Dynamic interactions among growth hormone, IGF-1, and sex steroidal hormones have a major role in the achievement of full height potential and the body composition changes in adolescence. Testosterone and estrogen affect the growth hormone neuroendocrine rhythms, and growth hormone, in turn, potentiates many of the metabolic actions of the sex steroids. Leptin is also thought to have a key regulatory role in the process of sexual development in the child, but the precise nature of these interactions is unclear. The targeted replacement of hormonal deficiencies in puberty and manipulation of the timing of pubertal maturation have resulted in better strategies to treat profoundly short children during this period; however, more research is needed to determine the consequences of such approaches in aspects of metabolism other than linear growth.