Asian Journal of Research and Reports in Endocrinology

Delayed puberty in adolescent boys arises most commonly from a self-limited maturational variant, constitutional delay of growth and puberty, but must be distinguished from permanent hypogonadotropic or hypergonadotropic hypogonadism before hormonal treatment is selected, because the two conditions demand fundamentally different therapeutic goals. This critical narrative review synthesises the available evidence on testosterone and human chorionic gonadotropin as therapeutic agents across these three clinical contexts. Short courses of low-dose testosterone reliably accelerate short-term growth and pubertal maturation in constitutional delay, with reassuring although methodologically limited evidence regarding near-adult height, whereas human chorionic gonadotropin, generally combined with follicle-stimulating hormone preparations, has emerged as a physiologically directed alternative to testosterone monotherapy in hypogonadotropic hypogonadism because it stimulates testicular growth and spermatogenic potential rather than producing virilisation alone. The review critically appraises diagnostic strategies for differentiating constitutional delay from hypogonadotropic hypogonadism, including gonadotropin-releasing hormone agonist and human chorionic gonadotropin stimulation testing and adjunctive biomarkers such as inhibin B and anti-Müllerian hormone, and considers the distinct management questions raised by Klinefelter syndrome, in which hypergonadotropic hypogonadism follows a different natural history. Across all three contexts, the evidence base is characterised by small sample sizes, heterogeneous dosing regimens, short follow-up, and a scarcity of trials incorporating validated patient-reported and fertility-related outcomes. Bone health, psychosocial wellbeing, and long-term reproductive potential are increasingly recognised as central outcomes but remain inconsistently measured. This review integrates evidence across diagnostic, therapeutic, and psychosocial domains to clarify what is well supported, what remains provisional, and where the principal contradictions in the literature lie, and it proposes methodologically robust priorities for future research, including harmonised diagnostic thresholds, adequately powered comparative trials of gonadotropin regimens, and longitudinal assessment of fertility and bone outcomes into adulthood.