Editing Delayed puberty (section)

=== Genetic or acquired defect of the hormonal pathway of puberty (hypogonadotropic hypogonadism) ===
Boys aged >12 years old with [[hypogonadotropic hypogonadism]] are most often treated with short-term testosterone while males with testicular failure will be on life-long [[testosterone]].<ref name=":7" /><ref name=":10">{{cite journal | vauthors = Watson S, Fuqua JS, Lee PA | title = Treatment of hypogonadism in males | journal = Pediatric Endocrinology Reviews | volume = 11 | pages = 230–9 | date = February 2014 | issue = Suppl 2 | pmid = 24683947 }}</ref><ref name="legato">{{cite book | veditors = Legato MJ | editor-link = Marianne Legato | date = 2004 | title = Principles of Gender-Specific Medicine | volume = 1–2 | isbn = 978-0-12-440905-7 | page = 22 | last1 = Legato | first1 = Marianne J. | last2 = Bilezikian | first2 = John P. | publisher = Elsevier Science }}</ref> Choice of formulation (topical vs injection) is dependent on the child's and family's preference as well as on how well they tolerate side effects.<ref name=":10" /> Although testosterone therapy alone will result in the start of puberty, to increase fertility potential, they may need pulsatile GnRH or hCG with rFSH.<ref name=":7" /><ref name=":10" /> hCG can be used by itself in boys with spontaneous onset of puberty from non-permanent forms of [[hypogonadotropic hypogonadism]] and rFSH can be added in cases of low sperm count after 6 to 12 months of treatment.<ref name=":7" />

If puberty has not started after 1 year of treatment, then permanent [[hypogonadotropic hypogonadism]] should be considered.<ref name=":7" />

Girls with hypogonadotropic hypogonadism are started on the same sex steroid therapy as their counterparts with a constitutional delay, however doses are gradually increased to reach full adult replacement levels.<ref name=":7" /> Dosage of estrogen is titrated based on the woman's ability to have withdrawal bleeds and to maintain appropriate bone density.<ref name=":7" /> Induction of fertility must also be done through pulsatile GnRH.<ref name=":7" />