- Puberty is an interval characterised by the acquisition of the secondary sexual characteristics, accelerated linear growth, increase in the secretion of sex hormones, maturation of gonads (testes in boys), and the potential for reproduction. It is typically complete within 2 to 5 years.
- Delayed puberty is defined as the lack of any pubertal signs by the age of 14 years in boys.
- More common in boys.
- May be functional (constitutional delay, underlying chronic disease, malnutrition, excessive exercise) or organic, due to either a lack of serum gonadotrophin production or action (hypogonadotrophic hypogonadism), or gonadal insufficiency with elevated gonadotrophins (hypergonadotrophic hypogonadism).
- Most patients seek medical assistance because of slow growth rather than slow pubertal development.
- Careful assessment of height and pubertal stage is crucial for evaluation of the underlying cause.
- The distinction between organic gonadotrophin deficiency and constitutional delay of puberty is not easy and is often resolved only with time.
- Patients with constitutional delay are typically observed. Sex-steroid treatment is reserved for those with psychosocial maladaptation, and consists of a short course of sex steroids to induce puberty.
- Patients with an organic cause for delay are given sex-steroid therapy to induce puberty and are most likely to require lifelong hormone replacement therapy after puberty is complete.
Delayed Puberty in Boys
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Note that this email address contacts the team managing the website rather than the service itself; as such, please do not reach out with clinical queries or concerns.
Summary
Initial Management
Height and weight to be measured as part of delayed puberty work up and plotted on growth chart. Parent’s heights provide key information in assessing growth and puberty.
Who to Refer
- Puberty is considered delayed in boys if lack of any signs of puberty by age 14 years.
- Initial signs of puberty in boys are growth of testes with volumes of greater than 3ml. This information can be gathered by discussing with boys directly as to whether they have noticed any growth or maturation of genitals.
- Additionally lack of pubic and axillary hair growth and linear growth falling off centiles by age 14years would warrant referral to paediatrics.
- Delayed puberty can be secondary to chronic disease. Please indicate whether there is suspicion of this.
- If bloods are being checked prior to referral please include – LH, FSH, testosterone, prolactin, TFTs, coeliac disease.
- Bone age is a useful investigation however this can be carried out on the day of clinic in order to minimise trips to hospital.