Delayed Puberty

What Is Delayed Puberty?

Puberty is the time when your body grows from a child's to an adult's. You'll know that you are going through puberty by the way that your body changes.

Usually, these changes begin between the ages of 8 and 14 for girls, and between 9 and 15 for guys. This wide range in age is normal, and it's why you may develop several years earlier (or later) than most of your friends.

Sometimes, though, people pass this normal age range for puberty without showing any signs of body changes. This is called delayed puberty.

Doctors usually can help teens with delayed puberty develop so they can catch up with their peers.

What Are the Signs of Puberty?

If you're a girl, you'll notice that:

• your breasts develop
• your pubic hair grows
• you have a growth spurt
• you get your period (menstruation)
• your body gets curvier with wider hips

If you're a guy, you'll notice that:

• you start growing pubic and facial hair
• you have a growth spurt
• your testicles and penis get larger
• your body shape changes — your shoulders will widen and your body will become more muscular

These changes are caused by the sex hormones — testosterone in guys and estrogen in girls — that your body is making in much larger amounts than before.

What Happens in Delayed Puberty?

Signs of delayed puberty in guys include:

• the penis and testicles not starting to grow larger by age 14
• genital growth that takes longer than 5 years
• short stature compared with their peers, who now are growing faster

In girls, signs include:

• no breast development by age 14
• not starting to menstruate within 5 years of when breasts start to grow or by age 16

What Causes Delayed Puberty?

Puberty can be delayed for several reasons.

Family History

Most often, it's simply a pattern of growth and development in a family. A guy or girl may find that his or her parent, uncle, aunt, brothers, sisters, or cousins developed later than usual, too. This is called constitutional delay (or being a late bloomer), and it usually doesn't need treatment. These teens in time will develop normally, just later than most of their peers.

Medical Problems

Medical problems also can cause delays in puberty.

• Some people with chronic illnesses like diabetes, cystic fibrosis, kidney disease, or even asthma may go through puberty at an older age. That's because their illnesses can make it harder for their bodies to grow and develop. Proper treatment and better control of these conditions can help make delayed puberty less likely.
• A person who's malnourished — without enough food to eat or without good nutrients — may also develop later than peers who eat a healthy, balanced diet. For example, teens with the eating disorder anorexia nervosa often lose so much weight that their bodies can't develop properly. Girls who are extremely active in sports may be late developers because their level of exercise keeps them so lean. Girls' bodies need enough fat before they can go through puberty or get their periods.
• Delayed puberty can also happen because of problems in the pituitary or thyroid glands. These glands make hormones important for body growth and development.

Some people who don't go through puberty at the normal time have problems with their chromosomes, which are made up of DNA that contain our body's construction plans. Problems with the chromosomes can affect normal growth processes. For example:

• Turner syndrome happens when one of a female's two X chromosomes is abnormal or missing. This causes problems with how a girl grows and with the development of her ovaries and production of sex hormones. Women who have untreated Turner syndrome are shorter than normal, may not go through puberty in the usual way, and may have other medical problems.
• Males with Klinefelter syndrome are born with an extra X chromosome (XXY instead of XY). This condition can slow sexual development. Guys who have it are typically tall for age, may have learning problems, and may have other medical problems.

How Is Delayed Puberty Diagnosed?

The good news is that if there is a problem, doctors usually can help teens with delayed puberty to develop more normally. If you're worried that you're not developing as you should, ask your parents to make an appointment with your doctor.

The doctor will:

• Do an exam.
• Take a medical history, including whether others in your family had a similar growth pattern.
• Ask about any medicines you take.
• Check your growth chart to see if there's a pattern that points to a problem.

The doctor also might:

• Order blood tests to check for thyroid, pituitary, chromosomal, or other problems.
• Order a bone age X-ray, to see if your bones are maturing normally.

How Is Delayed Puberty Treated?

Often, doctors find no underlying physical problem. Most teens with delayed puberty are just developing a bit later than average and will catch up.

If doctors do find a problem, they might send a teen to see a pediatric endocrinologist, a doctor who specializes in treating kids and teens who have growth problems, or to another specialist for further tests or treatment.

Some late bloomers struggle with waiting for the changes of puberty to start. So doctors may offer hormone treatment:

• Guys might get a short course of treatment with testosterone (usually a monthly injection for 4–6 months) to get the changes of puberty started.
• Girls might get low doses of estrogens for 4–6 months to start breast development.

After treatment ends, a teen's own hormones usually take over to complete the process of puberty. If they don't, the doctor will discuss long-term sex hormone replacement.

Dealing With Delayed Puberty

It can be tough to watch your friends grow and develop when the same thing's not happening to you. You may feel like you're never going to catch up. Even when the doctor or your parents reassure you that things will be OK, it's hard to wait for something that can affect how you feel about yourself.

If you're feeling depressed or having school or other problems, talk to your mom or dad, your doctor, or another trusted adult about finding a counselor or therapist you can talk to. They can help you sort out your feelings and suggest ways to cope with them.

Delayed puberty can be difficult for anyone to accept and deal with. But it's a problem that usually gets solved. Ask for help if you have any concerns about your development.