Delayed Sexual Development
(Delayed Puberty; Delayed Sexual Maturation)
Girls enter puberty between the ages of 7 and 13. Boys enter this stage between the ages of 9 and 14. Delayed sexual development is when this stage is late.
Some children take longer than their peers to develop. They will catch up with time. This is the most common cause.
Other causes may be:
- Chronic illness
- Malnutrition or weight loss, such as with anorexia nervosa
- Hypogonadism—not enough male or female sex hormones
- Other endocrine diseases, such as hypothyroidism or Cushing disease
- Chromosomal abnormalities, such as:
- Hypopituitarism—destroys the ability to make hormones that stimulate male or female sex hormones
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This problem is more common in children who were born with certain birth defects, such as cleft lip and palate, and heart defects.
Other things that may raise the risk of this problem are:
- Family history of delayed puberty
- Being underweight
One common symptom for both boys and girls is being short for their age. Other problems by gender are:
- Lack of testicular enlargement by age 14
- Sex organs that do not fully develop within 5 years after they started to develop
- Lack of breast development by age 13
- Lack of menstruation 2 and one-half years or more after initial breast development
You will be asked about your child’s symptoms and health history. A physical exam will be done. Your child's milestones and growth record will be reviewed. This may be enough to make the diagnosis.
Your child's hormone levels may be tested. This can be done with blood tests.
An x-ray of the left wrist bones may be taken. This helps to find out if your child is still growing.
Most children do not need treatment. The child’s height, weight, and sexual development will continue to be monitored.
Some children will be treated based on the cause, such as treating a chronic illness. For others, choices may be:
- Counseling to help a child cope with problems like low self-esteem
- Sex hormones to help start sexual growth in children who are very delayed
There are no guidelines to prevent this problem.
Family Doctor—The American Academy of Family Physicians
Healthy Children—American Academy of Pediatrics
About Kids Health—The Hospital for Sick Children
Caring for Kids—Canadian Paediatric Society
Arrigo T, Rulli I, et al. Pubertal development in cystic fibrosis: an overview. J Pediatr Endocrinol Metab. 2003 Mar;16 Suppl 2:267-270.
Delayed puberty. Kids Health—Nemours Foundation website. Available at: http://kidshealth.org/teen/sexual_health/changing_body/delayed_puberty.html. Accessed December 15, 2020.
Delayed puberty in boys: information for parents. Healthy Children—American Academy of Pediatrics website. Available at: http://www.healthychildren.org/English/ages-stages/gradeschool/puberty/Pages/Delayed-Puberty.aspx. Accessed December 15, 2020.
Female delayed puberty. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/female-delayed-puberty. Accessed December 15, 2020.
Male delayed puberty. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/male-delayed-puberty. Accessed December 15, 2020.
Wei C, Crowne EC. Recent advances in the understanding and management of delayed puberty. Arch Dis Child. 2016 May;101(5):481-488.
What causes normal puberty, precocious puberty, and delayed puberty. National Institute of Child Health and Human Development website. Available at: http://www.nichd.nih.gov/health/topics/puberty/conditioninfo/Pages/causes.aspx. Accessed September 22, 2020.
Last reviewed September 2020 by EBSCO Medical Review Board Chelsea Skucek, MSN, BS, RNC-NIC Last Updated: 5/26/2021