Delayed puberty and growth hormone injections

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:As a pediatrician, I don't know why anyone would recommend growth hormone injections for constitutional growth delay. It's just delayed puberty -- CGD itself doesn't have any effect on final height. They just reach it later.

Are you sure you don't mean "familial short stature?"

Our endo told us the same thing (in that, why start him on medication just to give him medication) in our DS' case.

I'm 5'7", ex-dh is 6'4". DS is 15.5, bones measure about 2/3 years behind (we didn't have his teeth examined). ADHD and on meds since 2nd grade. He's finally showing signs of puberty now so his was really delayed but based on his bone age scans (we've been discussing this situation for the last two years with his endo) he has a lot of room to grow so she pretty much released us from seeing her. Last year he grew 4 inches in total so I think it's all finally happening.

That said, I feel you OP on the sports thing. Even now with his 4" of growth last year he's still on the smaller side in his grade and this year, for the first time since t-ball, he didn't want to try out for the baseball team because he felt he couldnt keep up size wise or strength wise which made me sad for him because he was so committed to his sport.

What your endo says doesn’t make sense? Why give him meds just to give him meds? You have been giving him ADHD meds since 2nd grade. That is most likely the cause of delayed puberty and height.

So many boys are affected. Kids at my boys school now ask boys in 9th and 10th grade who haven’t gone through puberty if they have ADHD.

ADHD meds do not cause delayed puberty. In some kids, they can decrease appetite, but if your child has been gaining weight each yr and seems to eating normally it doesn’t affect height or puberty

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:As a pediatrician, I don't know why anyone would recommend growth hormone injections for constitutional growth delay. It's just delayed puberty -- CGD itself doesn't have any effect on final height. They just reach it later.

Are you sure you don't mean "familial short stature?"

Our endo told us the same thing (in that, why start him on medication just to give him medication) in our DS' case.

I'm 5'7", ex-dh is 6'4". DS is 15.5, bones measure about 2/3 years behind (we didn't have his teeth examined). ADHD and on meds since 2nd grade. He's finally showing signs of puberty now so his was really delayed but based on his bone age scans (we've been discussing this situation for the last two years with his endo) he has a lot of room to grow so she pretty much released us from seeing her. Last year he grew 4 inches in total so I think it's all finally happening.

That said, I feel you OP on the sports thing. Even now with his 4" of growth last year he's still on the smaller side in his grade and this year, for the first time since t-ball, he didn't want to try out for the baseball team because he felt he couldnt keep up size wise or strength wise which made me sad for him because he was so committed to his sport.

What your endo says doesn’t make sense? Why give him meds just to give him meds? You have been giving him ADHD meds since 2nd grade. That is most likely the cause of delayed puberty and height.

So many boys are affected. Kids at my boys school now ask boys in 9th and 10th grade who haven’t gone through puberty if they have ADHD.

ADHD meds do not cause delayed puberty. In some kids, they can decrease appetite, but if your child has been gaining weight each yr and seems to eating normally it doesn’t affect height or puberty

NP:

My understanding is that low BMI tends to delay puberty. For both girls and boys. Whether ADHD is a contributor of low BMI or not (seems it may be for some but not others)

I have 3 teens and it is generally the skinny kids who end up hitting puberty later (and heavier kids earlier) so anecdotally this would make total sense. Obviously there are exceptions

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:As a pediatrician, I don't know why anyone would recommend growth hormone injections for constitutional growth delay. It's just delayed puberty -- CGD itself doesn't have any effect on final height. They just reach it later.

Are you sure you don't mean "familial short stature?"

Our endo told us the same thing (in that, why start him on medication just to give him medication) in our DS' case.

I'm 5'7", ex-dh is 6'4". DS is 15.5, bones measure about 2/3 years behind (we didn't have his teeth examined). ADHD and on meds since 2nd grade. He's finally showing signs of puberty now so his was really delayed but based on his bone age scans (we've been discussing this situation for the last two years with his endo) he has a lot of room to grow so she pretty much released us from seeing her. Last year he grew 4 inches in total so I think it's all finally happening.

That said, I feel you OP on the sports thing. Even now with his 4" of growth last year he's still on the smaller side in his grade and this year, for the first time since t-ball, he didn't want to try out for the baseball team because he felt he couldnt keep up size wise or strength wise which made me sad for him because he was so committed to his sport.

What your endo says doesn’t make sense? Why give him meds just to give him meds? You have been giving him ADHD meds since 2nd grade. That is most likely the cause of delayed puberty and height.

So many boys are affected. Kids at my boys school now ask boys in 9th and 10th grade who haven’t gone through puberty if they have ADHD.

ADHD meds do not cause delayed puberty. In some kids, they can decrease appetite, but if your child has been gaining weight each yr and seems to eating normally it doesn’t affect height or puberty

NP:

My understanding is that low BMI tends to delay puberty. For both girls and boys. Whether ADHD is a contributor of low BMI or not (seems it may be for some but not others)

I have 3 teens and it is generally the skinny kids who end up hitting puberty later (and heavier kids earlier) so anecdotally this would make total sense. Obviously there are exceptions

Plenty of kids on adhd have normal BMIs

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:As a pediatrician, I don't know why anyone would recommend growth hormone injections for constitutional growth delay. It's just delayed puberty -- CGD itself doesn't have any effect on final height. They just reach it later.

Are you sure you don't mean "familial short stature?"

Our endo told us the same thing (in that, why start him on medication just to give him medication) in our DS' case.

I'm 5'7", ex-dh is 6'4". DS is 15.5, bones measure about 2/3 years behind (we didn't have his teeth examined). ADHD and on meds since 2nd grade. He's finally showing signs of puberty now so his was really delayed but based on his bone age scans (we've been discussing this situation for the last two years with his endo) he has a lot of room to grow so she pretty much released us from seeing her. Last year he grew 4 inches in total so I think it's all finally happening.

That said, I feel you OP on the sports thing. Even now with his 4" of growth last year he's still on the smaller side in his grade and this year, for the first time since t-ball, he didn't want to try out for the baseball team because he felt he couldnt keep up size wise or strength wise which made me sad for him because he was so committed to his sport.

What your endo says doesn’t make sense? Why give him meds just to give him meds? You have been giving him ADHD meds since 2nd grade. That is most likely the cause of delayed puberty and height.

So many boys are affected. Kids at my boys school now ask boys in 9th and 10th grade who haven’t gone through puberty if they have ADHD.

ADHD meds do not cause delayed puberty. In some kids, they can decrease appetite, but if your child has been gaining weight each yr and seems to eating normally it doesn’t affect height or puberty

NP:

My understanding is that low BMI tends to delay puberty. For both girls and boys. Whether ADHD is a contributor of low BMI or not (seems it may be for some but not others)

I have 3 teens and it is generally the skinny kids who end up hitting puberty later (and heavier kids earlier) so anecdotally this would make total sense. Obviously there are exceptions

Plenty of kids on adhd have normal BMIs

Of course. As I said, ADHD meds are a contributor for some, not all.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:As a pediatrician, I don't know why anyone would recommend growth hormone injections for constitutional growth delay. It's just delayed puberty -- CGD itself doesn't have any effect on final height. They just reach it later.

Are you sure you don't mean "familial short stature?"

Our endo told us the same thing (in that, why start him on medication just to give him medication) in our DS' case.

I'm 5'7", ex-dh is 6'4". DS is 15.5, bones measure about 2/3 years behind (we didn't have his teeth examined). ADHD and on meds since 2nd grade. He's finally showing signs of puberty now so his was really delayed but based on his bone age scans (we've been discussing this situation for the last two years with his endo) he has a lot of room to grow so she pretty much released us from seeing her. Last year he grew 4 inches in total so I think it's all finally happening.

That said, I feel you OP on the sports thing. Even now with his 4" of growth last year he's still on the smaller side in his grade and this year, for the first time since t-ball, he didn't want to try out for the baseball team because he felt he couldnt keep up size wise or strength wise which made me sad for him because he was so committed to his sport.

What your endo says doesn’t make sense? Why give him meds just to give him meds? You have been giving him ADHD meds since 2nd grade. That is most likely the cause of delayed puberty and height.

So many boys are affected. Kids at my boys school now ask boys in 9th and 10th grade who haven’t gone through puberty if they have ADHD.

ADHD meds do not cause delayed puberty. In some kids, they can decrease appetite, but if your child has been gaining weight each yr and seems to eating normally it doesn’t affect height or puberty

NP:

My understanding is that low BMI tends to delay puberty. For both girls and boys. Whether ADHD is a contributor of low BMI or not (seems it may be for some but not others)

I have 3 teens and it is generally the skinny kids who end up hitting puberty later (and heavier kids earlier) so anecdotally this would make total sense. Obviously there are exceptions

I don’t know if I would characterize my kid as an exception but my oldest boy had delayed puberty with a normal BMI. My younger son is on track to being equally delayed with a normal BMI.

It runs in the family. DH was the same.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:As a pediatrician, I don't know why anyone would recommend growth hormone injections for constitutional growth delay. It's just delayed puberty -- CGD itself doesn't have any effect on final height. They just reach it later.

Are you sure you don't mean "familial short stature?"

If it’s delayed puberty won’t he get a growth spurt later? My brother left high school at 5’10” and soon after got to his full height of 6’2”.

He will. It just means that his "constitution" is programmed to hit the growth spurt later, and usually one or both of his parents did the same. But it's not a deficiency of growth hormone or even of adult height.

More information is coming out about the risks of additional growth hormone over and above normal levels (not really relevant to true growth hormone or pituitary deficiency, which are separate diagnoses from constitutional growth delay). This issue isn't settled yet, but GH isn't without risks. And if the child is going to reach normal height, just later, I'm not sure why someone would pursue this.

https://www.webmd.com/children/news/20140813/children-prescribed-growth-hormone-may-face-stroke-risk-later-study
Children, Growth Hormone, & Possible Risk Later

https://www.nytimes.com/2021/03/29/well/live/growth-hormones-short-children-height.html
Weighing the Use of Growth Hormones for Children: New research has linked growth hormone treatment to serious adverse health effects years later

I also think puberty blockers for early puberty have their own risks and have decided not to give to my kids, they are normal height, though short.

Those articles are about daily growth hormone shots to increase height NOT about puberty blockers.

Puberty blockers have no long term problems used for precocious puberty. They have possible long term effects is used after 12 years old to block normal puberty for trans kids.

[Anonymous]

Someone mentioned “tooth age” could you say more about that? Can the orthodontist check for that? My son is only 9.5 now so puberty is at least a bit off but he didn’t get his first tooth until 14-15 months and didn’t start losing baby teeth until after 8 years old. I wonder if that’s correlated to him being a “late bloomer” puberty wise.

[Anonymous]

Anonymous wrote:Someone mentioned “tooth age” could you say more about that? Can the orthodontist check for that? My son is only 9.5 now so puberty is at least a bit off but he didn’t get his first tooth until 14-15 months and didn’t start losing baby teeth until after 8 years old. I wonder if that’s correlated to him being a “late bloomer” puberty wise.

Tooth age is completely unrelated to puberty

[Anonymous]

Anonymous wrote:Someone mentioned “tooth age” could you say more about that? Can the orthodontist check for that? My son is only 9.5 now so puberty is at least a bit off but he didn’t get his first tooth until 14-15 months and didn’t start losing baby teeth until after 8 years old. I wonder if that’s correlated to him being a “late bloomer” puberty wise.

While there might not be causation between tooth age and puberty, there is a general correlation. This has been shown in studies and my own DS. He had zero teeth until about 12 months. He was 2 to 2.5 years delayed in puberty.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8475244/

[Anonymous]

Anonymous wrote:

Anonymous wrote:My son was very late to hit puberty and didn’t hit his growth spurt until 16. (His voice also didn’t change until then and he didn’t grow under arm or leg hair until then, either.)

Until about age 12 he always was on the tall side and then was significantly shorter than everyone else as most of the other boys were in the throes of puberty. I went to the ped with our concerns and she assured me he was a late bloomer.

He’s now 18 and 6’5” tall (and still growing it seems) and has committed to a D1 school to play a sport next fall.

Can I ask what sport, and how he managed to hang in there during the tiny years? My oldest was a very late bloomer and had to switch to track and cross country in HS- no way was he making any cut sports teams at his size (after playing club basketball and travel baseball for years). Ended up 6’2”. My younger DS is now 14 and is blooming “on time” but his smaller friends all started getting benched and/or cut last year (soccer and baseball). I really feel for them.

He is playing football in college if you can believe it- He’s always been a 3 sport athlete (soccer in the fall until freshman year) and goes to a private school (not one of the all boys ones) so there are definitely more opportunities. He played travel/club through 8th, but since then only has played for his school.

When they ask, my advice to friends with younger kids is to have their kid(s) play as many sports as possible as long as possible especially at the rec level. Rec sports are awesome. Avoid specializing in one sport too early at all costs. This was the first year my son didn’t play basketball and baseball and that’s only because he was so behind as far as strength goes. We didn’t want him lifting until he was done most of his growing. He spent the winter/spring lifting and working on skills specific to football. This year he’ll likely play basketball and baseball since he’s committed.

Also, the grass is brown everywhere when it comes to travel/club- so many politics. I’ve seen really talented kids get cut in lots of sports.

I also believe that travel/club sports have, in many ways, ruined sports for kids and all they are is a big money grab. Probably not popular opinion in these parts, but looking back at my kids’ experiences I can say that with full confidence.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:As a pediatrician, I don't know why anyone would recommend growth hormone injections for constitutional growth delay. It's just delayed puberty -- CGD itself doesn't have any effect on final height. They just reach it later.

Are you sure you don't mean "familial short stature?"

Our endo told us the same thing (in that, why start him on medication just to give him medication) in our DS' case.

I'm 5'7", ex-dh is 6'4". DS is 15.5, bones measure about 2/3 years behind (we didn't have his teeth examined). ADHD and on meds since 2nd grade. He's finally showing signs of puberty now so his was really delayed but based on his bone age scans (we've been discussing this situation for the last two years with his endo) he has a lot of room to grow so she pretty much released us from seeing her. Last year he grew 4 inches in total so I think it's all finally happening.

That said, I feel you OP on the sports thing. Even now with his 4" of growth last year he's still on the smaller side in his grade and this year, for the first time since t-ball, he didn't want to try out for the baseball team because he felt he couldnt keep up size wise or strength wise which made me sad for him because he was so committed to his sport.

What your endo says doesn’t make sense? Why give him meds just to give him meds? You have been giving him ADHD meds since 2nd grade. That is most likely the cause of delayed puberty and height.

So many boys are affected. Kids at my boys school now ask boys in 9th and 10th grade who haven’t gone through puberty if they have ADHD.

ADHD meds do not cause delayed puberty. In some kids, they can decrease appetite, but if your child has been gaining weight each yr and seems to eating normally it doesn’t affect height or puberty

Yeah, they absolutely can delay puberty! I wish we were given this information but none of the doctors ever mentioned it. It happened to our son and several of the boys that we know are in adhd meds. Obviously not everyone who takes adhd meds is affected and eventually boys go through puberty but the delay was absolutely brutal for our son. And we never ever would have had him on adhd meds while approaching puberty had we known!

Here is one study-

https://onlinelibrary.wiley.com/doi/full/10.5694/mja12.10931

Main outcome measures: Subjects’ growth parameters before treatment were compared with controls aged 7 or 8 years; growth parameters and longitudinal changes on treatment to ages 12.00–13.99 and 14.00–15.99 years were compared with controls reviewed at 13 and 15 years of age, respectively. The subjects’ pubertal staging and height velocity were related to their treatment history.

Results: Sixty-five subjects were recruited; mean duration of treatment was 6.3 ± 1.9 years. At baseline, their growth parameters were not significantly different from those of the controls after adjusting for age. Compared with the controls, after adjusting for current age and baseline growth parameter z score, subjects aged 12.00–13.99 years had significantly lower weight and body mass index (P < 0.01), and those aged 14.00–15.99 years had significantly lower height and weight (P < 0.05). At 12.00–13.99 years of age, the subjects were comparable to the controls in their pubertal development adjusted for age, but those aged 14.00–15.99 years reported significant delay (mean Tanner stage, 3.6 for subjects v 4.0 for controls; P < 0.05). The dose of medication was inversely correlated with the height velocity from baseline to 14.00–15.99 years of age (P < 0.05).

CONCLUSION: Prolonged treatment (more than 3 years) with stimulant medication was associated with a slower rate of physical development during puberty. To maintain adequate height velocity during puberty, we recommend keeping the dose as low as possible.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:As a pediatrician, I don't know why anyone would recommend growth hormone injections for constitutional growth delay. It's just delayed puberty -- CGD itself doesn't have any effect on final height. They just reach it later.

Are you sure you don't mean "familial short stature?"

If it’s delayed puberty won’t he get a growth spurt later? My brother left high school at 5’10” and soon after got to his full height of 6’2”.

He will. It just means that his "constitution" is programmed to hit the growth spurt later, and usually one or both of his parents did the same. But it's not a deficiency of growth hormone or even of adult height.

More information is coming out about the risks of additional growth hormone over and above normal levels (not really relevant to true growth hormone or pituitary deficiency, which are separate diagnoses from constitutional growth delay). This issue isn't settled yet, but GH isn't without risks. And if the child is going to reach normal height, just later, I'm not sure why someone would pursue this.

https://www.webmd.com/children/news/20140813/children-prescribed-growth-hormone-may-face-stroke-risk-later-study
Children, Growth Hormone, & Possible Risk Later

https://www.nytimes.com/2021/03/29/well/live/growth-hormones-short-children-height.html
Weighing the Use of Growth Hormones for Children: New research has linked growth hormone treatment to serious adverse health effects years later

Speaking as an adult who had delayed puberty, it’s not just about height. Delayed puberty sets you back socially for years; many people completely miss the boat on normal adolescent development like dating in high school or college. It can take another decade to grow into your sexuality, and if that Carrie’s into one’s 20s it has domino effects on dating for marriage.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:As a pediatrician, I don't know why anyone would recommend growth hormone injections for constitutional growth delay. It's just delayed puberty -- CGD itself doesn't have any effect on final height. They just reach it later.

Are you sure you don't mean "familial short stature?"

If it’s delayed puberty won’t he get a growth spurt later? My brother left high school at 5’10” and soon after got to his full height of 6’2”.

He will. It just means that his "constitution" is programmed to hit the growth spurt later, and usually one or both of his parents did the same. But it's not a deficiency of growth hormone or even of adult height.

More information is coming out about the risks of additional growth hormone over and above normal levels (not really relevant to true growth hormone or pituitary deficiency, which are separate diagnoses from constitutional growth delay). This issue isn't settled yet, but GH isn't without risks. And if the child is going to reach normal height, just later, I'm not sure why someone would pursue this.

https://www.webmd.com/children/news/20140813/children-prescribed-growth-hormone-may-face-stroke-risk-later-study
Children, Growth Hormone, & Possible Risk Later

https://www.nytimes.com/2021/03/29/well/live/growth-hormones-short-children-height.html
Weighing the Use of Growth Hormones for Children: New research has linked growth hormone treatment to serious adverse health effects years later

Speaking as an adult who had delayed puberty, it’s not just about height. Delayed puberty sets you back socially for years; many people completely miss the boat on normal adolescent development like dating in high school or college. It can take another decade to grow into your sexuality, and if that Carrie’s into one’s 20s it has domino effects on dating for marriage.

I agree with this somewhat, yet also disagree somewhat. Maybe it depends on the degree of delay. My DH had delayed puberty and our oldest DS did/does also. I see how socially difficult it is and has been for my DS (currently 16)- although he has (finally) started, most would guess he is 14ish at most. On the other hand- my DH had a similar experience but was dating by senior of HS, had girlfriends in college etc. It was the worst in middle school through mid high school and then got better from there. It hurt DH in sports for sure (which in HS seemed like a big deal, and hurt socially in terms of making friends)- but he switched to a no-cut sport and busied himself with other things. My DS is doing the same.

Not disagreeing that it is really really tough, but I honestly don’t think the effects last into adulthood for most.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My son was very late to hit puberty and didn’t hit his growth spurt until 16. (His voice also didn’t change until then and he didn’t grow under arm or leg hair until then, either.)

Until about age 12 he always was on the tall side and then was significantly shorter than everyone else as most of the other boys were in the throes of puberty. I went to the ped with our concerns and she assured me he was a late bloomer.

He’s now 18 and 6’5” tall (and still growing it seems) and has committed to a D1 school to play a sport next fall.

Can I ask what sport, and how he managed to hang in there during the tiny years? My oldest was a very late bloomer and had to switch to track and cross country in HS- no way was he making any cut sports teams at his size (after playing club basketball and travel baseball for years). Ended up 6’2”. My younger DS is now 14 and is blooming “on time” but his smaller friends all started getting benched and/or cut last year (soccer and baseball). I really feel for them.

He is playing football in college if you can believe it- He’s always been a 3 sport athlete (soccer in the fall until freshman year) and goes to a private school (not one of the all boys ones) so there are definitely more opportunities. He played travel/club through 8th, but since then only has played for his school.

When they ask, my advice to friends with younger kids is to have their kid(s) play as many sports as possible as long as possible especially at the rec level. Rec sports are awesome. Avoid specializing in one sport too early at all costs. This was the first year my son didn’t play basketball and baseball and that’s only because he was so behind as far as strength goes. We didn’t want him lifting until he was done most of his growing. He spent the winter/spring lifting and working on skills specific to football. This year he’ll likely play basketball and baseball since he’s committed.

Also, the grass is brown everywhere when it comes to travel/club- so many politics. I’ve seen really talented kids get cut in lots of sports.

I also believe that travel/club sports have, in many ways, ruined sports for kids and all they are is a big money grab. Probably not popular opinion in these parts, but looking back at my kids’ experiences I can say that with full confidence.

Football is a sport that players really don’t do travel sports or club sports. And football takes more skill than most people understand. Why would he risk injury by playing basketball when he’s been recruited to a D1 school? It’s not worth it.

[Anonymous]

Anonymous wrote:

Anonymous wrote:My son was very late to hit puberty and didn’t hit his growth spurt until 16. (His voice also didn’t change until then and he didn’t grow under arm or leg hair until then, either.)

Until about age 12 he always was on the tall side and then was significantly shorter than everyone else as most of the other boys were in the throes of puberty. I went to the ped with our concerns and she assured me he was a late bloomer.

He’s now 18 and 6’5” tall (and still growing it seems) and has committed to a D1 school to play a sport next fall.

Can I ask what sport, and how he managed to hang in there during the tiny years? My oldest was a very late bloomer and had to switch to track and cross country in HS- no way was he making any cut sports teams at his size (after playing club basketball and travel baseball for years). Ended up 6’2”. My younger DS is now 14 and is blooming “on time” but his smaller friends all started getting benched and/or cut last year (soccer and baseball). I really feel for them.

NP here. I have a 14 year old baseball player and he's played teams that are just enormous. His team has a very wide range of sizes- a few are around 5'10" while two are under 5'. Always wondered if coaches are weeding out players based on height or if tall kids self-select for those teams.