Girls enter puberty between the ages of 8-14. Boys enter this stage between the ages of 9-14. When this stage is late, it is called delayed sexual development.
This condition can be caused by: Constitutional delay—some children simply take longer than their peers; they will catch up at some point
(boys and girls)
Noonan syndrome (boys and girls)HypogonadismKallmann syndromeHypopituitarism
caused by infection,
, and central nervous system lesions
One common symptom for both boys and girls is shortness in height. Other symptoms by sex include:
Symptoms in boys:
Lack of testicular enlargement by age 14Lack of pubertal maturation by age 14Sex organs that don’t completely develop within five years after they started to develop
Symptoms in girls:
Lack of breast development by age 13No breast tissue or pubic hair by the age of 14Lack of menstruation for five years or more after initial breast developmentFailure to menstruate by age 15-16
You will be asked about your child’s symptoms and medical history. A physical exam will be done. Your child's milestones and growth record will be reviewed. An
of the left wrist bones may be taken. This will help to assess if bone
is normal for your child’s age.
Your child's hormone levels may be tested. This can be done with blood tests.
Images may be taken of your child's bodily structures. This can be done with: MRI scanPelvic ultrasound (female)Skull x-ray
There is often no treatment for those who are healthy and just starting later than their peers. They will continue to be monitored.
Other treatment depends on the cause. For those who have a chronic underlying disease, treatment is aimed at the specific condition. After the condition is treated, puberty often begins on its own.
For others treatments may include:
Sex hormones will help begin sexual development. They may be given to those with chromosomal abnormalities. This can include Turner syndrome or Klinefelter syndrome. Hormones may also be given to teens who are severely delayed or overly stressed by their lack of development.
Other medications may be added to sex hormone replacement medications. They may help increase height in children and young adults with constitutional delay of puberty.
Counseling may be suggested for adolescents who are struggling with the delay. This may help the child cope with social pressures.
Your child’s height, weight, and sexual development will continued to be monitored. This will help determine if any treatment has been effective.
Most causes of delayed sexual development cannot be prevented. To help reduce the chance, make sure your child maintains a healthy lifestyle. This includes making sure your child is eating well and getting nutrients. Make sure any underlying illness is treated.
Blondell RD, Foster MB, et al. Disorders of puberty.
Am Fam Physician. 1999 Jul 1;60(1):209-218. Available at:
http://www.aafp.org/afp/990700ap/209.html. Accessed June 4, 2014.
Delayed puberty. Healthy Children—American Academy of Pediatrics website. Available at:
http://www.healthychildren.org/English/ages-stages/gradeschool/puberty/Pages/Delayed-Puberty.aspx. Updated May 11, 2013. Accessed June 4, 2014.
Delayed puberty. Kids Health—Nemours Foundation website. Available at:
http://kidshealth.org/teen/sexual_health/changing_body/delayed_puberty.html. Updated August 2011. Accessed June 4, 2014.
Female delayed puberty. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed. Updated July 15, 2013. Accessed June 4, 2014.
Male delayed puberty. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed. Updated February 7, 2012. Accessed June 4, 2014.
Last reviewed May 2014 by Kari Kassir, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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