Practice variation in the management of girls and boys with delayed puberty

Jia Zhu, Henry A. Feldman, Erica A. Eugster, Patricia Y. Fechner, Leena Nahata, Paul S. Thornton, Yee Ming Chan

Research output: Contribution to journalArticle

1 Scopus citations


Objective: Delayed puberty is a common condition, and typical management includes “watchful waiting” and/or sex-steroid therapy. We sought to characterize treatment practices and to assess provider comfort with the management of delayed puberty in girls and boys. Methods: A national survey of pediatric endocrine providers assessed definitions of delayed puberty, practices around sex-steroid therapy, reasons for treatment, and comfort in managing delayed puberty in girls and boys. Results: Of 184 respondents (12% participation rate), 64% and 71% used the traditional age cutoffs for defining delayed puberty of 13 years for girls and 14 years for boys, respectively. Nearly half (45%) of providers would treat boys relatively earlier than girls, compared to 18% who would treat girls relatively earlier (P<.0001). Providers were more likely to cite bone density as a reason to treat girls and alleviating patient and parental distress, accelerating growth, and “jump starting” puberty as reasons to treat boys. Greater experience in endocrine practice was associated with greater comfort managing delayed puberty in both boys and girls. Approximately 80% of providers agreed that clinical guidelines are needed for the management of delayed puberty. Conclusion: There is a high degree of variability in the clinical management of delayed puberty, and our results suggest that providers are more hesitant to treat girls compared to boys and have different reasons for treating each. It remains to be determined if these discrepancies in treatment are justified by biologic differences between girls and boys or represent nonevidence-based disparities in care.

Original languageEnglish (US)
Pages (from-to)267-284
Number of pages18
JournalEndocrine Practice
Issue number3
StatePublished - Mar 2020
Externally publishedYes

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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    Zhu, J., Feldman, H. A., Eugster, E. A., Fechner, P. Y., Nahata, L., Thornton, P. S., & Chan, Y. M. (2020). Practice variation in the management of girls and boys with delayed puberty. Endocrine Practice, 26(3), 267-284.