A big review looked at kids with early puberty and compared using just a GnRH drug (like gonadorelin) versus adding other hormones such as growth hormone, stanozolol, oxandrolone, or estrogen. Adding growth hormone gave kids a few extra centimeters of predicted adult height and faster growth, but the studies were quite mixed and not all the data were solid. Other drugs showed some promise, but there isn’t enough evidence yet. The benefits were bigger when treatment lasted longer or used higher growth‑hormone doses.

Central precocious puberty (CPP) can reduce adult height. Studies comparing the efficacy of gonadotropin-releasing hormone analogue (GnRHa) monotherapy with combination therapies show inconsistency. To synthesize evidence comparing the effects of GnRHa monotherapy and combination therapies on height-related outcomes in children with CPP. PubMed, EMBASE, Cochrane Library, Wanfang Data, and CNKI through December 31, 2024. Randomized controlled trials (RCTs) and cohort studies involving children ≤12 years with CPP or early puberty, reporting height-related outcomes and a ≥ 6-month follow-up. Data were pooled using common- or random-effects models and reported as mean differences (MDs) with 95% confidence intervals (CIs) for primary outcomes, including height gain (adult height minus pretreatment predicted adult height [PAH]), PAH change (posttreatment PAH minus pretreatment PAH), and growth velocity (GV) in children with CPP. 70 studies (30 RCTs and 40 cohort studies; 5,266 children) were included. Growth hormone (GH) combination therapy significantly improved PAH change (MD, 3.48 cm; 95% CI, 2.98 to 3.98) and GV (MD, 1.82 cm/year; 95% CI, 1.32 to 2.31) in RCTs, and height gain (MD, 3.81 cm; 95% CI, 2.77 to 4.84) and PAH change (MD, 3.06 cm; 95% CI, 2.26 to 3.86) in cohort studies, compared with GnRHa monotherapy. However, high heterogeneity remains across outcomes, even after subgroup analysis of treatment duration and GH dose, which limits the certainty of these findings. Stanozolol, oxandrolone, and estrogen showed improved growth outcomes, although evidence was limited. Longer treatment durations and higher GH doses were associated with greater benefits. GH combination therapy enhances growth outcomes in children with CPP compared to GnRHa alone. Stanozolol, oxandrolone, and estrogen show promise but require further research. Personalized combination regimens and additional long-term RCTs are needed, particularly involving male patients and non-GH adjunctive therapies.