Delayed Puberty

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Craig Alter, MD

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Kids Health

What is delayed puberty?

Delayed puberty is when a teen goes through these body changes later than the usual age range. For girls, it means no breast development by age 13 or no menstrual periods by age 16. For boys, it means no enlargement of the testicles by age 14.

What causes delayed puberty?

Some teens are “late bloomers” who just happen to start puberty later than most children their age. Being a late bloomer is the most common cause of delayed puberty. It’s not caused by a medical problem and usually doesn’t need treatment. Late bloomers will eventually start puberty on their own and catch up to their friends.

Other causes for delayed puberty may be due to Kallmann Syndrome. This condition is described as a lack of sense of smell, as well as low luteinizing and follicle-stimulating hormones. 

Sometimes, girls don’t start having periods, because their uterus and vagina don’t develop properly. Or they may have too much of a hormone called prolactin, or a condition called polycystic ovary syndrome (PCOS).

Does my child need to see a doctor if he/she has delayed puberty?

Most likely, your child’s delayed puberty won’t need treatment. But if you or your teen are concerned about it, it’s wise to see a doctor, especially if your child started to develop but then suddenly stopped. Your family doctor or pediatrician can tell you if your child should be checked for medical problems. Often, the only thing teens need is reassurance that they’ll catch up to their peers.

How does a doctor check for delayed puberty?

Your doctor will ask about your teen’s health and medicines. The doctor will also want to know whether your child has noticed any signs of puberty or if there’s a family history of delayed puberty. Your child will have a physical exam and also might have blood tests to check hormone levels. The doctor will check your child’s growth by measuring height and weight and doing an X-ray of the hand to see if his or her bones are developing more slowly than usual. Sometimes, a doctor can see signs of puberty that you or your teen might not have noticed. Some teens need a brain scan (such as an MRI) to check for problems with the pituitary gland. Girls might need a sonogram to see if their uterus and ovaries are developing as they should.

Less common causes of delayed puberty include:

  • Medical conditions that keep the intestines from absorbing nutrients from food, such as celiac disease or inflammatory bowel disease
  • Malnutrition (not getting proper nourishment) due to an eating disorder such as anorexia
  • Problems with the pituitary or thyroid glands, which make hormones that help children grow and develop
  • Problems with the ovaries or testicles, which make sex hormones
  • Genetic problems such as Turner syndrome in girls or Klinefelter syndrome in boys
  • Some cancer treatments that affect sex hormone production
  • Medicines that decrease appetite such as stimulants for attention deficit hyperactivity disorder (ADHD)

What’s the treatment for delayed puberty?

If your doctor doesn’t find a medical problem, your teen probably doesn’t need any treatment and will eventually start developing on his or her own. Your doctor may want to keep track of your child’s progress toward puberty.

If your teen does have a medical problem, your doctor might refer you to a pediatric endocrinologist, an expert in growth and puberty.

Sometimes, doctors will prescribe short-term hormone therapy to help teens start developing. Girls take estrogen pills or use skin patches; boys get testosterone injections. Some teens need long-term hormone therapy, if they are not able to make normal amounts of estrogen or testosterone.

What can I do to help my child cope with delayed puberty?

Seeing your child’s pediatrician or family doctor to make sure nothing is wrong is the first step. If your child feels worried or depressed, consider counseling for him or her. Some teens need extra help to sort out their feelings.

Questions to ask your doctor

  • Does my child have delayed puberty?
  • What’s causing my child’s delayed puberty?
  • Does my child need treatment for delayed puberty?
  • What are the options for treatment?
  • What are the risks and benefits of each treatment option?
  • How long will my child need treatment?
Edited: November 2017