GNRH1 and precocious puberty: Guidelines for hormonal therapies are established and usage before the age of 16 years can be initiated, although there is limited published data before 14 years of age.15 The off-label use of GnRH agonists in children with normally timed puberty more than doubled (12–29%) from 2013 to 2016, whereas its use to treat precocious puberty (FDA-approved indication) increased only slightly.101 A similar temporal trend showing a dramatic rise in use of histrelin implants (from 0 to 63) among TG children occurred from 2004 to 2016 using data from the Pediatric Health Information System.102