anyone here has done growth hormone injections for their son, and what the outcome was. Were there any side effects? How much do they cost? How long was the course of treatment? And was there noticeable growth?
Any insight would be extremely helpful and much appreciated! Thanks in advance for taking the time to respond!

Testosterone at 15.5 to jump start puberty is within the recommended guidelines so I think your approach is reasonable but I think your child's mental distress is worrisome.

It's surprising that he thinks he's one of the smallest in his class. We have a 9th grader who is small and there are a lot of kids who are even smaller at 5'1''-5'3'' in 9th and they do play competitive sports. One of those smaller children we know is a top, county ranked swimmer and another is on an ECNL or MLSNext soccer team. I get it. Height, size and testosterone does make a significant difference in sports performance at this age but it's only temporary and your son needs some perspective. He's probably otherwise healthy and athletic and 5 foot 4 is really not that small overall.

I'm not the OP, but just to counter this -- 5'4 seems really small when you haven't started puberty, because you aren't abnormally short necessarily but you look very childish. My son is 14 and 5'4 and definitely not the shortest in his friend group -- he's right in the middle actually -- but the kids who are shorter are further along in puberty, and it shows. There is also the issue of strength for sports, which OP mentioned. Without puberty, a kid can only get so strong....and it is hard to compete with kids halfway through puberty in ANY sport, contact or otherwise. So I completely understand OP's son's distress. He's in high school - probably wants to ask girls to homecoming, etc - and feels he looks like a child. It's not just about height.

+1

My 14yo is 5’4” and there are plenty of boys in his height range- but height isn’t the main issue. Mine is 105lbs and has barely started puberty (Tanner 2, says the ped)- looks like a little kid still. Many of the other boys- including many in his height range- are quite a bit more physically developed with deeper voices and muscles etc. They look their age, while people usually guess my son is 12ish. It’s really tough on him, and is something I never really realized was so difficult for boys (never paid attention growing up I guess). Sports are terribly difficult at this time as well- has always been a great athlete but it is almost impossible to compete with the more developed boys. He’ll get through this period, as all kids do, but it is so hard for him. He should eventually be around average height I think (we are 6’0” and 5’6”- so not tall but not short either).

[Anonymous]

Going through this and it’s definitely hard. Takes a lot of reassuring and confidence building. Imagine what this is like with siblings or other younger family members around. Athletics become more difficult because everyone is getting bigger, stronger, or taller than you including potentially the kids younger than you. Social relationships change as you’re not maturing as rapidly as everyone around you. Everyone assumes you’re 12 when you’re not. Being viewed as younger is great when you 50, not when you’re 15.

[Anonymous]

NP here. This thread has been very helpful and informative. DH is a freshman who will be turning 15 soon. He’s barely 5’3, 100lbs with signs of puberty. He looks like a little child compared to his peers and the smallest on his JV team. It’s definitely weighing on him mentally, whereas before HS, his small size didn’t seem to faze him, despite playing multiple sports.

Information about the testosterone shots and the resource from the PP who’s a pediatrician is helpful and we will explore if that might be an option for DS at his 15-year check-up. DH, who’s 6’0” was also a very late bloomer and recalled how he struggled with confidence and kept him from going out for HS sports despite being a great athlete. He says to this day, even though he’s now above average in height, he still sees himself as the small guy in his friend group, despite having caught up to and even having surpassed many of them in height.

[Anonymous]

Anonymous wrote:NP here. This thread has been very helpful and informative. DH is a freshman who will be turning 15 soon. He’s barely 5’3, 100lbs with signs of puberty. He looks like a little child compared to his peers and the smallest on his JV team. It’s definitely weighing on him mentally, whereas before HS, his small size didn’t seem to faze him, despite playing multiple sports.

Information about the testosterone shots and the resource from the PP who’s a pediatrician is helpful and we will explore if that might be an option for DS at his 15-year check-up. DH, who’s 6’0” was also a very late bloomer and recalled how he struggled with confidence and kept him from going out for HS sports despite being a great athlete. He says to this day, even though he’s now above average in height, he still sees himself as the small guy in his friend group, despite having caught up to and even having surpassed many of them in height.

Oops, obviously meant DS.