Late puberty

What is late puberty? — Puberty is a term for the changes in the body that happen as a child becomes an adult. Late puberty is when a child starts puberty much later than normal. The body changes in late puberty are the same as those in normal puberty. They just happen when a child is older.

Puberty usually starts between ages 9 to 12 in girls and ages 10 to 13 in boys. With late puberty:

  • A girl hasn’t shown any signs of puberty by age 12. Usually, the first sign of puberty in girls is that the breasts grow bigger.
  • A boy hasn’t shown any signs of puberty by age 14. Usually, the first sign of puberty in boys is that the testicles get bigger.


What causes late puberty? — Puberty is caused by hormones in the body. The brain makes hormones that start puberty. These hormones travel to the testicles (in boys), and the ovaries (in girls). The brain hormones signal the testicles to make a hormone called “testosterone.” They signal the ovaries to make a hormone called “estrogen.” Estrogen and testosterone cause the changes in the body.

Late puberty can happen if this process doesn’t happen on time. But it doesn’t mean your child has a medical problem. Some children start puberty late because:

  • They are growing more slowly than other children. This can be normal.
  • Late puberty runs in their family. If a parent went through puberty late, chances are good that their child will, too. This is especially true for boys.

Other children start puberty late because of a medical problem or condition. These can include:

  • An abnormal growth or other problem in the brain, ovaries, or testicles
  • A long-term illness or condition
  • Problems caused by abnormal genes that babies can be born with

Children (especially girls) can also start puberty late if they are too thin, don’t eat enough, or exercise much more than normal.


Will my child need tests? — Yes. If your child isn’t showing any signs of puberty, the doctor or nurse will want to know why. He or she will talk with you and your child, and do an exam. He or she will also probably do:

  • Blood tests
  • X-rays of one of your child’s hands and wrists – These X-rays can show how fast your child is growing.

Depending on these results, the doctor might do other tests. These can include more blood tests or a CT scan, ultrasound, or other imaging test of your child’s brain or belly. Imaging tests create pictures of the inside of the body.

The doctor or nurse will also do repeat exams over time to follow your child’s growth and development.


How is late puberty treated? — Treatment depends on your child’s age and the cause of the late puberty.

If puberty is late because of a medical problem, the doctor will treat the problem (if it can be treated). Different treatments might include medicines (such as hormones) or surgery. After treatment, your child will most likely start puberty.

If your child is normal but growing slowly, or if late puberty runs in his or her family, treatment usually involves “watching and waiting” for puberty to start on its own.

If your child is underweight or exercises too much, the doctor can give you advice about how to help your child get to a healthy weight and have a healthy lifestyle.

Some children (mostly boys) who are normal but growing slowly are treated with hormone treatment to help start puberty. Doctors usually recommend this treatment only if late puberty is having a big impact on the child’s life.


What else can I do to help my child? — You can help your child feel good about him or herself. Point out your child’s strengths instead of focusing on his or her body. Some children who start puberty late can have a hard time fitting in, because they look younger than other children their age.