Delayed Puberty

Puberty is the last part of childhood during which boys and girls become sexually mature. They start to look more like adults and become able to have babies. Boys develop facial and body hair, deep voice, and larger testicles. Girls develop breasts and pubic hair. Puberty usually starts between ages 8 to 13 for girls and ages 10 to 14 for boys.

Puberty Timeline

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Delayed puberty is when puberty starts later than expected. Puberty is delayed when it starts after age 13 for girls and after age 14 for boys.

• Delayed puberty can be normal if a lot of people in your family also started puberty late

• Sometimes delayed puberty is caused by health problems or because the child had radiation or chemotherapy treatments (for example, for cancer)

• A sign of delayed puberty in boys is no testicle growth by age 14

• Signs of delayed puberty in girls include no breast development by age 13 or no period by age 16

• Treatment depends on what's causing the delayed puberty—doctors may have your child take hormones

Milestones in Sexual Development for Girls and Boys

During puberty, sexual development occurs in a set sequence. However, when the changes begin and how quickly they occur vary from person to person. For girls, puberty begins around age 8 to 13 years and lasts about 4 years. For boys, puberty begins around age 9 to 14 years and lasts about 4 to 6 years. The chart shows a typical sequence and normal range of development for the milestones of sexual development.

Delayed puberty can be a normal difference that runs in families. Most of the time, healthy children with delayed puberty will have a late growth spurt and eventually catch up to other children their age.

Sometimes delayed puberty is caused by another health problem such as:

• Diabetes

• Inflammatory bowel disease

• Cystic fibrosis

• Anemia

• Undergoing cancer treatment

• In boys, testicle injury or infection

• A genetic problem that affects hormones, such as Turner syndrome

Girls who diet and exercise too much often have delayed puberty.

Delayed puberty is more common in boys. Boys with delayed puberty usually:

• Have no testicle growth by age 14

• Are short

Girls with delayed puberty usually have:

• No breast development by age 13

• No period by age 16

Children may be teased or bullied if they have delayed puberty.

• Boys who have no sign of puberty should see a doctor by age 14

• Girls who have no sign of puberty should see a doctor by age 12 to 13—girls who haven't had a period by age 16 should also see a doctor

Your child's doctor may want to see your child every 6 months to see whether puberty has started.

Doctors diagnose delayed puberty based on your child's sexual development.

To see why puberty is delayed, doctors ask about your child's eating habits. They'll also do tests:

• X-rays of your child's bones

• Blood tests

• Hormone level tests

• Sometimes, genetic testing

• Sometimes, MRI (magnetic resonance imaging) to make sure there's no brain or pituitary gland problem

Doctors will treat any health problems that are keeping puberty from starting.

Children who are naturally late to develop usually don't need any treatment. If delayed puberty is causing a lot of stress or continues for a long time, doctors may prescribe sex hormones. The sex hormones will start puberty and help your child develop physically and sexually.

Genetic disorders can't be cured, but taking sex hormones can help with physical development.