Editing Delayed puberty (section)

=== Primary failure of the ovaries or testes (hypergonadotropic hypogonadism) ===
Whereas children with constitutional delay will have normal levels of sex hormones post-puberty, gonadotropin deficiency or hypogonadism may require lifelong sex steroid replacement.<ref name=":1" />

In girls with [[primary ovarian failure]], [[estrogen]] should be started when puberty is supposed to start.<ref name=":0" /> [[Progestin]]s are usually added after there is acceptable breast development, about 12 to 24 months after starting estrogen, as starting treatment with progestin too early can negatively affect breast growth.<ref name=":0" /> After acceptable breast growth, administering [[estrogen]] and [[progestin]] in a cyclical manner can help establish regular menses once puberty is started.<ref name=":6" /><ref name=":9" /> The goal is to complete sexual maturation over 2 to 3 years.<ref name=":0" /> Once sexual maturation has been achieved, a trial period with no hormonal therapy can determine whether or not the child will require life-long treatment.<ref name=":1" /> Girls with congenital GnRH deficiency require enough sex hormone supplementation to maintain body levels in the expected pubertal levels necessary to induce ovulation, especially when fertility is a concern.<ref name=":0" />

Males with primary failure of the testes will be on lifelong [[testosterone]].<ref name=":14" />

Pulsatile GnRH, weekly multi-LH, or hCG and FSH can be used to induce fertility in adulthood for both males and females.<ref name=":7" /><ref name=":9" />