What is puberty?
Puberty is a normal stage of development when a child’s body changes and matures into an adult body. Chemical signals in the brain trigger hormone changes that affect the entire body. This leads to growth spurts, maturing of reproductive organs, and other changes, such as breast development in females and facial hair or genital changes in males. In addition to physical changes, puberty often involves changes in emotions, sleep, and behavior.
Puberty normally begins between the ages of 8 and 13 in females and 9 and 14 in males. It usually lasts 2-5 years. The timing and pace of puberty vary from person to person.
Puberty begins when the brain sends chemical signals that tell the body to start making certain hormones. These hormones tell the body how to grow and develop.
An area of the brain called the hypothalamus starts the process. It releases a hormone called gonadotropin-releasing hormone (GnRH).
GnRH signals another part of the brain, the pituitary gland, to release 2 hormones: luteinizing hormone (LH) and follicle-stimulating hormone (FSH).
LH and FSH signal the gonads (ovaries in females and testes in males) to mature and make sex hormones.
- In females, the ovaries make estrogen.
- In males, the testes make testosterone.
These sex hormones prepare the body to be able to have children. They also cause physical changes, such as:
- Breast growth and wider hips in females
- Genital enlargement, facial hair, and increased muscle size in males
The ovaries and testicles continue to make these hormones, which control the changes of puberty.
Puberty causes changes in both females and males. Some changes are shared, but others depend on biological sex. In addition to physical changes, puberty often brings changes in mood and sleep patterns, as well as increased interest in social relationships and independence.
Signs of puberty in females
In females, common signs include:
- Increase in height and weight
- Breast development
- Widening of the hips
- Growth of pubic and other body hair
- Increased sweat and body odor
- Start of menstrual periods
- Skin changes, such as acne
Signs of puberty in males
In males, common signs include:
- Increase in height and weight
- Enlargement of testes and penis
- Growth of facial hair, pubic hair, and other body hair
- Increase in muscle mass
- Increased sweat and body odor
- Skin changes, such as acne
- Voice deepening
How illness and treatment can affect puberty
Often, medical conditions and treatments have no effect on puberty. But sometimes they can affect when and how puberty happens. Puberty problems usually happen because of changes in how hormones are made or their effects on the body.
Early puberty
Early puberty means having signs of puberty at a younger age than expected (before age 8 in girls and before age 9 in boys). This is also called precocious puberty.
It occurs when the hypothalamus and pituitary gland signal the ovaries (in females) or testes (in males) to make sex hormones earlier than normal. In some cases, certain types of tumors can make extra hormones that start puberty early. Early puberty or puberty that progresses faster than expected can affect growth and shorten final adult height.
Delayed puberty
Delayed puberty means having signs of puberty at an older age than expected (no breast tissue by age 13 in girls and no genital changes by age 14 in boys). Many children with delayed puberty will still go through puberty normally, just at a later time. In some cases, a medical condition may cause puberty to start late.
Arrested puberty
Arrested puberty means that puberty has already started, but then it stops.
- In females, delayed or arrested puberty affects estrogen production and can stop further breast development, delay the first menstrual period, cause irregular periods, or make periods stop.
- In males, arrested puberty affects the production of testosterone and may stop genital growth before reaching adult size, or prevent voice change or facial hair.
Risk factors for puberty problems
Risk factors for puberty problems include:
- Medical conditions that affect the brain, pituitary gland, adrenal glands, ovaries, or testes
- Surgery to the brain, pelvic area, or reproductive organs
- Radiation to the brain or pelvic area
- Germ cell tumors that make sex hormones
- Adrenal tumors that make sex hormones
- Chemotherapy
- Poor nutrition
- Severe obesity
Medicines that may affect puberty
Diagnosis of puberty problems
All children and teens should have a yearly medical exam or well-child visit to check growth and development. This includes measuring your child’s height and weight and looking at how their body is changing. It is important to discuss any concerns you may have about your child’s development or puberty with your health care provider during these checkups.
If your child is at risk of puberty problems, your care team may send them to a hormone specialist called an endocrinologist. They can provide specialized care for puberty-related concerns.
Tests to diagnose puberty problems may include:
- Blood tests to check hormone levels, such as:
- Luteinizing hormone (LH)
- Follicle-stimulating hormone (FSH)
- Estradiol
- Testosterone
- Imaging tests to see how bones are growing. These tests help your care team know if your child is maturing at the expected rate.
Treatment of puberty problems
Treatment of puberty disorders or problems depends on the cause. Your care team will work with you and your child to develop a care plan to manage puberty-related concerns.
In cases of early puberty, medicines may be used to temporarily stop puberty. This helps slow physical changes and bone growth, allowing for more normal development.
In cases of delayed puberty, your health care provider may prescribe hormone replacement therapy (HRT). HRT gives the body the hormones it needs to grow and develop.
Males
In males, treatment may include:
- Testosterone: Testosterone replacement therapy may be given as an injection (shot) or topical gel.
Females
In females, treatment may include:
- Estrogen: Given as a pill or patch
- Progesterone: Given as a pill
- Combination therapy: These often have both estrogen and progesterone to help keep normal levels of sex hormones.
Your care team will discuss the best options for your child and explain the benefits and risks of these treatments. Regular checkups are important to monitor progress and adjust the care plan as needed.
Tips for managing puberty problems
Puberty can be challenging for many children. Having puberty earlier or later than others can be especially hard. Your child may feel self-conscious, embarrassed, or unsure about what is happening to their body. Here are some ways to support your child:
- Talk about it: Encourage open and honest communication. Let your child know it is normal for kids to grow at different times. Help your child know what to expect and answer their questions.
- Share feelings: Create a safe space for your child to talk about what they are thinking and feeling. Ask how they feel about body changes. Listen and support them.
- Get help if needed: A counselor or mental health provider can help if your child feels worried, sad, or embarrassed. A child life specialist or pediatrician can help explain body changes in an age-appropriate way.
- Eat healthy and stay active: Good nutrition and physical activity are important for strong bones and muscles. Offer a variety of healthy foods to be sure your child gets the calories and nutrients they need.
- Practice good hygiene: Show your child how to use deodorant and care for their skin. Prepare your child for practical needs, such as shaving or using menstrual products.
Questions to ask the care team
