Delayed Puberty

Puberty is said to be delayed when physical signs do not appear by age 13 for girls or age 14 for boys. Delayed puberty may run in families. However, delayed puberty may also be due to chromosomal abnormalities, genetic disorders, chronic illnesses, or tumors that damage the pituitary gland or the hypothalamus in the brain, which make hormones that regulate sexual maturation.

Lacking signs of puberty is the primary indicator that a child may have delayed puberty. Each child may experience symptoms differently. Common symptoms may include:

• Girls:

  • Lack of any breast development by age 12

  • More than 5 years between initial breast growth and first menstrual period

  • Failure to menstruate by age 15

• Boys:

  • Lack of testicular enlargement by age 14

  • Lack of pubic hair by age 15

  • More than 5 years to complete adult genital development

The symptoms of delayed puberty may look like other problems or medical conditions. Always consult your child's doctor for a diagnosis.

In addition to a complete medical history and physical exam, diagnosis of delayed puberty may include:

• Blood tests. These check for chromosomal abnormalities, measure hormone levels, and test for chronic disorders that may delay puberty (such as diabetes and anemia).

• X-r of the left hand and wrist. An X-ray of the hand can estimate your child's bone age. With delayed puberty, bone age is often delayed relative to the calendar age.

• Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

• Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

Your child's doctor will consider his or her age, overall health, and other factors when advising treatment.

Treatment for delayed puberty depends on the cause of the problem. Often, when the underlying cause is treated, puberty proceeds normally. If the delayed puberty is inherited, no treatment is usually necessary. In some cases, treatment may involve hormone therapy to stimulate the development of secondary sexual characteristics, or surgery to correct an anatomical problem.