Limitations
testis
Measurements of testis volume (primary outcome) were performed according to clinical practice in pediatric endocrinology by a few (three) doctors. Ultrasound is a more accurate method but is not yet clinically used in our pediatric endocrine unit.Another limitation of our study is that we lack information about the adult testicle volume from our study cohort.Although we have long clinical experience with TE, it has not been evaluated in clinical trials for pubertal development. Without these data, it was difficult to power a study to detect a potential difference in new treatments. Therefore, in the present design, the new treatment was considered clinically similar if its results were 80%–125% of the results of traditional treatment.A limitation is that we do not know the spontaneous progression of puberty in our study cohort. It was not possible to have a control group or a placebo due to the clinical care in our unit. The 