Checking for pigmentation of skin and hair. Checking for mirror movements of the hands or signs of neurodevelopmental delay. Lab tests Early morning hormonal testing including FSH, LH, testosterone, oestrogen and prolactin. GnRH and/or hCG stimulation test to determine activity of hypothalamus and pituitary. Sperm test Liver function, renal function and inflammation marker testing. Karyotype to check for chromosomal abnormalities. Medical imaging Performing wrist x-ray to determine bone age. Brain MRI to rule out any structural abnormalities in the hypothalamus or pituitary and to check for presence of olfactory bulbs. Ultrasound of kidneys to rule out unilateral renal agenesis. Bone density scan (DXA) to check for osteoporosis or osteopenia. Treatment For both males and females, the initial aim for treatment is the development of the secondary sexual characteristics normally seen at puberty. Once this has been achieved, continued hormone replacement therapy is required for both males and females to maintain sexual function, bone health, libido and general wellbeing. In males, testosterone replacement therapy is required for the maintenance of normal muscle mass. Early treatment is sometimes required for male infants with suspected KS/CHH to correct undescended testes and micropenis if present with the use or surgery or gonadotropin or DHT treatment. Females with KS/CHH normally do not require any treatment before adolescence. Currently, no treatments exist for the lack of sense of smell, mirror movement of the hands or the absence of one kidney. Treatment for both males and females with KS/CHH normally consists of one of three options which can be used for both hormone replacement therapy and/or fertility treatment. Sex hormone replacement (testosterone or oestrogen & progesterone). Gonadotropin therapy (medications that replicate the activity of FSH and LH). GnRH pulsatile therapy. Hormone replacement therapy The method and dose of treatment will vary depending on the individual being treated. Initial treatment is normally made with lower doses in younger patients in order to develop the secondary sexual characteristics before adult doses are reached. For males with KS/CHH the types of testosterone delivery include daily patches, daily gel use, daily capsules, subcutaneous or intramuscular injections or six-monthly implants. Different formulations of testosterone are used to ensure both the anabolic and androgenic effects of testosterone are achieved. Nasal testosterone delivery methods have been developed but their use in KS/CHH treatment has not been formally evaluated. Gonadotropin therapy, in the form of human chorionic gonadotropin (hCG) injections, with or without the use