Sex Differences in Pediatric and Adolescent Endocrinology: What Are the Origins?

BACKGROUND

Endocrine disorders appear to be unevenly distributed between females and males in pediatric endocrinology.

SUMMARY: This narrative review collects causes from nurture and nature that may contribute to these differences in prevalence. For this purpose, the scientific literature from 1990 to 2025 was evaluated using the keywords sex-specific difference, gender-specific difference, sex difference, gender difference in combination with the endocrine disorder being treated.

KEY MESSAGES: One identified reason for sex differences in pediatric and adolescent endocrinology is arbitrary thresholds regarding the timing of puberty, which may favor the diagnosis of precocious puberty in females. Another reason for sex differences appears to be the different severity of psychosocial stress, which may contribute to sex differences, with males more frequently diagnosed with delayed puberty and growth hormone deficiency (GHD). Possibly contributing biological factors include the different regulation of endocrine processes in both sexes, which imply lower or higher homeostatic stability. Such sex dimorphism of biology has been described for the regulation of GH and LH/FSH. Therefore, nature may have an additional impact on sex disparities in GHD and precocious puberty. Less convincing data on the influence of nature were available for delayed puberty. This review can aid physicians to critically review their individual clinical practice and refrain from prematurely diagnosing and treating healthy children when therapeutic interventions are not truly warranted.