Why Hasn’t My Child Hit Puberty?

When your child doesn’t ‘hit puberty’ at the expected time, he or she may have delayed puberty. This means their body hasn’t started to mature in terms of sexual development at the typical age. This can be a great source of stress and embarrassment for teens and deserves attention, as every adolescent wants to fit in.

In most cases, delayed puberty is nothing to worry about. Every kid is different and some just start sexual development later than others. But in some cases, there is a medical cause for the delay that requires treatment. Your primary care provider (PCP) is an important resource for this discussion and sometimes a pediatric endocrinologist (a “hormone” doctor) is needed to further evaluate.

How We Define Delayed Puberty

In girls, we think about delayed puberty if there is no breast development by age 13, no menstrual periods by age 15 or if periods do not start within 3 years of starting after breast development.

In boys, we think about delayed puberty if there is no growth of the testicles by age 14, though usually pubic hair develops around the same time. Testicular growth tends to be best recognized by a PCP, and so regular checkups are important. Boys may also fail to have the expected growth spurt or voice change.

Causes of Delayed Puberty

Puberty is usually a question of when, not if. Most cases of delayed puberty are not an actual health problem. Some kids just develop later than others - what we call a “late bloomer.” This has a medical name: “Constitutional Delay of Growth and Puberty.” In many of these cases, late puberty runs in the family.  Puberty will eventually happen in these children and overall development is normal. No special treatment is needed, other than monitoring.

Occasionally, a health problem may be causing the delay. Conditions that can delay or prevent pubertal development tend to be chronic diseases and conditions such as diabetes, inflammatory bowel disease, Cystic Fibrosis, kidney disease and cancers (and their treatments). The list is very long. Some genetic conditions are known to have puberty or fertility problems as well and a pediatric endocrinologist can help diagnose and treat such conditions. In addition, abnormally low body weight (underweight) can make it difficult for the body to mature correctly.

Evaluating and Treating Delayed Puberty

In addition to checking your child’s physical development and taking a thorough medical history, your child may need blood tests and possibly a special X-ray to look at the maturity of their bones. Based on the testing, the doctor may then require more testing. In special cases, low-dose sex hormones (testosterone or estrogen) may be given to try to “jump-start” puberty and improve self-confidence.

Children with health disorders causing the problem are best off treating the underlying condition, as this tends to give us the best overall results. For genetic disorders that have no cure, and for other permanent problems that affect puberty, hormone replacement therapy may be required to help them mature physically.

Helping Your Child Cope With Delayed Puberty

Sometimes, children just need to hear that their body is normal and healthy and will start developing when it’s ready. But if you or your child are concerned about delayed puberty, reach out to your PCP to discuss their development and plan proper follow-up. Regardless of your child’s experience, of course, you can help your child by reminding him or her that you love them and are there to support them.

For more information on Nationwide Children's Hospital’s Endocrinology services, click here.