Puberty | Blank Children's Endocrinology Clinic

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Blank Children's Hospital

Puberty

Puberty is when girls and boys mature sexually.  It usually starts sometime between the ages of 8 and 13 years for girls and 9 and 14 years for boys.  Puberty is considered precocious (early) when signs appear in girls before age 8 years or in boys before age 9 years.  Delayed puberty is when signs are not present by age 13 years for girls or age 14 years for boys.

Signs of Puberty

Girls

  • Breasts
  • Pubic hair
  • Underarm hair
  • Acne
  • Periods
  • Growth spurt

Boys

  • Enlarging testes and penis
  • Pubic hair
  • Underarm hair
  • Acne
  • Facial hair
  • Deepening of the voice
  • Growth Spurt

Precocious Puberty

Precocious puberty may be due to early production of puberty-stimulating hormones from the brain (central precocious puberty) or to hormone production in the body without brain signals (peripheral precocious puberty).  Central precocious puberty is the most common type.

The cause of central precocious puberty in girls is often idiopathic, which means the cause is not known.  An identifiable cause is more common in boys.  Some potential causes include brain abnormalities, family history of the disease, rare genetic syndromes, disorders of the adrenal gland, and disorders of the ovary or testis.

Diagnosis of precocious puberty includes a complete history and physical exam.  Labs to assess hormone levels and imaging studies to assess the bone age +/- organs possibly responsible for inappropriate hormone production may be ordered.

In some children with central precocious puberty, a hormone to halt the brain’s production of puberty-stimulating hormones is used as treatment.  For peripheral precocious puberty, treatment depends on the source of the puberty hormones.

Resources

Delayed Puberty

Delayed puberty may be due to the ovaries or testes not producing enough sex hormones (primary hypogonadism) or to the brain not producing puberty-stimulating hormones (central hypogonadism).

Delayed puberty is often due to constitutional delay, being a “late bloomer.”  Sometimes chronic medical conditions, genetic syndromes, chromosome abnormalities, malnutrition, or eating disorders affect the timing of puberty.  

Diagnosis of delayed puberty includes a complete history and physical exam.  Labs to assess hormone levels and imaging studies to assess the bone age may be ordered.

Usually, treatment is not necessary.  In some situations, a brief course of testosterone or estrogen is used to “jump-start” puberty.  If there is a reason the body is unable to go through puberty, long-term testosterone or estrogen replacement is needed.   

Resources