What are current treatment options and long-term outcomes for boys diagnosed with central precocious puberty?

1. What “central” means and why boys are evaluated differently

Central CPP is premature activation of the hypothalamic‑pituitary‑gonadal axis leading to testicular enlargement in boys before age 9 ^[2]. Because boys with CPP more often have an identifiable organic cause — intracranial lesions, prior cranial irradiation, trauma or genetic syndromes — neuroimaging and etiologic workup are routine in boys, and clinicians have a lower threshold to search for central nervous system pathology than they do for girls ^{[3] [6]}.

2. First‑line treatment: GnRH agonists — mechanism and common agents

Long‑acting GnRHa are the internationally accepted first‑line therapy; they desensitize the pituitary to GnRH, suppress luteinizing hormone (LH) and follicle‑stimulating hormone (FSH), slow sex steroid production and therefore pause pubertal progression and bone‑age advancement ^{[1] [7]}. Common agents and delivery forms mentioned in the literature and market reports include leuprolide (monthly or 3‑month depot), triptorelin, histrelin implants and intranasal or subcutaneous older formulations ^{[8] [9] [10] [11]}.

3. Goals of treatment and typical monitoring

The principal clinical aims are to (a) preserve final adult height by slowing skeletal maturation, (b) stop or reverse secondary sexual changes, and (c) address psychosocial concerns; treatment is usually continued until a physiologic age of puberty is appropriate (often cessation around ages suggested in guidelines: roughly 12–14 for boys, with Korean guidelines noting 13–14 years as helpful for FAH) ^{[12] [13]}. Monitoring includes auxology (height, growth velocity), bone age, pubertal staging and hormone markers to ensure suppression and to time treatment discontinuation ^{[14] [12]}.

4. Evidence on height outcomes in boys

Data on boys are smaller but consistent: retrospective cohorts and focused studies report that GnRHa increases predicted adult height (PAH) and final adult height (FAH); one PLOS One cohort found PAH increased ~4.1 cm after GnRHa in boys and FAH exceeded predicted heights ^[4]. Narrative and systematic reviews conclude “overall positive final adult height outcomes” in boys, while noting heterogeneity, small samples and methodological limits ^{[15] [3]}.

5. Long‑term safety: fertility, bone density, metabolic health

Long‑term follow‑up literature and reviews summarize generally reassuring outcomes: most studies show recovery of hypothalamic‑pituitary‑gonadal function after stopping therapy, normalization of bone mineral density over time, and no clear, consistent long‑term harms to fertility or cardiometabolic health — though quality and quantity of data (especially in boys) are limited and some uncertainties remain around risks such as PCOS in girls or transient decreases in BMD during treatment ^{[16] [5] [7]}. Reviews repeatedly stress the need for higher‑quality, long‑term controlled studies ^{[5] [16]}.

6. When additional therapies or combinations are considered

Some centers and studies report combining growth‑promoting treatments (e.g., recombinant human growth hormone) with GnRHa in selected patients, but systematic reviews call this approach controversial and state evidence is low‑certainty; such combined approaches are individualized and debated in recent meta‑analyses ^[17]. No widespread consensus supports routine combination therapy for boys ^[17].

7. Gaps, uncertainties and practical implications for families

Clinical consensus supports GnRHa for boys with rapidly progressing CPP or when an organic cause is found, but available sources emphasize limited male‑specific randomized data, variable reporting of psychosocial outcomes, and incomplete long‑term surveillance for bone, metabolic and reproductive endpoints ^{[3] [5] [16]}. Parents should expect etiologic evaluation (including neuroimaging in boys), discussion of height and psychosocial goals, review of GnRHa options and schedules, and planned monitoring during and after treatment ^{[6] [1]}.

8. Bottom line

For boys diagnosed with CPP, current standard care is GnRHa depot therapy to suppress puberty and protect adult height, with cohort and review data showing generally favorable height and long‑term outcomes but limited male‑specific randomized evidence and remaining uncertainties that warrant individualized care and long‑term follow‑up ^{[1] [4] [5]}.