Counsel an adolescent boy and his family on delayed puberty — OSCE

Candidate brief

You have eight minutes to counsel a distressed fourteen-year-old boy and his parents on constitutional delay of growth and puberty. Use a structured, honest, empathic approach that acknowledges the psychosocial burden, explains the reassuring natural history, addresses the family's anxiety about growth hormone, and lays out the option of a short course of testosterone as a shared decision. [1] [2]

Key teaching and communication objectives

Acknowledge and validate the boy's distress and the parents' anxiety before delivering information. Address the boy directly as well as the parents, and allow him to voice what bothers him most about the delay. [2]

Explain the diagnosis in plain language: his body clock is running late rather than being broken, his bone age matches his height age, puberty will begin on its own, and his final adult height will be normal for the family. Reinforce this with the family history (his father shaved at seventeen) and the cohort evidence that boys with constitutional delay reach standard adult height without treatment. [2] [3]

Address the growth-hormone question directly and honestly: growth hormone does not raise the final height of a true normal variant, so it would expose him to years of daily injections, cost, and side effects without a meaningful benefit. Frame the principle as treating the distress, not the height. [1]

Lay out the option of a short course of testosterone — a representative dose, a three-to-six-month course, specialist-initiated, with the goal of accelerating the onset of puberty and relieving the distress — as a genuine choice rather than a default. Confirm that it does not compromise his final height. Offer the family time to decide, schedule a review to confirm the trajectory, and provide written information and a named contact. [2] [3]