Delayed Puberty | Symptoms & Causes

What is delayed puberty?

While there’s a wide range of what’s considered “normal” in terms of when boys and girls start to go through puberty, delayed puberty is defined simply as:

  • boys: lack of increase in testicle size by age 14

  • girls: lack of breast development by age 13

Is it serious?

Most likely not. If your child has delayed puberty but is otherwise healthy, he or she should be evaluated and possibly treated, but it’s not something that you should consider to be an emergency.

Is delayed puberty equally common in girls and boys?

That’s hard to know, since boys seem to be more likely to seek evaluation, perhaps because they (or their parents) may be more concerned with keeping up with peers in terms of height. 


What causes delayed puberty?

A few different things can cause delayed puberty.

1. Constitutional growth delay (CGD)

  • CGD is a temporary delay in skeletal growth, which keeps a child from being as tall as his peers, at least for a while.

  • Among boys, around 60 percent of the time, delayed puberty is caused by constitutional growth delay.

  • It’s hard to say for sure, but CGD is thought to affect around twice as many boys as girls.

  • CGD is a normal variant of growth, but may still make a child feel distressed. 

  • As we grow up, our bones “mature.” If a child has CGD, a doctor can look at an x-ray of his hand and wrist, and see that his bones appear “younger” than expected for his chronological age.

  • CGD is often inherited. If one or both parents were “late-bloomers,” it’s likely that their child may be, too.

  • Kids with CGD go through puberty and reach an appropriate adult height, just not as quickly as their peers do.

2. An underlying medical condition

These might include:

  • cardiac conditions
  • celiac disease (which affects a child’s ability to gain weight, making it harder to grow at the same rate as his peers)
  • conditions that prevent the hypothalamus or pituitary gland from sending the “start puberty” signal
  • conditions that prevent the ovaries or testes from being able to respond to the “start puberty” signal
  • certain genetic conditions, such as Klinefelter’s syndrome in boys and Turner syndrome in girls

3. Some psychiatric medications can contribute to delayed puberty, too.

Signs and symptoms

While delayed puberty is actually defined by signs (lack of increase in testicle size by age 14 or lack of breast development by age 13), we often see children who come in for an evaluation because they’re concerned that they’re not growing as quickly as their peers.

My child has developed pubic hair and body odor, but still no breast development. Should I be concerned?

Your child could have pubic hair and body odor but still meet the definition for delayed puberty, so she should be evaluated.

This is because while they tend to happen around the same time, development of breasts and development of public hair/body odor are two separate processes, each triggered by their own hormones. The diagnosis of delayed puberty only takes into account the process and the hormones that lead to breast development. 


Q: Should I be concerned about my child’s delayed puberty?

A: In the overwhelming majority of cases, no. Kids with delayed puberty should definitely be evaluated by a specialist, but most often, it’s nothing to worry about. Even if your child has an underlying medical condition, puberty can almost always be started through hormone therapy. 

Most often, it only requires brief treatment to “jump-start” puberty, but in some cases, doctors will recommend long-term hormone therapy.

Q: Will delayed puberty affect my child’s ultimate growth and development?

A: It’s possible. Kids with CGD tend to not grow as much during their growth spurts as other children, which may make them a little smaller as adults. 

Q: Is delayed puberty harmful?

A: No, delayed puberty isn’t harmful. Since there are medical causes, kids with delayed puberty should be evaluated, but most of the time it’s not a medical problem.

Still, if your child feels as though he’s not keeping up with his peers in growth and physical development, it can be very upsetting. These feelings should be taken seriously.

Q: When my child finally does go through puberty, will it happen faster than normal? 

A: It could. Kids with CGD sometimes go through puberty at a slightly faster pace.

Q: Will delayed puberty affect my child’s ability to have children?

A:It depends on what’s causing the delay. If the delay is temporary, like in CGD, it typically doesn’t affect fertility. Certain medical conditions that affect hormones can cause problems with fertility, and researchers are working on how to improve fertility in these cases.