Puberty is said to be delayed when physical signs do not appear by age 13 for girls and age 14 for boys. Delayed puberty can be hereditary; meaning that the late onset of puberty may run in families. However, delayed puberty may also be due to chromosomal abnormalities, genetic disorders, chronic illnesses, or tumors that damage the pituitary gland or the hypothalamus, which affect maturation.
Lacking signs of puberty is the primary indicator that a child may be experiencing delayed puberty. The following are the most common symptoms of delayed puberty. However, each child may experience symptoms differently. Symptoms may include:
Lack of any breast development by age 12
More than five years between initial breast growth and first menstrual period
Failure to menstruate by age 14
Lack of testicular enlargement by age 14
Lack of pubic hair by age 15
More than five years to complete adult genital development
The symptoms of delayed puberty may resemble other problems or medical conditions. Always consult your child's doctor for a diagnosis.
In addition to a complete medical history and physical examination, diagnosis of delayed puberty may include:
Blood tests. Tests to check for chromosomal abnormalities, to measure hormone levels, and to test for diabetes, anemia, and other conditions that may delay puberty.
X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. Simple X-ray of the left hand and wrist bones is often performed to determine bone maturity.
Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
Specific treatment for delayed puberty will be determined by your child's doctor based on:
Your child's age, overall health, and medical history
Extent of the condition
Your child's tolerance for specific medications, procedures, or therapies
Expectations for the course of the condition
Your opinion or preference
Treatment for delayed puberty depends on the cause of the problem. Often, when the underlying cause is treated, puberty proceeds normally. If the delayed puberty is due to heredity, no treatment is usually necessary. In some cases, treatment may involve hormone therapy to stimulate the development of secondary sexual characteristics, or surgery to correct an anatomical problem.