Delayed puberty is absence of sexual maturation at the expected time.

Delayed puberty may result from constitutional delay (see Endocrine Disorders in Children: Secondary), which often occurs in adolescents with a family history of delayed growth. Prepubertal growth velocity is normal, but skeletal maturation and adolescent growth spurt are delayed; sexual maturation is delayed but normal. Other causes include Turner's syndrome in girls, Klinefelter's syndrome in boys, CNS disorders (eg, pituitary tumors that reduce gonadotropin secretion), certain chronic disorders (eg, diabetes mellitus, inflammatory bowel disorders, renal disorders, cystic fibrosis), and excess physical activity, especially in girls.

In girls, delayed puberty is diagnosed if no breast development occurs by age 13, if no pubic hair appears by age 14, if > 5 yr elapse between the beginning of breast growth and menarche, or if menstruation does not occur by age 16. In boys, delayed puberty is diagnosed if no testicular enlargement occurs by age 14, if no pubic hair appears by age 15, or if > 5 yr elapse between initial and complete growth of the genitals. Short stature may indicate delayed puberty in either sex. Although many children seem to be starting puberty earlier than in past years, there are no indications that the criteria for delayed puberty should change.

Constitutional delay of puberty is more prevalent in boys. Girls with severe pubertal delay should be investigated for primary amenorrhea (see Menstrual Abnormalities: Amenorrhea). If boys show no sign of pubertal development or of skeletal maturation beyond 11 to 12 yr by age 15, they may be given a 4- to 8-mo course of IM testosterone enanthate 50 mg once/mo. These low doses induce puberty with some degree of virilization and do not jeopardize adult height potential.

Last full review/revision May 2009 by Nicholas Jospe, MD