Can I consider HGH therapy for pubertal delay at 18?

Question

Hello doctor,

I am an 18-year-old male. I have a family history of pubertal delay; for example, my father grew eight inches taller at age 17. I am below my expected mid-parental height.

I was wondering, at what bone age specifically is it not worth considering HGH therapy to normalise height?
If the bone age is 17 or 16.5, for example, and the growth plates are open, would it be worth considering?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern about your height.

What I can tell you is that growth hormone therapy for increasing height becomes significantly less effective or not worthwhile once the growth plates are close to fusing, which typically corresponds to a bone age around 16 years or higher in males, as this is when most remaining growth potential is very limited or essentially exhausted.

Many clinical guidelines and studies consider growth largely complete at a bone age of 16 years or more in boys, with therapy often discontinued at that point or when growth velocity drops below about 0.78 inches per year, since further meaningful height gain is unlikely even with treatment.

In cases of constitutional delay of growth and puberty, like the family history you describe with your father's late growth spurt, a delayed bone age offers more potential for natural catch-up growth over time, and hormone therapy is rarely needed unless the predicted adult height is substantially below target.

For a bone age of 16 or 16.5 years with still-open growth plates, the potential benefit from growth hormone is usually quite modest compared to starting earlier, often amounting to only a few centimeters at best in idiopathic short stature or similar situations, and the response tends to diminish as skeletal maturation advances.

Some studies show that even short courses of therapy in late adolescence or near-adult bone ages can add height in select cases, but the gains are smaller than in prepubertal or early pubertal stages.

The decision depends heavily on factors like your current growth velocity, the exact degree of plate openness on imaging, predicted adult height versus mid-parental target, and overall health assessment.

Given your age of 18 and family pattern of delayed but eventual growth, a thorough evaluation by a pediatric endocrinologist would be essential to review the following before considering therapy:

Specific bone age X-ray.
Recent growth rate.
Pubertal status.
Height predictions.

I hope this helps.

Thank you.