When a teenage boy presents with concerns about delayed pubertal development, the most likely diagnosis is constitutional delayed puberty (CDP) (Table 1). In one series of 232 children (including 158 boys) who had delayed puberty seen at Boston Children's Hospital, 63% of the boys had CDP. (1) Such boys generally are healthy but short (below the 10th percentile and often well below the 3rd percentile), with penile length normal for a prepubertal boy (usually 6 to 7 cm stretched) and testes that measure 2.5 cm or less in length (or <4 mL in volume with a Prader orchiometer) (Table 2).
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