At Westchester Health, I often have parents bring their son or daughter to see me because they’re concerned that he/she is not developing sexually at the same rate as other adolescents their age. Often, these children will ultimately develop normally but will simply experience the hormonal changes of puberty a little later than their peers. In some cases, however, a child is experiencing delayed puberty.
This means that he/she is within the normal age range for puberty (between 8 and 14 for girls, and between 9 and 15 for boys) but not showing any signs of developmental hormonal changes. When this occurs, what I tell the parents and the child is that there are things we can do to help treat this condition so that he/she does not feel left behind, physically and emotionally.
What causes puberty to start?
Merck Manual defines puberty, or sexual maturation, as the point at which 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 (testes in boys and ovaries in girls).
These sex glands then secrete the sex hormones testosterone in boys and estrogen in girls, which cause the development of secondary sex characteristics, including facial hair and muscle mass in boys, breasts in girls, and in both sexes, pubic and underarm hair and sexual desire (libido).
Normal signs of puberty
- Pubic, underarm and facial hair grows
- growth spurt
- testicles and penis get larger
- body shape changes: shoulders widen and body becomes more muscular
- breasts develop
- pubic and underarm hair grows
- growth spurt
- period starts (menstruation)
- body shape gets curvier with wider hips
Signs of delayed puberty
- penis and testicles not growing larger by age 14
- genital growth taking longer than 5 years
- short stature compared with their peers, who now are growing faster
- no breast development by age 14
- no menstruation within 5 years of when breasts start to grow, or by age 16
What causes delayed puberty?
The onset of puberty can be delayed for several reasons, according to TeensHealth. Most often, it simply runs in the family, with a child’s relatives also having developed later than usual (called constitutional delay of puberty). These adolescents are otherwise healthy and will develop normally, just later than most of their peers.
However, a number of physical problems, disorders or injuries can cause delayed puberty, including:
- inflammatory bowel disease
- kidney disease
- cystic fibrosis
- radiation therapy
- autoimmune disorders such as Hashimoto thyroiditis or Addison disease
- disorders that directly affect the ovaries
- tumor affecting the pituitary gland or hypothalamus
- testicular damage, injury or infection (such as mumps)
- being very thin due to anorexia, dieting or excessive exercise
- chromosomal abnormalities such as Turner syndrome in girls and Klinefelter syndrome in boys
- genetic disorders such as Kallmann syndrome
Good news: delayed puberty can be treated
After a doctor has performed a physical examination of your child, requested blood tests to check for thyroid, pituitary, chromosomal or other problems, ordered a bone X-ray, and checked your child’s growth chart, if he/she feels that your child is experiencing delayed puberty, there are several treatment options available, including:
- Boys can be given testosterone injections (usually monthly for 4–6 months) to stimulate puberty.
- Girls can be given low doses of estrogen for 4–6 months (pills or skin patches) to start breast development.
- After treatment ends, a teenager’s own hormones usually take over to propel the process of puberty. If they do not, long-term sex hormone replacement is an option.
- Genetic disorders cannot be cured but hormone therapy can help sex characteristics develop.
Surgery may be needed to remove tumors, but be aware that these children are at risk of hypopituitarism.
To know more
For helpful information about endocrine disorders in children, check out our blog: What You Need To Know About Growth Disorders.
Concerned about your child’s sexual maturation? Please come see me.
If you’re worried that your child is not hitting the standard benchmarks of puberty and sexual development, please call (914) 458-8800 to make an appointment with me. I’ll examine your child, evaluate his/her physical characteristics, perform some tests, and together with you, decide on the best steps to take going forward. Whenever, wherever you need us, we’re here for you.
By Joan DiMartino-Nardi, MD, pediatric endocrinologist with Westchester Health, member of Northwell Health Physician Partners