Delayed puberty

[Mary Mallozziberg]

Delayed puberty is defined as absence of the start of sexual maturation at the expected time.

• Most often, children simply develop later than their peers but ultimately develop normally.
• Sometimes, delayed puberty is caused by chronic medical problems, hormonal disorders, radiation therapy or chemotherapy, disordered eating or excessive exercise, genetic disorders, tumors, and certain infections.
• Typical symptoms include a lack of testicular enlargement in boys and a lack of breasts and menstrual periods in girls.
• The diagnosis is based on the results of a physical examination, various laboratory tests, a bone age x-ray, and, if needed, genetic testing and magnetic resonance imaging.
• Treatment depends on the cause and may include hormone replacement therapy.

(See also Puberty in Boys and Puberty in Girls.)

The start of sexual maturation (puberty) takes place when the hypothalamus gland begins to secrete a chemical signal called gonadotropin-releasing hormone. The pituitary gland responds to this signal by releasing hormones called gonadotropins, which stimulate the growth of the sex glands (the testes in boys and the ovaries in girls). The growing sex glands secrete the sex hormones testosterone in boys and estrogen in girls. These hormones cause the development of secondary sex characteristics, including facial hair and muscle mass in boys, breasts in girls, and pubic and underarm hair and sexual desire (libido) in both sexes.

Some adolescents do not start their sexual development at the usual age.

In boys, delayed puberty is more common and is defined as

• No enlargement of the testes (testicles) by age 14
• A time lapse of more than 5 years from the start to the completion of growth of the genitals

In girls, delayed puberty is defined as

• No breast development by age 13
• A time lapse of more than 3 years from the beginning of breast growth to the first menstrual period
• No menstruation (amenorrhea) by age 16