Delayed Puberty in Children

Puberty that happens later than usual is called delayed puberty. For many children, delayed puberty is often inherited, and they will develop at their own pace. However, some medical conditions or other factors can affect hormone function and delay puberty. 

What is Delayed Puberty? 

During puberty, the body changes from that of a child to that of an adult. 

For girls, these changes usually begin between the ages of 8 and 14, and for boys, between the ages of 9 and 15. Because of this typical wide age range, one may develop many years earlier (or later) than most of their friends. 

However, occasionally people pass this typical age range for puberty without exhibiting any physical changes. We refer to this as delayed puberty. 

Signs and Symptoms of Delayed Puberty 

Delayed puberty in girls

Menstruation does not start by the age of 15 or within three years after the onset of breast development, nor do breasts start to develop by the age of 13.

Delayed puberty in boys

Testicles don’t begin enlarging by the age of 14 or it’s been at least five years since testes began enlarging, but puberty isn’t complete yet. 

Other possible signs include: 

Compared to their age, your child is shorter. This is due to the fact that your child has not undergone the growth associated with puberty. 

Your child has a delayed bone age, which means they have less developed bones than children of the same age. Only an X-ray will allow a medical practitioner to observe this. 

Your child will not develop pubic hair. 

Your child may have pubic hair and still have delayed puberty. They may also develop armpit hair and the start of body odor. These are symptoms of a natural body process called adrenarche. This happens before puberty. 

The hormones that trigger Adrenarche are not the same hormones that regulate puberty in children. Thus, your child might go through adrenarche but still not start puberty at the expected time. 

What is the most common cause of delayed puberty?

Puberty can be delayed for several reasons. 

Family History- Most often, it's just a pattern of growth and development in a family. 

Medical Conditions- Medical conditions can sometimes delay puberty. Children with long term illnesses such as diabetes, cystic fibrosis, kidney disease, or even asthma may reach puberty later than usual. Poor nutrition can also cause delays. Children who are malnourished often develop later than those who eat a healthy, balanced diet. 

Delayed puberty may also be linked to problems with the pituitary or thyroid glands, which control hormone production. Certain chromosomal conditions can interfere with normal growth and development. 

A chromosomal abnormality that may inhibit the growth and development of an individual is Turner syndrome, which occurs in females. This occurs when one of a girl’s two X chromosomes is missing or abnormal.  Turner syndrome affects growth, ovarian development, and sex hormone production. Girls with untreated Turner syndrome are usually shorter than average, may not experience puberty in the normal way, and may have other health problems. 

Klinefelter’s syndrome occurs in males as a result of the presence of an extra X chromosome, typically found in an XXY chromosome combination rather than the XY combination, and it leads to slower sexual maturation.  Boys with Klinefelter syndrome are often taller for their age and may have learning difficulties or other medical problems. 

How Is Delayed Puberty Diagnosed?
For diagnosing cases of delayed puberty, the physician would consider the medical history of the child, which would include inquiring about whether members of the child’s family had a comparable growth rate and onset of puberty.The growth chart of the child would be analyzed for any features indicative of delayed development. 

Tests may include blood tests to measure hormone levels and check for medical conditions, genetic testing to identify gene changes linked to delayed puberty, and imaging tests such as MRI or ultrasound to confirm or rule out certain conditions. The pediatrician may refer the child to a pediatric endocrinologist or another specialist for further evaluation and treatment. 

How Is Delayed Puberty Treated?
In many cases, no underlying medical problem is found. Most teenagers with delayed puberty are simply late bloomers and will eventually develop normally. 

If a medical cause is identified, the doctor may refer the child to a pediatric endocrinologist or another specialist for further care. 

In some cases, short term hormone treatment may be suggested. Boys may receive testosterone for four to six months to help start puberty related changes. Girls may receive low doses of estrogen for four to six months to begin breast development. 

After treatment, the body usually continues the puberty process on its own. If this does not happen, the doctor may discuss long term hormone replacement therapy. 

Why Choose Ankura Hospital for Pediatric Endocrinology? 

Our pediatric endocrinology team At Ankura Hospital is dedicated to helping children with hormonal disorders and delayed puberty. Every child receives personalized care with treatment plans tailored to their individual growth and needs. We use advanced diagnostic tests, including hormone panels, genetic testing, and imaging, to ensure accurate diagnosis. Our holistic approach supports not just physical growth but also emotional and developmental well-being. With years of successful treatments and families trusting us with their children’s health, Ankura Hospital is committed to guiding every child toward healthy development.