Girls enter puberty between the ages of 7-13. 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 pointThis is the most common cause of delayed puberty in boys and girlsChronic illnessMalnutrition or significant weight loss, such as with anorexia nervosa Hypogonadism—not enough male or female sex hormones Hypogonadotropic, such as Kallmann syndrome—the brain can't make the hormones that stimulate male or female sex hormonesHypergonadotropic—the male testis or female ovary can't make sex hormonesOther endocrine diseases, such as hypothyroidism or Cushing's diseaseChromosomal abnormalities:
(boys and girls)Noonan syndrome (boys and girls)Hypopituitarism
caused by infection,
trauma, and central nervous system lesions—destroys the ability to make hormones that stimulate male or female sex hormones
One common symptom for both boys and girls is being short for their age. Other symptoms by gender include:
Symptoms in boys:
Lack of testicular enlargement by age 14Sex organs that don’t completely develop within 5 years after they started to develop
Symptoms in girls:
Lack of breast development by age 13Lack of menstruation 2 ½ years or more after initial breast development
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 will be taken to assess bone age. This will help to assess if bone
is normal for your child’s current level of pubertal development.
Your child's hormone levels will be tested. This can be done with blood tests.
Images may be taken of your child's bodily structures if the cause needs to be further identified. This can be done with: MRI scanPelvic ultrasound (female)
No treatment is usually needed 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 start sexual development. They will be given to those who cannot make their own, such children 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. They may stimulate the onset of normal 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 continue 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.
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 November 21, 2015. Accessed November 23, 2016.
Delayed puberty. Kids Health—Nemours Foundation website. Available at:
http://kidshealth.org/teen/sexual_health/changing_body/delayed_puberty.html. Updated January 2015. Accessed November 23, 2016.
Delayed puberty. Patient UK website. Available at: http://www.patient.co.uk/doctor/delayed-puberty. Updated July 9, 2015. Accessed November 23, 2016.
Delayed puberty/sexual development in children. Boston Children’s Hospital website. Available at: http://www.childrenshospital.org/conditions-and-treatments/conditions/delayed-puberty-delayed-sexual-development. Accessed November 23, 2016.
Male delayed puberty. EBSCO DynaMed Plus website. Available at:
http://www.dynamed.com/topics/dmp~AN~T116902/Male-delayed-puberty. Updated November 9, 2016. Accessed November 23, 2016.
What causes normal puberty, precocious puberty, and delayed puberty. National Institute of Child Health and Human Development website. Available at: http://www.nichd.nih.gov/health/topics/puberty/conditioninfo/Pages/causes.aspx. Updated November 30, 2012. Accessed November 23, 2016.
Last reviewed November 2016 by Michael Woods, MD, FAAP
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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