What has delayed puberty?
Delayed puberty is defined as the absence of expected sexual maturity. Puberty is an interval characterized by the acquisition of the secondary sexual characteristics, accelerated linear growth, increase in the secretion of sex hormones, maturation of gonads (testes in boys; ovaries in girls), and the potential for reproduction. It is typically complete within 2 to 5 years. Delayed puberty is defined as the lack of any pubertal signs by the age of 13 years in girls and 14 years in boys
More often, children develop later than their peers but eventually develop normally. Sometimes delayed puberty can be due to chronic medical problems, hormonal disorders, radiation therapy or chemotherapy, irregular diet or excessive exercise, genetic defects, tumors, and some infections.
Lack of testicular enlargement in boys and lack of menstruation of the breasts and structures in girls are common symptoms. Diagnosis is based on the results of the physical examination, various laboratory tests, bone age X-rays, and, if necessary, genetic testing, and MRI.
Treatment depends on the cause and may include hormone replacement therapy. Sexual maturity (puberty) begins when the hypothalamus gland begins to secrete a chemical called gonadotropin-releasing hormone. The pituitary gland responds to this signal by releasing hormones called gonadotropins, which stimulate the growth of the sex glands (testicles in boys and ovaries in girls).
The growing sex glands secrete testosterone in boys and sex hormones called estrogen in girls. These hormones cause the development of secondary sexual characteristics, including facial hair and muscle mass in boys, breasts and pubic and armpit hair in girls, and sexual desire (libido) in both sexes.
- Some adolescents do not begin their sexual development at a normal age.
- In boys, delayed puberty is very common and defined
- The testes (testes) do not expand by age 14
- It has been more than 5 years since the start of genital growth
- In girls, delayed puberty is defined
- No breast development at age 13
- More than 3 years have passed from the start of breast growth to the first trimester
- At age 16, there is no amenorrhea.
Symptoms of delayed puberty
If you are a girl, you may notice:
- Your breasts will grow
- Your pubic hair will grow
- You have growth
- You have your period (structural menstruation)
- Your body is curly with wide hips
If you are a person, you may notice:
- Pubic and facial hair begins to grow
- You have growth
- Your testicles and penis will get bigger
- Your body shape changes: your shoulders expand and your body becomes more muscular
- These changes are caused by sex hormones (testosterone in boys and estrogen in girls), your body produces much greater amounts than ever.
What causes delayed puberty?
A few different things can delay puberty.
Constitutional growth retardation (CGD)
- CGD is a temporary delay in skeletal growth that prevents the child from being as tall as her peers for a time.
- In boys, 60 per cent of the time, the delay is due to the constitutional growth retardation of puberty.
- It’s hard to say for sure, but CGE is expected to affect boys twice as much as girls.
- CGD is a common growth variant, but it still causes pain in children.
- As we grow, our bones “mature.” If a child has CGD, a doctor may look at an X-ray of her hand and wrist and see that her bones appear “smaller” than expected over time.
- CGD is often inherited. If one or both parents are “late,” your child may be, too.
- Boys with CGD reach puberty and reach the appropriate adult height, not as quickly as their peers.
- The underlying medical condition
These may include:
- Celiac disease (which affects a child’s ability to gain weight, making it difficult for them to grow at par)
- Conditions that prevent the hypothalamus or pituitary gland from sending the “early puberty” signal
- Conditions that prevent the ovaries or testicles from responding to the “onset of puberty” signal
- Certain genetic conditions, such as Klinefelter syndrome in boys and Turner syndrome in girls
- Some psychiatric medications can help delay puberty.
Diagnosis of delayed puberty
- Physical exam: An early puberty evaluation should include a complete history and physical examination to assess puberty development, nutritional status, and growth.
- X-ray of bone age: Doctors usually take one or more X-rays of the bones (called bone age X-rays) to see the level of bone maturity.
- Blood test: Doctors take blood samples and perform basic laboratory tests to discover signs of chronic disease, hormone level tests, and genetic tests.
- Sometimes MRI: Magnetic resonance imaging (MRI) can be done to confirm that there is no brain tumor or structural abnormality in the pituitary gland.
Doctors usually evaluate boys who do not have signs of puberty at age 14 and girls who do not have signs of puberty at age 13 or 16 years. If these children look healthy, they will have a constitutional delay. The doctor may decide to re-examine those in their teens over a 6-month period to make sure puberty begins and develops normally. Girls with severe delays should be screened for primary amenorrhea.
Treatment of delayed puberty
- Treat the cause: Treatment of delayed puberty depends on its cause. When the underlying disorder causes puberty to be delayed, puberty generally continues after the disorder has been treated. If doctors find a problem, they can send a teenager to see a pediatric endocrinologist, a doctor who specializes in treating children and adolescents who have a treatment problem, or another specialist for further testing or treatment.
- Hormonal therapy: We can treat delayed puberty with hormone therapy. Even if your child has a constitutional developmental delay (CGD) and progresses at his or her own pace through adolescence, having a “boost” to adolescence through hormone therapy can go a long way to his overall well-being. You, your pediatrician, and your child will discuss whether it is the right option for her.
Some late blooming people wait until the onset of puberty changes. So doctors can offer hormone therapy:
- Adolescence that is naturally delayed in development does not require treatment, but if adolescence is very stressed due to a delay or absence, some doctors may prescribe supplemental sex hormones to speed up the process. This treatment is very common in children. Children who are late for puberty need extra support from their parents, family, and friends to maintain a healthy body image and self-esteem.
- Boys may be given a short course of testosterone (usually a monthly injection for 4 to 6 months) to initiate puberty changes.
- Girls can be given low doses of estrogen for 4 to 6 months to start breast development.
- After treatment, teens often take their own hormones to complete the puberty process. If not, your doctor will discuss long-term sex hormone replacement.
- Genetic defects cannot be cured, but hormone therapy can help develop sexual symptoms.
- Surgery is needed to remove the pituitary tumors, and these children are at risk for hypopituitarism (a deficiency of one or more pituitary hormones).