Delayed puberty

By Medically reviewed by hellodoktor


What is delayed puberty?

The start of sexual maturation (puberty) takes place when the hypothalamus gland begins to secrete a chemical signal called gonadotropin-releasing hormone. The pituitary gland responds to this signal by releasing hormones called gonadotropins, which stimulate the growth of the sex glands (the testes in boys and the ovaries in girls). The growing sex glands secrete the sex hormones testosterone in boys and estrogen in girls. These hormones cause the development of secondary sex characteristics, including facial hair and muscle mass in boys, breasts in girls, and pubic and underarm hair and sexual desire (libido) in both sexes.

Delayed puberty is defined as absence of the start of sexual maturation at the expected time.

How common is delayed puberty?

Delayed puberty can affect patients at any age. It can be managed by reducing your risk factors. Please discuss with your doctor for further information.


What are the symptoms of delayed puberty?

In boys, delayed puberty is more common and is defined as:

  • No enlargement of the testicles by age 14
  • A time lapse of more than 5 years from the start to the completion of growth of the genitals

In girls, delayed puberty is defined as

  • No breast development by age 13
  • A time lapse of more than 5 years from the beginning of breast growth to the first menstrual period
  • No menstruation by age 16

Although adolescents are typically uncomfortable about being different from their peers, boys in particular are likely to feel psychologic stress and embarrassment resulting from delayed puberty. Girls who remain smaller and less sexually mature than their peers are not stigmatized as quickly as are boys.

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.


What causes delayed puberty?

Central (both sexes):

  • CDGP – sporadic or familial; Constitutional delay is by far the most common cause in both boys and girls but can only be diagnosed once other causes have been eliminated.
  • Chronic illness – eg, kidney disease, Crohn’s disease.
  • Malnutrition – eg, anorexia nervosa, cystic fibrosis, coeliac disease.
  • Excessive physical exercise, particularly athletes or gymnasts.
  • Psychosocial deprivation.
  • Steroid therapy.
  • Impaired hypothalamo-pituitary axis
  • Tumours adjacent to the hypothalamo-pituitary axis – eg, craniopharyngioma, optic glioma, germinomas, astrocytomas, pituitary tumours (including hyperprolactinaemia).
  • Congenital anomalies – eg, septo-optic dysplasia, congenital panhypopituitarism.
  • Irradiation treatment.
  • Trauma: surgery, head injury.



  • Bilateral testicular damage: cryptorchidism, failed orchidopexy, atresia, testicular torsion, infection (mumps rarely causes prepubertal damage).
  • Syndromes associated with cryptorchidism or gonadal dysgenesis: Noonan’s syndrome, Prader-Willi syndrome, Bardet-Biedl syndrome, Klinefelter’s syndrome, other XY aneuploidy syndromes, XO/XY.
  • Irradiation, total or testicular.
  • Drugs – eg, cyclophosphamide.


  • Gonadal dysgenesis: Turner syndrome, Prader-Willi syndrome, Bardet-Biedl syndrome, Swyer syndrome (45,XY).
  • Irradiation, total or abdominal.
  • Drugs – eg, cyclophosphamide, busulfan.
  • Intersex disorders – eg, complete androgen insensitivity syndrome (primary amenorrhoea may be the presenting symptom), congenital adrenal hyperplasia.
  • Polycystic ovary syndrome.
  • Toxic damage: galactosaemia, iron overload (thalassemia).

Risk factors

What increases my risk for delayed puberty?

There are many risk factors for delayed puberty , such as:

  • Fhx of delayed puberty
  • Congenital pituitary structural abnormalities
  • Gene mutations
  • Chromosomal disorders
  • Syndromic diagnosis
  • Eating disorders
  • Chronic systemic illness
  • Malnutrition
  • Intense exercise
  • Congenital testicular abnormalities
  • Acquired gonadal abnormalities
  • Pituitary surgery
  • Adrenal hypoplasia
  • Chemotherapy
  • Radiation therapy
  • Histiocytosis
  • Sickle cell disease
  • Iron overload (associated with transfusion)

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is delayed puberty diagnosed?

  • A physical examination
  • Bone age x-ray
  • Blood tests
  • Sometimes magnetic resonance imaging

The initial evaluation of delayed puberty should consist of a complete history and physical examination to evaluate pubertal development, nutritional status, and growth. Doctors often take x-rays of one or more bones to see the level of bone maturity (called a bone age x-ray). Doctors may do basic laboratory tests to look for signs of chronic disease, hormone level tests, and possibly a chromosomal analysis.

Doctors usually evaluate boys who have no signs of puberty by age 14 years and girls who have no signs of puberty by age 12 to 13 years or who have not menstruated by age 15 to 16 years. If these children otherwise appear healthy, they most likely have constitutional delay. The doctor may decide to re-examine these adolescents at 6-month intervals to ensure that puberty begins and progresses normally.

Girls with severely delayed puberty should be evaluated for primary amenorrhea.

How is delayed puberty treated?

  • Treatment of cause
  • Hormone therapy

The treatment for delayed puberty depends on its cause. When an underlying disorder is the cause of delayed puberty, puberty usually proceeds once the disorder has been treated.

An adolescent who is naturally late in developing needs no treatment, but if the adolescent is severely stressed by delayed or absent development, some doctors may give supplemental sex hormones to begin the process sooner. Treatment is much more common in boys.

If boys show no sign of puberty by age 14, they may be given a 4- to 6-month course of testosterone. At low doses, testosterone starts puberty, causes the development of some masculine characteristics (virilization), and does not prevent adolescents from reaching their adult height potential.

In girls, low doses of estrogen may be started with pills or skin patches.

Genetic disorders cannot be cured, but hormone therapy may help sex characteristics develop.

Surgery may be needed to remove tumors, and these children are at risk of hypopituitarism.

Lifestyle changes & Home remedies

What are some lifestyle changes or home remedies that can help me manage delayed puberty?

The following lifestyles and home remedies might help you cope with delayed puberty:

  • Maintain a healthy nutritional diet
  • Consult a nutritionist if need be, and stick to a healthy eating schedule
  • Minimize stress and have an optimistic mindset
  • Exercise

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

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