Because of the arbitrary nature of thresholds for normal results on provocative GH tests, children with otherwise unexplained short stature and normal provocative GH test results may be considered to have GH deficiency if they meet most of the following criteria: Height > 2.25 standard deviations (SD) below the mean for age or > 2 SD below the midparental height percentile Growth velocity < 25th percentile for bone age Bone age > 2 SD below the mean for age Low serum insulin - like growth factor 1 (IGF-1) and IGF binding protein type 3 (IGFBP-3) levels Other clinical features suggesting growth hormone deficiency Because GH levels rise during puberty, many children who fail provocative GH stimulation testing before puberty may have normal results after puberty or when primed with gonadal steroids.