Puberty - Complications of puberty

Some children experience puberty earlier or later than others.

There are several possible reasons for this. In some cases, early or late puberty could be a sign of an underlying condition and tests may be needed.

Early (precocious) puberty

An unusually early puberty is where the symptoms of puberty, such as breast development, enlargement of the testes and pubic hair growth, start before eight years of age in girls and nine years of age in boys.

The start of puberty is usually triggered by the GPR54 gene, which sends signals to your brain and starts a chain reaction and release of hormones in your body. The early start of this chain reaction can be caused by:

a problem in the brain, such as a tumour
a brain injury due to head trauma
a brain infection, such as meningitis
a problem in the ovaries or thyroid gland
an inherited tendency (it may run in your family)

But for most girls there's no known reason for starting puberty early. In boys, early puberty is less common and more likely to be associated with an underlying medical problem.

Treatment for early puberty

To diagnose the cause of early puberty, your GP may recommend that you have a blood test to check for any problems with your hormones.

Your GP may refer you to a paediatric specialist for further assessment and tests. These may include an ultrasound scan and magnetic resonance imaging (MRI) scan to check for tumours and the correct functioning of glands and organs.

Depending on the cause, early puberty can be treated by:

treating the underlying cause
using medication to lower the high levels of sex hormones and stop sexual development progressing

Treatment with medication is only usually recommended if it's thought that an early puberty would cause significant current problems for the young girl. However, this usually isn't the case, unless puberty started well before eight years of age.

If puberty started particularly early (before six years of age), it will usually only result in the girl being short. In most cases, an early puberty won't usually cause any significant health problems.

However, early puberty can cause behavioural issues which can have a disruptive impact on the child's education. You may want to discuss this further with your doctor. This may be particularly relevant for girls with additional special educational needs (SEN).

Delayed puberty

In girls, an unusually late puberty is diagnosed if:

there are no signs of breast development by 13 years of age
four years have passed since the start of puberty and the breasts haven't reached full adult development
a girl hasn't had her first period by 14½ years of age

In boys, an unusually late puberty is diagnosed if:

there are no signs of testicular development by 14 years of age
3-4 years have passed since the beginning of puberty and the penis and testicles haven't reached full adult development

The delayed onset of puberty can be caused by:

an inherited tendency (late puberty may run in your family)
having a long-term illness, such as cystic fibrosis, diabetes, or kidney disease
malnutrition, possibly from an eating disorder, or a chronic illness such as cystic fibrosis
over-exercising, such as in the case of professional athletes and gymnasts
tumours or other internal damage to your glands
hormonal conditions, such as an underactive thyroid gland
a genetic condition that affects sexual development, such as androgen insensitivity syndrome (a rare condition where a person is genetically male, but their body is insensitive to male sex hormones)

Treatment for late puberty

If there's no obvious cause for delayed puberty, such as a long-term illness, your GP may need to carry out some tests to diagnose the cause.

Your GP may refer you to a paediatric specialist for further assessment and tests. These may include blood tests to check for any problems with your hormones. Ultrasound and MRI scans may also be used to check for tumours and the functioning of glands and organs.

As with early puberty, treatment for late puberty will depend on the underlying cause. In most cases, treating the underlying causes should trigger puberty. In some cases, you may need to take medicines containing hormones to trigger the start of puberty.