Background <p>Growth hormone (GH) therapy is an effective option for short-stature children. In this study, we aimed to report our real-life experience of using GH treatment in Syria by comparing its effects in four different indications: growth hormone deficiency (GHD), idiopathic short stature (ISS), small for gestational age (SGA), and Turner syndrome (TS).</p> Methods <p>We evaluated retrospectively the anthropometric data of 200 short-stature children who started therapy between 4 and 9 years and were treated between Jan-2018 and Jun-2023. Auxological parameters included growth velocity (GV), height (Ht), and bone age (BA).</p> Results <p>After four years of GH therapy, all groups showed a significant increase in GVSDS and HtSDS (<i>p</i> &lt; 0.00 for both). GHD revealed the most improvement (mean ΔGVSDS: 3.43) versus those with other indications (ISS: 2.39, SGA: 2.54, TS: 1.77). The mean ΔHtSDS observed ranged from a minimum of 0.82 in children with TS, 1.21 in SGA, and 1.48 in ISS to a maximum of 2.06 in GHD. The mean bone age-chronological age was − 1.59 at baseline and − 1.67 after 4 years (<i>p</i> = 0.18). The highest percentage of improvement in GVSDS and HtSDS was during the first year of treatment (for all groups, <i>p</i> &lt; 0.00).</p> Conclusions <p>For Syrian children with GHD, ISS, SGA, and TS, GH therapy provides an efficient treatment choice. GH therapy was most effective in those with GHD and during the first year of treatment. These results support the use of GH therapy for Syrian short-stature children.</p> Clinical trial number <p>Not applicable.</p>