Frequently Asked Questions About Growth, Thyroid, and Hormone Care
This FAQ page answers the most common questions we hear about pediatric growth and puberty concerns, thyroid conditions, and hormone care for perimenopause and menopause. Each answer is written in plain language so you can understand symptoms, testing options, and what next steps may look like.
This content is for education only, and your clinician should confirm what applies to your situation.
What does a pediatric endocrinologist treat?
We care for children with growth concerns, early or delayed puberty, thyroid issues, and hormone-related conditions that affect development, mood, or metabolism.
Do I need a referral to make an appointment?
No referral is needed. You can schedule directly with us. There are no insurance approvals or delays.
What is direct-pay care?
Direct-pay means you work with us directly rather than through insurance. This allows for longer visits, quicker access, clear pricing, and a more personal connection with your doctor.
What does the initial visit include?
The first visit includes a full hour with Dr. Pauley to review your child’s growth history, symptoms, and overall health. The goal is clarity, options, and a plan.
How much does it cost?
The initial consultation is $495. Ongoing care is $195 per month and includes quarterly visits and access to Dr. Pauley via email, text, or call. The labs and additional services are priced separately, or you can use your insurance. We also offer a Growth membership, which also includes bone ages at the time of the visit.
What if I only want one visit or a second opinion?
That is perfectly fine. Many families come for a one-time visit or a second opinion. We are happy to offer insight even if you do not continue ongoing care.
When should I worry that my child is not growing normally?
A growth concern is worth evaluating when a child is growing much more slowly than before, dropping percentiles on the growth chart, or growing at a rate that does not match family height patterns. A growth evaluation focuses on the growth trend over time, overall health, nutrition, and hormone-related causes.
What is a growth evaluation?
A growth evaluation is a step-by-step review of growth history and development that may include a detailed medical history, a review of growth charts, a physical exam, and targeted testing to understand why growth is slower than expected.
What is a bone age X-ray, and why is it used?
A bone age X-ray is an imaging test of the hand and wrist that estimates skeletal maturity and helps predict how much growth time remains. A bone age X-ray can help clarify whether a child is maturing earlier, later, or on time for their age.
What is growth hormone deficiency?
Growth hormone deficiency is a condition in which the body does not produce enough growth hormone for typical growth and development. Growth hormone deficiency is diagnosed through a comprehensive evaluation that assesses growth patterns and may include specialized testing.
What is a growth hormone stimulation test (stim test)?
A growth hormone stimulation test, also called a stim test, is a structured test that checks how the body releases growth hormone after specific medications are used to stimulate release. A stim test is typically used when the growth history and initial testing suggest growth hormone deficiency.
What is growth hormone therapy, and how is it decided?
Growth hormone therapy is a treatment that uses growth hormone medication to support growth in children who meet medical criteria. Growth hormone therapy decisions are based on a child’s growth pattern, medical history, exam findings, and testing results.
Will growth hormone therapy guarantee my child will reach a certain height?
Growth hormone therapy does not guarantee a specific adult height. Growth hormone therapy outcomes vary based on the underlying diagnosis, age at treatment start, genetics, and how a child responds over time.
What is delayed puberty?
Delayed puberty is when puberty starts later than expected, commonly defined as no breast development by about age 13 in girls or no signs of puberty by about age 14 in boys. Delayed puberty can be a normal family pattern or related to medical or hormonal causes.
What is early puberty (precocious puberty)?
Early puberty, also called precocious puberty, is when puberty starts earlier than expected, commonly defined as before age 8 in girls or before age 9 in boys. Early puberty should be evaluated because it can affect growth timing and emotional well-being.
Do you treat thyroid problems in children and adults?
Yes, thyroid disorders are common endocrine conditions that can affect energy, mood, metabolism, and, in children, growth and development. Thyroid disorders may include hypothyroidism, hyperthyroidism, autoimmune thyroid disease, thyroid nodules, and abnormal thyroid lab patterns.
What is hypothyroidism?
Hypothyroidism is a condition in which the thyroid is underactive and does not produce enough thyroid hormone. Hypothyroidism symptoms can include fatigue, feeling cold, constipation, dry skin, and slower body processes, and a blood test is needed to confirm it.
What is hyperthyroidism?
Hyperthyroidism is a condition in which the thyroid gland is overactive and produces more thyroid hormone than the body needs. Hyperthyroidism symptoms can include feeling hot, palpitations, shakiness, anxiety, trouble sleeping, and unintended weight loss, and symptoms vary by person.
Do you offer menopause and perimenopause care?
Yes, perimenopause and menopause care focuses on identifying the hormone-related drivers of symptoms like hot flashes, sleep disruption, mood changes, and weight shifts, then building an individualized plan based on symptoms, goals, and medical history.
What is menopause?
Menopause is the point in time when a person has gone 12 consecutive months without a menstrual period. Menopause is often diagnosed based on symptoms and menstrual history, and testing is used when it is clinically appropriate.
What is menopause replacement therapy (MRT)?
Hormone therapy, also called HRT, is medication that replaces hormones that decline during the menopause transition and is commonly used to treat hot flashes and night sweats. Hormone therapy should be individualized because risks and benefits vary by health history and the type, dose, and route of administration.
Do you offer bioidentical hormones?
Bioidentical hormones are hormones that are chemically identical to those made by the human body. Bioidentical hormones may be available as FDA-approved products or compounded formulations, and the best option depends on the clinical situation and medical history.
Do you provide men’s hormone care, including low testosterone concerns?
Yes, men’s hormone care evaluates symptoms like low energy, mood changes, sleep issues, weight changes, and sexual health concerns to determine whether hormones, thyroid function, lifestyle factors, or other health issues may be contributing.
Do you offer medically supervised weight loss?
Medically supervised weight loss is a clinician-guided approach that evaluates metabolic and hormone contributors, reviews current health status, and builds a plan that may include nutrition guidance, lifestyle strategy, and medical options when appropriate.
Can you coordinate with my child’s pediatrician or my primary care provider?
Yes, coordinated care is often helpful in endocrine conditions. With your permission, records can be reviewed and shared so everyone is aligned on the plan.
Do you offer telehealth visits?
Telehealth visits are often a good fit for follow-ups, lab review, and planning conversations. Telehealth availability depends on the clinical need and what is safest and most appropriate for the visit type.
Do I need labs before the first appointment?
In most cases, you do not need labs before the first appointment. Lab testing is usually ordered after the initial history and evaluation, so testing is targeted and only what is necessary.
How quickly can testing and next steps happen?
Testing and next steps depend on what is needed, but the goal of a structured endocrine evaluation is to move from symptoms to clarity efficiently with a plan that fits the findings.
Explore related topics: Growth Concerns, Early Puberty, Thyroid Disorders.