Delayed Puberty

Overview

Puberty is the time when a child's body changes into an adult body. It includes growth spurts, body hair, breast growth in girls, and voice changes and testicle growth in boys. Delayed puberty means these changes start later than usual. For girls, doctors often check this when there are no breast buds by about age 13, or no periods by about age 15 to 16. For boys, it is often checked when the testicles have not started to grow by about age 14. These ages are guides, not strict rules. Many teens who start late are simply 'late bloomers' and catch up.

Yes, it is fairly common. The most common pattern, called constitutional delay (a normal late start), is seen more often in boys.

It affects children and teenagers. It can run in families. It is also more likely in children with long-term health conditions, poor nutrition, eating disorders, or very intense exercise and low body weight.

Symptoms

Common symptoms

• No breast buds by about age 13 in girls.
• No testicle growth by about age 14 in boys.
• No period by about age 15 to 16 in girls, or periods that have not started within about 3 years of breast growth.
• Being much shorter than friends, or growing more slowly than expected.
• Less pubic hair or underarm hair than peers, though this varies.
• Feeling worried, embarrassed, or left out because the body looks younger than peers.

Symptoms in children

• The signs are the same as above: puberty changes do not start within the usual age range.
• Some children may also be shorter than expected for their age.
• A child may feel anxious about looking different from friends.

Symptoms in older adults

• Delayed puberty is a childhood and teenage issue, so it does not usually apply to older adults.
• Adults who had delayed puberty may want to ask a healthcare provider about fertility (the ability to have children), bone health, and long-term hormone health.

Causes

Main causes

• Constitutional delay: a normal pattern of starting puberty later, often with a family history of late blooming.
• Long-term illnesses, such as bowel disease, kidney disease, low iron in the blood (anemia), or thyroid problems.
• Poor nutrition, eating disorders, or low body weight from very intense exercise or dieting.
• Hormone problems involving the brain areas that control puberty.
• Genetic conditions present from birth, such as Turner syndrome in girls or Klinefelter syndrome in boys.
• Previous radiation treatment or chemotherapy (cancer treatments).
• Rarely, a tumor or other problem in the brain or hormone glands.

Risk factors

• A family history of late puberty.
• Long-term health conditions.
• Low body weight, eating disorders, or extreme exercise.
• Certain genetic conditions.
• Previous cancer treatment, especially radiation or chemotherapy.

When to see a doctor

See a doctor urgently if:

• A new severe headache, vision changes, or vomiting.
• Painful swelling of a testicle.
• Very heavy vaginal bleeding, or bleeding with dizziness or fainting.
• Signs of an eating disorder with fainting, confusion, or very low food intake.

Book a routine appointment if:

• No breast buds by about age 13 in girls.
• No testicle growth by about age 14 in boys.
• No period by about age 15 to 16 in girls.
• Puberty starts but then stalls or reverses.
• Your child is much shorter than peers or growing very slowly.
• Your child is very upset about body changes or being teased.

Diagnosis

A healthcare provider will ask about your child's growth, health, family history, and puberty signs. They will do a physical exam and look at growth charts. Often, they will watch and recheck over a few months before doing tests.

Tests that may be done

• Blood tests to check hormone levels and look for health problems such as anemia or thyroid issues.
• A bone age X-ray (an X-ray of the hand and wrist) to see how mature the bones are.
• An ultrasound scan (using sound waves) to look at the ovaries or other organs if needed.
• A karyotype (a blood test that looks at chromosomes) if a genetic condition is possible.
• An MRI scan (a scan that uses magnets, not radiation) of the brain if hormone problems are suspected.

What to expect at your appointment

Not every child needs tests. The healthcare provider may first check growth again in a few months. If tests are needed, they are usually simple and can be done without needing to stay overnight. The results help show whether this is a normal late start or something that needs treatment.

Treatment

Treatment depends on the cause. Many children only need regular check-ups and reassurance. If a health condition, poor nutrition, or an eating disorder is found, treating that problem is the first step. If needed, a specialist may suggest hormone treatment to help puberty start.

Self-care at home

• Offer healthy meals and snacks with enough energy and nutrients.
• Support regular physical activity without extreme training or dieting.
• Make sure your child gets enough sleep.
• Avoid teasing about size or body changes, and listen to your child's feelings.
• Keep regular check-ups so growth and puberty signs can be tracked.

Medical treatments

When treatment is needed, a specialist may suggest hormone treatment to start puberty. This is decided case by case, based on age, tests, and the cause. The goal is to support normal growth and development. Your healthcare provider will explain the benefits and risks and check progress. This article does not recommend any specific medicine or dose.

When is surgery considered?

Surgery is rarely needed. It may be considered if a tumor or structural problem is found. Most children with delayed puberty do not need surgery.

Living with this condition

Focus on healthy routines and emotional support. Remind your child that people grow at different speeds. Keep school informed if teasing is a problem. Regular check-ups help everyone see progress over time.

Lifestyle tips

• Keep a regular sleep schedule.
• Stay active in ways your child enjoys.
• Avoid extreme dieting, overtraining, or weight-control practices that are not healthy.
• Avoid smoking, vaping, alcohol, and drugs, especially during the teen years.

Diet and exercise

A balanced diet with enough calories, protein, calcium, and iron supports growth. Regular movement, such as walking, swimming, cycling, or sports, is good for health. Very intense exercise plus low food intake can delay puberty, so balance is key.

Mental health and emotional wellbeing

Delayed puberty can cause stress, low self-esteem, anxiety, or depression, especially if a child is teased. These feelings are real and deserve support. If you or your child has thoughts of self-harm or suicide, contact your local emergency number or a crisis service immediately. You are not alone.

Prevention

You cannot always prevent delayed puberty, especially when it runs in families. You can support healthy growth by treating long-term health conditions, encouraging balanced eating, avoiding extreme dieting or overexercise, and getting regular check-ups.

Vaccines

No vaccine prevents delayed puberty.

Screening programmes

There is no routine screening test for delayed puberty. Healthcare providers check growth at routine child health visits, so keep those appointments.

Complications

If left untreated

• Some children may have a shorter adult height.
• Bone strength may be lower if puberty is very delayed.
• Some underlying causes can affect fertility (the ability to have children) if not checked.
• Teasing and feeling different can lead to anxiety, low mood, or low self-esteem.
• Rarely, a serious underlying problem such as a tumor may be missed if no one checks.

Long-term outlook

The outlook is usually good. Most children with constitutional delay catch up and develop normally. Even when there is an underlying cause, finding it early gives the best chance to support growth, hormone health, and emotional well-being.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.