Delayed Puberty: Causes and Treatment

When should children start puberty, what signs should we look out for, and what happens if there is delayed puberty?
Delayed Puberty: Causes and Treatment

Last update: 02 October, 2019

Puberty is the period in which there is an accelerated development of sexual characteristics and bone growth. This phase is the link between childhood and adulthood and can occur late in some children. We’ll be letting you know what you should do when there is delayed puberty.

When reaching puberty, a child experiences psychological and physical changes as they mature sexually. This usually takes place at 14 years of age in boys and at 13 in girls. 3% of teens have delayed puberty, especially boys who can show late development and temporary abnormalities.

Delayed puberty, is it common?

It arises when there are no changes in sexual growth and maturity in accordance with the age of the child.

A simple form of delayed puberty is more common. This is simply stunted growth due to natural or family reasons, and this is suffered by 30% girls and 60% boys. Human development is governed by the luteostimulating hormone, which governs the functioning of the gonads for testosterone and estradiol.

Puberty can begin gradually at 9 years of age with the development of sexual characteristics (ovaries and testicles). These produce estradiol hormones in females and testosterone in males. These changes cause breasts to grow in girls, and testicles in boys, and pubic and underarm hair in both sexes.

Delayed Puberty: Causes and Treatment


There are many factors here, and they can occur in any boy or girl. The known factors are:


  • Malnutrition
  • Hypothyroidism
  • Anorexia
  • Asthma
  • Crohn’s disease
  • Celiac disease
  • Pituitary and hypothalamus disorders
  • Renal failure
  • Inherited deficiencies
  • Kallman, Noonan and Prader-Willi syndromes
  • Turner and Klinefelter syndromes (sex chromosome abnormalities)
  • Dysmorphic syndromes
  • Gonadal insufficiency
  • Galactosemia in girls

Physiological conditions

The condition can cause different types of physiological reactions:

  • Delayed growth due to genetic elements
  • Headaches
  • Dizziness
  • Poor vision

Medical treatment

The treatment options are the following:

  • Therapy with glucocorticoids
  • Radiotherapy or chemotherapy
  • Surgeries

Puberty in girls and boys

The transformation during puberty is different in males and females. It can also be influenced by family history, race, sex, nutrition, and the geographic environment. In men, pubertal development is slower and that’s why it’s more frequent for them to suffer delayed puberty. The signs show themselves in the following ways:

In girls

It begins with the production of pituitary and ovarian hormones, which causes the appearance of the rapidly growing breast buds. In the next 2 or 3 years, the girl will have her first period, and that completes the stage of puberty. The first sign of delayed puberty is if, at 13 years of age, you still can’t see any sign of breast buds.

In boys

Puberty in boys is seen with an increase in the size of their testicles and penis. Pubic hair starts to grow, and, around one year later, they’ll usually have a growth spurt. Delayed puberty in boys is when their testicles are less than 0.8 inches in diameter at 14 years of age.

In both sexes, experts will call it a delayed puberty if development is very slow and takes more than 5 years to complete. That is, if at 15 years of age, the boys still haven’t seen any real growth in their testicles and penis, and the girls haven’t had their first period. This is also the case if their height or weight is considerably lower than what it should be at their age.

Delayed Puberty: Causes and Treatment

What to do when there is delayed puberty?

First of all, consult the pediatrician. They’ll make a detailed evaluation of the symptoms. It’ll be based on questions about development history such as height and birth weight. They’ll also analyze the child’s growth pattern, diseases suffered in childhood, medical treatments the child has received, and the family history in order to identify any genetic factors.

The physical examination will be to verify weight and height, nutritional condition, other body dimensions, genital status, and a neurological examination. They may do x-rays to see the bone condition. In addition to that, they may also carry out other tests to measure hormones and to rule out chronic diseases.

What treatments exist for delayed puberty?

When diagnosing general developmental delay, the doctor will make regular weight and height checks. The treatment they offer usually focuses on the endocrine and digestive systems. The procedures to follow depend on the causes:

  • Stunted growth. Especially in men, experts offer emotional help in order for them to overcome possible inferiority complexes. In cases of hypogonadism, they can receive hormonal treatments in low doses. This can be carried out in both boys and girls in order to induce the puberty process in a short period of time.
  • Chronic illnesses. The expert will recommend a treatment plan for the patient to follow.
  • Neurological problems. If there are problems in brain structure due to nutritional, psychological or other factors that prevent an adequate stimulation of pubertal development, then a neurologist will prescribe treatment.

To summarize, when there is delayed puberty, then the standard treatment is hormonal. This involves estrogen for girls and testosterone for boys. It isn’t a condition that is health-threatening and so there’s no reason to overly worry about the situation, as nature often just takes its course with a little help from the medical world.


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This text is provided for informational purposes only and does not replace consultation with a professional. If in doubt, consult your specialist.