Precocious (Early) Puberty

Download PDFs  


Craig Alter, MD

Additional Resources
Magic Foundation
Mayo Clinic
Kids Health

What is precocious puberty?

Precocious is the appearance of any sign of secondary sex characteristics in boys younger than age 9 and in girls younger than 7½ or 8. In the United States, precocious puberty affects about 1 – 2% of children. Yet, in most of these children, early puberty is a variation of normal, and no medical problem is present. Many children who go through puberty early or late have other family members who went through puberty early or late. Just as there are differences in the age at which puberty starts, there are also differences in the rate at which a child goes through puberty.

Near the end of puberty, growth in height stops. Because the bones of children with precocious puberty mature and stop growing earlier than normal, these children can be shorter than expected as adults. Precocious puberty can also cause emotional and social problems for children who are ahead of their peers in terms of sexual maturity.

Signs of precocious puberty


  • Breast development
  • Vaginal bleeding


  • Enlargement of the testicles and penis
  • Facial hair
  • Deepening voice

Both Boys and Girls

  • Pubic or underarm hair
  • Rapid height growth—a growth “spurt”
  • Acne
  • Adult body odor

What causes precocious puberty?

Many forms of precocious puberty are simply variants of normal development. For instance, breast development in very young girls and pubic or underarm hair in young children, without other signs of puberty, usually do not signal an underlying medical problem.

Two main types of precocious puberty are abnormal. The first is called central precocious puberty and the second is peripheral precocious puberty.

Central Precocious Puberty
Central precocious puberty (CPP) occurs when the hypothalamus releases GnRH and activates puberty early. In most girls with CPP, there is no underlying medical problem. In boys, the condition is less common and is more likely to have a link to a medical problem. Such problems include a tumor, brain trauma (such as a blow to the head, brain surgery, or radiation treatment to the head), or inflammation (such as meningitis).

Peripheral Precocious Puberty
Peripheral precocious puberty (PPP) is rarer than CPP. It results from early production of sex hormones due to problems with the ovaries, testicles, or adrenal glands. Another cause can be external exposure to sex hormones (such as coming into contact with an estrogen or testosterone cream).

How is precocious puberty diagnosed?

To make a diagnosis, your child’s doctor will take a medical history and perform a physical exam. Blood tests may be done to measure hormone levels. The doctor may order an x-ray of the hand to see if the child’s bones are maturing too fast. Sometimes a CT scan or MRI is ordered to check for a tumor.

Rarely, blood might be sent to a lab to look for a change in a gene (genetic mutation) that could result in an uncommon type of precocious puberty.

If your child has any sign of precocious puberty, visit a pediatric endocrinologist. This doctor is an expert in the treatment of hormone-related conditions in children. Precocious puberty requires tests to ensure there is no underlying medical cause. Your doctor will work with you to decide the best treatment option.

How is precocious puberty treated?

If your child has CPP, there are medications to prevent further pubertal development. If the problem is PPP, the treatment will depend on the underlying cause. It could involve medications, surgery (if there is a tumor), or removing the external source of the hormones (such as estrogen cream).

Questions to ask your doctor

  • Is my child going through early puberty?
  • If so, what is the cause of the early puberty?
  • Does my child need medicine?
  • What should I tell my child about these physical changes?
  • Should we see a pediatric endocrinologist?
Edited: September 2017