Puberty is considered delayed if a girl shows no outward signs of puberty (breast development) by age 13 or a boy shows no signs (testicular enlargement) by age 14. Often times this can simply be a family trait, but this can also be a sign of other medical conditions including genetic or chromosomal abnormalities.
Signs of Delayed Puberty
- Lack of breast development by age 13
- More than 5 years between breast development and menstrual period
- No menstrual period by age 16
- Lack of testicular enlargement by age 14
- Lack of pubic hair by age 15
- Have not completed puberty after 5 years
Evaluation of Delayed Puberty
A child with signs of delayed puberty may undergo a blood test to look at hormone levels and sometimes chromosome abnormalities; a bone age x-ray is used to look at the maturity of the bones in the hand. Occasionally an MRI is done as well to look at the pituitary gland, which controls the timing of puberty; further imaging of the gonads (ovaries, testes) may be done if necessary.
Treatment of Delayed Puberty
Often times delayed puberty is nothing to worry about and may be watched closely by a Pediatric Endocrinologist. Sometimes delayed puberty can by psychologically stressful for an adolescent, so hormonal therapy with physiologic doses of testosterone (for boys) or estrogen (for girls) may be started. Occasionally a genetic syndrome such as Turner’s Syndrome or Kleinfelter’s Syndrome may be found and will need to be treated long term by an Endocrinologist to help them progress through puberty.