Delayed Puberty: Causes, Symptoms, Diagnosis And Treatment

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Puberty is a period of life when a child’s body starts to transform into an adult. Delayed puberty is when the physical signs of sexual maturity do not appear at the expected age.

The expected age of puberty is between eight and 13 years for girls and between nine and 14 years for boys. Each child acquires puberty at different ages. If the signs of puberty are absent even after 2-2.5 years after the expected age, then the child may have late puberty. The absence of breast enlargement in girls or testicular enlargement in males may indicate late puberty (1) (2). Most of the time, the underlying cause is unknown, and the condition resolves on its own (3).

Read on to know about delayed puberty, its causes, signs, symptoms, and treatment.

What Causes Delayed Puberty?

In the majority of the cases, the exact cause of delayed puberty is unknown, and in a few cases, late puberty might run in the family. The following factors may contribute to delayed puberty in some cases.

  1. Constitutional delay of growth and puberty (CDGP): CDGP is characterized by short stature and delayed puberty and bone age. It can lead to an increase in the risk of delayed puberty. The condition often runs in the family and is diagnosed only after the underlying conditions are ruled out (1) (4).
  1. Underlying medical condition: An underlying medical condition such as celiac disease, which affects the ability of a child to grow at a normal pace, might lead to delayed puberty (5). A few other conditions that prevent the hypothalamus or pituitary gland from sending the ‘start puberty’ signal might also be responsible for the delay (2). Besides, it can also be caused by genetic disorders, such as Turner syndrome in girls and Klinefelter syndrome in boys.
  1. Other causes: Delayed puberty can also result from malnutrition, excessive physical exercise, stress, and the use of psychiatric medications (2).

Signs Of Delayed Puberty

The most common sign of delayed puberty is the delay in the development of the secondary sexual characteristics of the child (2).

In girls, the symptoms might include

  • an absence of breast growth by 12 years
  • a gap of more than five years between breast growth and the first menstrual cycle, and
  • no menstrual period by 15.

In boys, the symptoms might include

  • an absence of pubic hair or irregular pubic hair distribution,
  • no testicular enlargement by age 14, and
  • a period of more than five years to complete adult genital growth.

How Is Delayed Puberty Diagnosed?

The diagnosis of delayed puberty is relatively straightforward because the symptoms are physically evident. However, to determine the exact cause of delayed puberty, you might want to consult your doctor to perform certain tests and identify the underlying problem, if there is any.

A thorough examination of family history, medical history, growth pattern, and physical examination might help reveal the factors responsible for delayed puberty (1).

The common tests that might be used to diagnose late puberty are (4) (2)

  • Determination of bone age: A simple X-ray of the wrist can help determine the structure and density of the bone.
  • Blood tests: Blood tests can help measure the levels of the hormones responsible for the onset of puberty. This may help diagnose the primary reason for the delayed development of secondary sexual characteristics.

If Turner syndrome or Klinefelter’s syndrome is suspected, a thorough analysis of chromosomes might confirm the diagnosis (6).

Treatment For Delayed Puberty

Treatment for delayed puberty depends on the underlying cause of the problem (1). Generally, children with constitutional delay of growth and puberty get through puberty and acquire the required characteristics, although a little late.

In most cases, when the cause is treated, puberty proceeds normally. If the delayed puberty is inherited, no treatment is needed(7)). In some cases, treatment might include hormone therapy to increase testosterone or estrogen levels and induce puberty.

How To Help A Child Deal With Delayed Puberty?

It can be emotionally overwhelming for children to deal with delayed puberty and see other children growing faster than them. You need to be emotionally available for your child and reassure them that it is a temporary problem that will eventually get solved.

Although the age to attain puberty varies among children, if a girl experiences no breast enlargement and is devoid of menstruation by 15 or a boy shows a lack of or irregular public hair by 15, they may have delayed puberty. Dealing with puberty delay could be stressful for both parents and children. If you believe your child may be facing this issue or is showing signs of distress, you may speak to a doctor. Also, at times, your child may need some extra assistance to manage their feelings and apprehensions.

Key Pointers

  • Delayed puberty can be caused by family history, a constitutional delay of growth and puberty, a medical condition, or other causes such as malnutrition.
  • In girls, delayed puberty can lead to a lack of breast development and a late first menstrual cycle.
  • Boys with delayed puberty lack testicular enlargement and have an uneven distribution of pubic hair.
  • Those with inherited delayed puberty and CDGP do not require treatment, but those with other causes may require hormone therapy.


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Maria Carmela Villania-Mamauag

Maria Carmela Villania-Mamauag is a board certified diplomate of the Philippine Pediatric Society with a degree of Doctor of Medicine from Our Lady of Fatima University, Valenzuela City and a Bachelor in Science in Psychology from Saint Louis University, Baguio City which was augmented by a year of Bachelor in Science in Family Life and Child development at the University... more

Sindusha MS

Sindusha is a clinical nutritionist with over two years of experience in diverse fields of nutrition. She did her Masters in Food Science and Nutrition and has qualified UGC-NET. She interned as a quality control analyst and as a dietitian during her graduation. She was a part of several community nutrition projects and a phytochemical-based nutrition study during the same... more