Puberty promoting low dose testosterone treatment improved wellbeing and emotional state in boys with self-limited delayed puberty

OBJECTIVES: To evaluate changes in health-related quality of life in boys aged 14-16 years with delayed or slowly progressing puberty before and after low-dose testosterone treatment. Delayed puberty can cause short stature, emotional distress, and social challenges. Testosterone therapy promotes growth and masculinization, but its impact on quality of life remains poorly understood. Few studies have assessed psychosocial outcomes using validated instruments. METHODS: Twenty-seven boys enrolled in the Pubertal Replacement in Boys Study and were randomized to testosterone enanthate (75 mg/month for 6 months; n=12) (n=12) or testosterone undecanoate (n=12) (250 mg every 3 months; n=15). Standardized self-report questionnaires assessed generic quality of life (primary outcome), stature-specific quality of life, depressive symptoms, and enjoyment of physical activity. Assessments were conducted at baseline, 6 months, and 12 months. RESULTS: Twenty-six boys completed the study. Both regimens induced pubertal progression and a mean growth of 9.3 cm 12 months after start of replacement treatment. Significant improvements were observed in generic quality of life and depressive symptoms, with early gains sustained through 12 months. No changes were detected in stature-specific quality of life or enjoyment of physical activity. No statistical differences were found between treatment groups at 6 or 12 months. Exploratory analyses suggested that baseline testosterone serum levels were modestly associated with changes in social functioning, whereas later serum levels showed no such relationship. CONCLUSIONS: Low-dose testosterone therapy improves generic quality of life and mood in boys with self-limited delayed puberty, likely reflecting successful pubertal progression. These findings highlight the importance of psychosocial outcomes as indicators of treatment success, beyond growth acceleration, and support structured follow-up to address the emotional needs of adolescents with delayed puberty.