Normal male children begin to show signs of puberty such as accelerated height gain, pubic hair growth, and testicular enlargement around 10-12. These are normal pubertal changes. A very small percentage of males have delayed pubertal development and may not develop puberty until 18-20 years of age. They are normal variations and cannot yet be considered a disease. However, there are some adolescents who do not show any signs of puberty, no enlargement of the penis or testicles, no growth of pubic hair, and even no change in the voice of a child. These manifestations are called “pubertal immaturity”. Children with pubertal immaturity need to be diagnosed and treated in a hospital. Some of the most common disorders of pubertal dysplasia include Kallmann syndrome, hypogonadotropic hypogonadism, Klinefelter syndrome, and testicular insufficiency. They are described below. Kallmann syndrome: The clinical manifestation is pubertal dysplasia, accompanied by hyposmia or loss of sense of smell. The first question for patients with pubertal immaturity is “can you smell? In Kallmann’s syndrome, 1/3 of patients have genetic mutations, and in 2/3 of patients, the exact cause of the disease is still unclear. When androgen replacement therapy is routinely given, patients can show normal masculinization and be able to have a normal sexual life in the future. If FSH and LH replacement therapy is given, it can promote testicular growth and development, and most patients can solve their fertility problems. This treatment option is inexpensive at a cost of $600-800 per month if domestic drugs are chosen. If you choose a premium drug, the cost is about $3,000 per month. There is also the option of LHRH pump therapy. The price of a pump is a little over $30,000, and the cost of medication and consumables is about $1,000 per month. Hypogonadotropic hypogonadism: This disease is caused by a hypothalamic lesion that prevents the pituitary gland from regularly secreting FSH and LH, two hormones that promote the growth and development of the testes and promote the production of androgens and sperm. The treatment of this disease is similar to that of Kallmann syndrome. Androgens can be given to help the patient to complete the process of puberty and to be able to have a normal sexual life in the future. As for fertility, in most patients, this can be resolved by injections of HMG (or FSH) and HCG. Treatment is usually required for 1-2 years. In some patients with good results, sperm production is possible after about 9 months of treatment. In most patients, it takes 1.5 years of treatment to produce sperm. Currently, Concordia Hospital has been carrying out the treatment of such patients with GnRH pumps. Klinefelter’s syndrome: Also known as “Klinefelter’s syndrome”, it is caused by a lesion in the testes themselves. These patients may have varying degrees of pubertal development, but have decreased sperm and androgen production in the testes due to vitellogenic degeneration of the varicoceles in the testes. These patients usually have a chromosome of 47, XXY predominant, with various other subtypes. In these patients, the administration of androgen replacement therapy can restore normal masculine expression and allow normal sexual activity. However, because of the lesions produced by the testes themselves, most patients are unable to produce sperm and lose their fertility. Medication basically cannot restore fertility. Other testicular diseases causing hypogonadism include inflammation of the testes due to complications from mumps virus infection, and damage to the testes from trauma, radiation therapy and chemotherapy. All of these causes can lead to decreased androgen levels in men, and depending on the condition, androgen replacement therapy needs to be considered. In androgen replacement therapy, it is necessary to routinely monitor height, weight, various biochemical indicators and changes in bone density, because androgens have an important impact on various biochemical indicators and bone density. More importantly, attention should be paid to patients’ psychosexual health and self-confidence development. These patients often have a heavy sense of inferiority due to the absence of normal pubertal development. Timely administration of androgen replacement therapy, as well as psychological guidance and confidence support, can have a significant impact on the patient’s life.