Children with constitutional delay of growth and puberty do not require specific medical therapy. Emotional support for the child, counseling as indicated, and reassurance are often all that are needed. Pointing out early signs of puberty, often overlooked by the child, is also helpful. However, since most of these children are presumed by others to be younger than their chronologic age and are often ridiculed by their classmates, they may experience profound psychological effects, including poor self-esteem, social isolation, and prolonged parental dependence. Furthermore, pubertal delay has adverse effects on bone accretion, with decreased peak bone mass and consequent osteopenia in adulthood.119 For these reasons, as well as for the diagnostic benefit previously discussed, it is appropriate to consider a brief course of sex steroids in children with CDGP to promote short-term growth and pubertal development. Studies have clearly shown the benefit of treatment on physical
development and emotional well-being, and previous concerns about significant advancement of the bone age with resultant negative effects on final adult height are unfounded.120

The mainstay of therapy for boys with delayed puberty is testosterone, typically given as one of the long-acting esters, testosterone cypionate or testosterone enanthate. It is quite safe and has few side effects, except for the normal signs of puberty, including mood changes, gynecomastia, and increased erections. An oral testosterone ester, testosterone undecanoate, is available for use, but its efficacy may be limited by its variable oral absorption.121 Testosterone patches are also widely available, but exact dosing for pubertal induction has not been established.