Delayed Puberty

The hormonal signals sent by the brain to the ovaries in a girl, and to the testes in a boy initiate puberty. If girls at the age 13 and boys at the age 14 do not show any signs of hormonal and physical changes suggesting onset of puberty, then the condition is referred to as delayed puberty. Puberty is an important stage in the life of girls and boys. Transformation of a little girl into a woman, or of a boy into a man, takes place during puberty. Girls usually reach their womanhood between 8 and 14. Boys reach their manhood a little later; 10 to 14 is the normal age for boys to attain puberty.

Puberty Symptoms

The body exhibits several symptoms at the beginning of puberty, for example, breast development, growth of pubic hair, significant increase in height and weight, growth of hair in the armpits, start of menstruation (menarche), fat deposition at arms, buttocks, breasts, thighs, pubis as the body starts preparing for childbirth, beginning of ovulation, are noticed during female puberty stages.

Growth of testicles, scrotum and penis, growth of pubic hair, increase in height and weight, frequent erections, occasional nocturnal emissions, change in voice (deeper voice, voice may crack) due to growth of the larynx, and lengthening of the vocal cord, growth of hair in armpits and hair on face, oily skin and outburst of acne, broadening of shoulders, development of strong muscles, growth of hair on the chest, thighs, stomach and legs, can be noticed during male puberty stages.

Delayed Onset of Puberty

If breasts are not developed by 13 years, or if menstruation does not start by 3 years after breast development (or by 16), then the condition is called delayed puberty in girls. Similarly, absence of testicular enlargement by 14 years, or no signs of sexual development for 5 years or more after the onset of genitalia enlargement, is described as a delay in the onset of puberty in boys. The hormones, estrogen in girls and testosterone in boys, play an important role in puberty stages. Causes of late puberty are listed below.

• The normal variation in the age of attaining puberty
• Defective ovaries
• Malnutrition
• Anorexia nervosa, eating disorder
• Hypopituitarism, slow working pituitary gland
• Turner syndrome, chromosomal abnormality
• Kallmann syndrome, decreased functioning of the glands that produce sex hormones
• Prolonged high level of physical exertion (like that seen in athletes) in girls
• Various systemic diseases like inflammatory bowel disease, chronic renal failure, etc.
• Under-nutrition, various types of deficiencies like zinc deficiency
• Cystic fibrosis
• Mutations in follitropin subunit beta (FSHB)
• Hypothalamus disorders like Prader-Willi syndrome, Kallmann syndrome
• Various types of pituitary defects and diseases
• Gonadal defects and diseases like Turner syndrome
• Testicular failure due to various reasons like mumps, trauma, etc.
• Congenital and acquired abnormalities of the central nervous system
• Absence or unresponsiveness of organs in the reproductive system
• Several types of endocrine disorders leading to hormonal deficiencies and imbalances, for example, hypothyroidism, Cushing's syndrome

The list doesn't end here. There exist numerous causes of late puberty. Absence of physical growth and no growth of sexual organs (in short, absence of puberty symptoms during the estimated years for attaining puberty) are considered as signs of a delay in the onset of puberty. Children who do not reach puberty in the expected years usually have short stature. They are thin, owing to the delay in skeletal development.

Delayed Puberty Treatment

As there exist numerous causes of delayed onset of puberty, the treatment mainly depends upon the cause. The doctor may order several tests to find out the exact cause. Family history plays an important role in determining the age of puberty. Once the cause is detected, treatment can be designed. A balanced and healthy diet plays an important role in attaining puberty. The doctor may prescribe proper medications to improve hormonal levels. Those with chromosomal abnormalities are given sex hormones. Surgery might be required to remove tumors in the head (in case of poor functioning of the pituitary, hypothalamus).

Monitoring the height, weight and sexual development of the child helps check the effectiveness of the treatment. Psychological counseling is considered as part of the treatment. Girls and boys suffering from hormonal imbalance and puberty problems need strong support from the family.