Delayed Puberty

By Wendy Innes. May 7th 2016

Delayed puberty is a relatively rare occurrence, but if it happens, it can often leave parents and teenagers with a lot of questions and worries. Here we'll explain why it happens, its symptoms, and how it's treated so that parents and their teenage children can have a better understanding of delayed puberty.

What Is It?

Delayed puberty is a significant delay in the onset of normal sexual development. This can be caused by a number of medical conditions, family history or malnourishment (possible sign of an eating disorder). Puberty is considered delayed in girls after age 13 and after age 14 for boys if they have yet to show signs of normal sexual development.

The onset of puberty (sexual maturation) begins when the hypothalamus gland in the brain begins to secrete gonadotropin releasing hormone. This then stimulates the pituitary gland to produce gonadotropins, which stimulate the growth of reproductive organs. As a girl’s reproductive organs grow, her ovaries begin to produce estrogen. In boys, the testes begin to produce testosterone.

Delayed puberty occurs in about 2.5 percent of all adolescents. However, most are found to have no serious abnormalities and treatment will usually correct the problem.

There are a number of problems that can accompany delayed puberty, especially if the cause is a genetic abnormality. These problems include:

  • Learning disabilities
  • Obesity
  • Diabetes
  • Differences in physical characteristics (small stature, long arms and legs etc.)
  • Heart problems
  • Lung problems
  • Kidney disease
  • Thyroid problems
  • Vision problems
  • Celiac disease


There are a number of conditions that can cause delayed puberty:

  • Family History
  • Diabetes mellitus
  • Inflammatory bowel disease
  • Kidney disease
  • Cystic fibrosis
  • Anemia
  • Radiation or chemotherapy
  • Excessive exercise or dieting
  • Malnutrition

Less common causes include:

  • Turner's Syndrome in Girls: This genetic abnormality is rare, occurring in about one in every 4,000 births. It is characterized as partially or completely missing one of the two X chromosomes that girls are supposed to have. About 99 percent of fetuses that have this genetic abnormality will spontaneously abort.
  • Klinefelter's Syndrome in Boys: This genetic abnormality occurs when male fetuses develop with an extra X chromosome. This genetic abnormality is fairly common in children born with genetic abnormalities. In some cases, there can be multiple extra X chromosomes and as the number of extra X chromosomes increases, so does the severity of symptoms.
  • Other genetic disorders
  • Tumor that damages the hypothalamus or pituitary gland
  • Mumps


The symptoms of delayed puberty are fairly straightforward:

In girls, symptoms include:

  • No breast development by the age of 13
  • No menstruation within five years of the initial appearance of breast tissue
  • No menstruation by the age of 16
  • Lack of pubic hair by the age of 14

In boys, symptoms include:

  • No testicular development by the age of 14
  • Incomplete testicular development within five years of the start of development
  • Lack of pubic hair by age 15


Delayed puberty is diagnosed by doctors through several tests. Blood tests will measure the level of hormones in the blood, as well as testing for any concurrent conditions. X-rays will look at the age of the child's bones by examining the growth plates at certain points. CT or MRI scans can also be used when a more detailed image is required. Chromosome testing may also be done if the suspected cause is a chromosome abnormality.


The treatment of delayed puberty will depend upon its cause. If the cause is a problem in the endocrine system for example, treatment could be as simple as prescription medications. If the problem is more serious, such as a genetic abnormality, then treatment will be symptomatic since genetic abnormalities can't be cured.

Most often hormone replacement therapy is used to initiate puberty. This will bring about the physical changes that occur in puberty. However, depending upon the cause of the delay, the therapy could be required for the rest of the child's life. Often, if the cause of delayed puberty is genetic, the person is infertile, so therapy is used to normalize appearance and treat some of the other associated symptoms, such as osteoporosis or trouble concentrating.


One element of delayed puberty that is often overlooked is the psychological affects that delayed puberty can have on an adolescent. Adolescent years can be difficult for children who do not develop normally, so those who are visibly different from their peers at school face being ridiculed and bullied, especially when having to endure showers after gym class or changing in the locker room.

In addition to the physical effects of delayed puberty, the emotional effects of delayed puberty can be devastating. So the parents of teenagers who are being medically treated for delayed puberty should consider counseling or therapy as a part of treatment for delayed puberty, to help their children deal with the emotional affects that go along with the physical symptoms.


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