Delayed puberty and sexual development

The Condition


Puberty is a stage of sexual maturity characterised by many bodily changes. It occurs in girls between 7 to 13 years of age, and 9 to 15 years of age in boys. Delayed puberty is the absence of the onset of sexual maturation. Most often this is due to constitutional delay (temporary), and these children may simply be late bloomers and ultimately develop normally.


The lower part of the brain called the hypothalamus releases a hormone that initiates the pituitary gland to secrete another hormone called gonadotropins, which in turn stimulates the sex organs (testes in males and ovaries in females) to produce sex hormones. This results in the development of male and female sexual characteristics such as increased muscle mass and development of facial hair in boys, development of breasts and menses in girls, and sexual desire and underarm hair in both.


Various conditions can cause delayed puberty and sexual development. Some of these include:

Chronic conditions such as diabetes, kidney disease, cystic fibrosis, anaemia, autoimmune diseases and inflammatory bowel disease

Malnourishment, excessive exercise or dieting, especially in girls

Improper function of pituitary and thyroid glands, resulting in hormonal imbalance

Genetic factors as seen in conditions such as Turner syndrome (affects the development of ovaries and sex hormones in girls) and Klinefelter syndrome (affects males and slows down sexual development)

Infections, testicular injury or torsion in boys

Certain tumours, and radiation and chemotherapy for treatment of cancer


Children may find it difficult to accept that they are not growing at the same rate as their peers and in certain cases may need counselling to help them cope with their feelings of inadequacy. This problem is usually temporary and affected children can catch up with their friends.


Delayed puberty occurs more commonly in boys and is characterised by lack of testicular development even by the age of 14 years and very slow progress of puberty from onset to maturation (more than 5 years). In girls, symptoms of delayed puberty include no breast development even by 13 years of age, no menses by age 16, and more than 5 years from onset of breast development to first menses.


Initially, your child's doctor will obtain a complete medical and family history, and perform a physical examination to assess the growth and nutritional status of your child. The doctor may also order an X-ray to evaluate bone maturity. Basic laboratory tests to examine hormonal imbalances, chromosomal abnormalities and chronic disease may also be ordered. An MRI of the brain may be needed to look for any abnormality of the pituitary gland or tumour.


In most cases, delayed puberty may be just due to constitutional delay and may run in the family. If left untreated the condition usually corrects itself. In other cases, if the underlying cause is not treated this could lead to poor self-image, miscarriages or infertility.


If the underlying cause or disease is treated, puberty will proceed normally. In case of reduced production of hormones in the body, your child's doctor will suggest hormone therapy, with low doses of testosterone for boys and oestrogen for girls with regular check-ups to ensure that growth is proceeding normally. Surgical correction may be required in case a tumour is identified that is causing the delay.


The majority of cases of delayed puberty do not require treatment. In other cases, treatment of the underlying cause or hormonal replacement will be sufficient to solve the problem without any lasting side effects.


Extensive research is being done regarding treatment of delayed puberty. Some recent studies include:

  • Pitteloud N. Managing delayed or altered puberty in boys. BMJ. 2012 Dec 3;345:e7913.
  • Palmert MR, Dunkel L. Clinical practice. Delayed puberty. N Engl J Med. 2012 Feb 2;366(5):443-53.