What to Know About Delayed Puberty

Medically Reviewed by Dan Brennan, MD on July 26, 2022
5 min read

Puberty is the process of a child's body changing to an adult body. It doesn't happen overnight, and it doesn't happen at the same age in all children. Most girls undergo puberty changes between 8 and 14 years, and boys between 9 and 15 years. Delayed puberty is the absence of bodily changes beyond this age range.

Puberty depends on a complex mechanism run by the brain, the pituitary gland, and the gonads (ovaries or testes). These organs produce hormones that generate the features of puberty in your child's body. Puberty in girls is driven by estrogen, produced in greater amounts by the ovaries in response to pituitary hormones. In boys, the testes produce more testosterone in response to pituitary stimulation. A failure anywhere in this chain will cause a delay in the onset of puberty.

If your child doesn't show any physical changes of puberty by 14 years for girls or 15 for boys, you should consider the possibility that they are experiencing delayed puberty. Your doctor will examine your child and suggest some tests to find the cause. They may refer you to an endocrinologist, a doctor with expertise in hormonal disorders. 

The delayed onset of puberty is recognized by the absence of the physical changes of puberty. In girls, you should be warned by the absence of breast development by age 14 or the absence of periods by age 16. In boys, look out for slow genital growth. These children are shorter than their peers who are growing quickly.

Girls may show signs of puberty as early as 8 years. The chief changes in their bodies are:

  • Development of the breasts (thelarche)
  • Growth spurt (rapid increase in height)
  • Underarm and pubic hair growth
  • Start of periods
  • Wider hips and a curvier body shape

Almost all girls will show some or all of these signs by age 14 years. If this doesn't happen, it is considered delayed onset puberty.

Puberty in boys starts after 9 years. The chief changes are:

  • Larger testes and penis
  • Growth of facial, underarm, and pubic hair
  • Growth spurt (rapid increase in height)
  • Broader shoulders and muscular development
  • Deepening of the voice

Almost all boys will have such changes by age 15 years. If this doesn't happen, their puberty is delayed.

There's a large range of what is considered normal with regards to the age of puberty. Your child's friends and classmates may start earlier, but your child may also be within normal limits. There are several causes that can delay the onset of puberty.

Familial. If one parent had late puberty, it is likely to happen in the child too. 

Functional. A functional cause of delayed puberty is hypogonadotropic hypogonadism. The production of gonadotropin-releasing hormone {GnRH) from the hypothalamus is delayed. Without it, the pituitary gland does not release hormones to stimulate the ovaries or testes. Estrogen or testosterone are not produced, and puberty is delayed. Hypogonadotropic hypogonadism is sometimes part of some syndromes, but usually has no cause.

Constitutional growth delay. This is a condition affecting bone growth, and children do not grow tall as quickly as their peers. More than half of boys with delayed puberty have constitutional growth delay. With time, these children go through puberty and reach an appropriate adult height. This condition is considered a normal variant of growth, and your doctor won't treat it aggressively. 

Chronic disease. Any long-term disease puts a strain on the body. Growth and development are difficult. Cystic fibrosis, diabetes, kidney diseases, asthma, sickle cell disease, celiac disease, and others can cause delayed puberty. Appropriate treatment can control the disease and allow puberty to progress.

Malnutrition. Not getting enough food or having a diet poor in nutrients can reduce growth and maturation. Food scarcity, excessive physical activity, eating disorders, or an imbalanced diet can cause delayed puberty.

Genetic disorders. Chromosomal disorders like Turner syndrome and Klinefelter syndrome can prevent or slow puberty. Such diagnoses require laboratory testing. A team of specialists may be needed to manage the various manifestations.

Other causes. Eating disorders, chemotherapy or radiotherapy, past disease or surgery on the ovaries or testes, metabolic disorders like galactosemia, and other factors can lead to delayed puberty. Some medicines can also delay puberty.

Your doctor will carry out a complete physical examination and order some tests and X-rays. If an underlying medical cause is found, treating it usually achieves the desired result. If no disease is found, your doctor may advise you to wait. The changes of puberty often start on their own at a later age.

Your doctor may start treatment if your child has low self-esteem or psychosocial stress. Other reasons for starting treatment are bullying, dropping out of sports, and poor academic performance. The treatment of delayed puberty consists of testosterone (for boys) or estrogen (for girls).

The treatment is safe and has no long-term effects. It improves growth velocity and sexual maturation within a few months. The treatment is given for a few months, watching for puberty changes. Once the onset is confirmed, your doctor may stop the treatment. The body's own hormones usually take over and continue pubertal development.

What should you do at home? Apart from the medical treatment:

  • Enroll your child in activities appropriate for their body type.
  • Encourage them to get adequate sleep and eat a balanced, healthy diet.
  • Make sure they're physically and socially active.

Most children with delayed puberty achieve normal adult height and physical features. This can occur naturally, or with treatment. But some children also have mental health issues during their teen years because of delayed puberty. Seeing their friends growing and developing while they're not is distressing. Also, these children may get bullied or left out of sports.

You should reassure and encourage your child with delayed puberty. Teach them to accept and like their body at every stage of life by being a good body-image role model yourself. Tell your child frequently that delayed puberty is just that — a delay. In the course of time, they will be as tall and well-developed as their friends.

Some children may be depressed and withdraw from social activities. School problems are also possible. A therapist or counselor can help, along with emotional support at home.

Delayed puberty is not dangerous, and almost all children ultimately grow into healthy adults. But some children with delayed puberty have underlying medical problems. If your child is not growing and developing till a late age, you should consult your healthcare provider.