# Sex Steroid Priming on Growth Hormone Stimulation Test: A Scoping Review

## TL;DR

Using sex steroids before growth hormone testing can improve test accuracy in children, reducing false diagnoses of growth hormone deficiency.

## Contribution

This review identifies how sex steroid priming enhances GH responses and suggests ways to standardize protocols for better diagnostic outcomes.

## Key findings

- Sex steroid priming increases GH peak responses in peripubertal children during GH stimulation tests.
- Estrogen and testosterone enhance GH secretion, but effects depend on dose, duration, and individual factors.
- Preliminary evidence suggests priming may reduce false-positive GHD diagnoses.

## Abstract

What are the main findings?
Sex steroid priming before GH stimulation testing increases GH peak responses in many peripubertal children, reducing the risk of false-positive GHD diagnoses.Both estrogen (girls) and testosterone (boys) enhance spontaneous and stimulated GH secretion, though effects vary with dose, duration, route, and individual factors.

Sex steroid priming before GH stimulation testing increases GH peak responses in many peripubertal children, reducing the risk of false-positive GHD diagnoses.

Both estrogen (girls) and testosterone (boys) enhance spontaneous and stimulated GH secretion, though effects vary with dose, duration, route, and individual factors.

What is the implication of the main finding?
Priming may improve the diagnostic accuracy of GH testing and help distinguish true GHD from temporary low GH responses due to low sex steroid levels.Standardized priming protocols and inclusion of additional biomarkers (IGF-1, IGFBP-3, adipokines, and kisspeptin) could optimize clinical decision-making. Future studies should focus on multicenter trials, patient-centered outcomes, and predictive algorithms to guide individualized management.

Priming may improve the diagnostic accuracy of GH testing and help distinguish true GHD from temporary low GH responses due to low sex steroid levels.

Standardized priming protocols and inclusion of additional biomarkers (IGF-1, IGFBP-3, adipokines, and kisspeptin) could optimize clinical decision-making. Future studies should focus on multicenter trials, patient-centered outcomes, and predictive algorithms to guide individualized management.

Background/Objectives: Growth hormone (GH) secretion and activity are closely modulated by sex steroids, particularly during puberty, when GH response to stimulation tests (GHSTs) may be blunted in children with low circulating sex steroids. This systematic review evaluates the role of sex steroid priming in enhancing GH secretion during GHST and improving diagnostic accuracy especially in peripubertal children with GH deficiency (GHD). Methods: We conducted a medical literature review to assess the use of sex steroid priming in children undergoing GHST; our search was carried out via PubMed after paper selection based on strict eligibility criteria. Results: Seventeen studies published between 1969 and 2022 were analyzed overall, which corresponded to a total number of 1097 participants. Most studies reported a significant increase in GH peak levels after priming, reducing false-positive GHD diagnoses. However, protocols varied considerably in hormone type, dosage, and administration, and some studies showed no benefit in the case of a true GHD. Conclusions: While sex steroid priming appears to improve GHST specificity in GHD without negatively impacting growth outcomes, standardized guidelines about pre-administration of exogenous sex steroids are currently lacking, and further prospective studies are needed to define its diagnostic potential.