Delayed Puberty (Pubertas Tarda): Drug Therapy

Therapeutic target

In cases of proven hypogonadism (endocrine dysfunction of the testes leading to testosterone deficiency), induction of puberty.

Active substances (main indication) – in girls

Estrogens/gestagens

Active ingredients Dosage Duration of therapy
Estradiol valerate 0.2 mg/d (day of month: 1-28) 6 months
Estradiol valerate 0.5 mg/dmonth 1-28) 6th-12th month
Estradiol valerate +chloromadinone acetate 1-1.5 mg/d (day of month: 1-28)2 mg/d (day of month: 1-12) In 2nd year (Tanner stage B3: glandular body > areola (nipple areola), flowing contour between areola and breast body).
Estradiol valerate +chloromadinone acetate 2 mg/d (day of month: 1-28)2 mg/d (day of month: 1-12) From the 3rd year
Alternative to chloromadionoacetate
Progesterone (micronized) 200 mg/d
Dydrogesterone 10 mg/d

Active substances (main indication) – in boys

Hypogonadotropic hypogonadism (start: 13-14 years of age)/complete hypergonadotropic hypogonadism (start: 12-13 years of age)testosterone.

Active ingredient Dosage Duration of therapy
Testosterone enanthate 50 mg i.m. every 4 weeks. 1st-6th month
Testosterone enanthate 100 mg i.m. every 4 weeks. 7-12 months
Testosterone enanthate 250 mg i.m. every 4 weeks. 2nd year
Testosterone enanthate 250 mg i.m. every 3 weeks.

Partial hypergonadotropic hypogonadismTestosterone.

Active ingredient Dosage Special features
Testosterone enanthate 100-250 mg i.m. every 4 weeks. Start when morg. Testosterone serum concentration below age norm at pubertal age.

Constitutional/biological developmental delay (with pronounced psychological stress!)

Testosterone

Active substance Dosage Duration of therapy
Testosterone enanthate 100 mg i.m. every 4 weeks Month 1-6; month 7-12 pauseReevaluate after month 12.
  • Side effects: Acne, mood swings, aggressiveness, premature epiphyseal closure.
  • In hypogonadotropic hypogonadism can be alternatively started with hCG-/rhFSH administration (s.c.); also pulsatile GnRH therapy is possible → if male phenotype achieved, testicular growth completed as well as fertility, then can be further treated with testosterone until childbearing.