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Puberty Problems

What Is Puberty?

Puberty is the phase of life when a child goes through physical and hormonal changes that mark the transition to adulthood. These changes result from the:

  • Production of sex hormones in the pituitary gland
  • Maturing of the reproductive organs such as testes in males and ovaries in females

Puberty begins when an area of the brain called the hypothalamus starts to release gonadotropin-releasing hormone (GnRH). When GnRH travels to the pituitary gland, it releases two more puberty hormones — luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These hormones signal a girl’s ovaries to start producing the female sex hormone, estrogen, and a boy’s testicles to start producing the male sex hormone, testosterone.

Sex hormones instruct reproductive organs to develop or mature in preparation for one day being able to have children. Estrogen and testosterone also cause the development of secondary sex characteristics, which lead to male-female differences, such as women's breasts and rounded hips, and men's facial hair and muscle development. The maturing ovaries and testicles make increasing amounts of sex hormones, further promoting the process of puberty.

Puberty normally begins between the ages of 8-13 in girls and ages 9-14 in boys. It can last between 2-5 years. The timing and duration of puberty is influenced by a person’s genetic background.

Along with physical changes during puberty, preteens and teens may begin to gain more interest in romantic relationships and sex.

Signs of Puberty

Puberty can have different patterns.

In girls, it usually begins with a growth spurt and development of breast “buds.” Other signs include:

  • Growth of pubic and other body hair
  • Body odor
  • Beginning of menstruation
  • Acne

In boys, it typically begins with enlargement of the testicles and penis.

Other signs include:

  • Growth of pubic hair, other body hair, and facial hair
  • Body odor
  • Muscle growth
  • Growth spurt
  • Acne
  • Deepening of the voice

How Cancer and Treatment Can Affect Puberty

The effect of cancer and cancer treatment on puberty varies from person to person.

It largely depends on when treatment occurs and the type of therapy. Often treatment has no effect on puberty. But certain childhood cancers and childhood cancer treatments may trigger children to begin puberty early. In other cases, treatment may cause a delay or interruption in puberty or failure to begin puberty.

Risk Factors

Risk factors for effects on puberty include:

  • Surgical procedure to brain, pelvic area, or sexual organs
  • Radiation to brain or pelvic area
  • Chemotherapy with alkylating agents and certain other medicines
  • Germ cell tumors producing sex hormones

Alkylating drugs

Heavy metal drugs

Non-classical alkylators

Early Puberty

The symptoms of early puberty are similar to the signs of normal puberty but they happen earlier—before the age of 8 in girls and before age 9 in boys and at an accelerated rate.

Early puberty occurs when the hypothalamus and pituitary glands signal the ovaries (in girls) or testicles (in boys) to make female or male hormones earlier than normal. It can also occur when certain tumor types are producing excess hormones.

Early puberty:

  • Causes development of sexual traits earlier than expected
  • May lead to rapid bone growth and premature closure of the bone’s growth plates that can result in short stature.

Delayed Puberty

Delayed puberty occurs when puberty does not begin within the normal range of ages. Many children with delayed puberty will eventually go through an otherwise normal puberty, just at a late age.

In some cases, puberty that has already started may stop for a period of time. This occurrence may be called arrested puberty.

In females, it can affect menstruation. There may be a delay in the start of menstruation, irregular menstrual periods, and/or early menopause.

In males, it may affect the production of testosterone.

Failure to Enter Puberty

Some children may have a long-lasting condition that may prevent puberty from occurring.

The care team will work with survivors to develop a care plan to deal with puberty-related concerns.

What Survivors Can Do

If survivors have risk factors for early or delayed puberty, the following tests may be recommended:

  • A blood test for FSH (follicle stimulating hormone), LH (luteinizing hormone) and sex hormone (estradiol or testosterone) levels
  • Bone age X-ray (an X-ray that measures the developmental age or maturation of bone)

If a problem is detected, the provider may refer the patient to an endocrinologist. In cases of early puberty, medications may be used to temporarily stop puberty and to decrease the rate of bone maturation. In cases of delayed puberty, hormone replacement therapy may be prescribed to stimulate puberty.

In males:

Treatment may include testosterone replacement therapy. Testosterone is available in skin patches, injections, and topical gel. An endocrinologist will determine which form of therapy is best.

In females:

The provider may recommend:

  • Estrogen, either as a pill or a patch
  • Progesterone, given as a pill
  • Combination therapy — Oral contraception pills (often containing both estrogen and progesterone) to maintain normal levels of sex hormones

Hormone replacement therapy may have side effects. Some are potentially serious. Patients are encouraged to talk to their providers about its risks and benefits.

Sometimes experiencing puberty earlier or later than others their age can be difficult. Survivors may also be referred to a psychologist or counselor. It is important to evaluate and manage the psychological effects of early or delayed puberty.


Reviewed: February 2019