Delayed sexual development - boys; Pubertal delay - boys; Hypogonadism
Delayed puberty in boys is when puberty does not begin by 14 years of age.
When puberty is delayed, these changes either don't occur or don't progress normally. Delayed puberty is more common in boys than in girls.
In most cases, delayed puberty is simply a matter of growth changes beginning later than usual, sometimes called late bloomer. Once puberty begins, it progresses normally. This is called constitutional delayed puberty, and it runs in families. This is the most common cause of late maturity.
Delayed puberty also may occur when the testies produce too little or no hormones. This is called hypogonadism.
This can occur when the testes are damaged or are not developing as they should.
It can also occur if there's a problem in parts of the brain involved in puberty.
Certain medical conditions or treatments can lead to hypogonadism:
Boys begin puberty between ages 9 and 14 and complete it in 3.5 to 4 years.
Puberty changes occur when the body starts making sex hormones. The following changes normally begin to appear in boys between ages 9 to 14:
- Testicles and penis get bigger
- Hair grows on the face, chest, legs, arms, other body parts, and around the genitals
- Height and weight increase
- Voice gets deeper
When puberty is delayed:
- Testicles are smaller than 1 inch by age 14
- Penis is small and immature by age 13
- There is very little body hair or almost none by age 15
- Voice remains high-pitched
- Body stays short and thin
- Fat deposits may occur around the hips, pelvis, abdomen, and breasts
Delayed puberty may also cause stress in the child.
Exams and Tests
Your child's health care provider will take a family history to know if delayed puberty runs in the family. The provider will perform a physical exam. Other exams may include:
An x-ray of the left hand and wrist to evaluate bone age may be obtained at the initial visit to see if the bones are maturing. It may be repeated over time, if needed.
The treatment will depend on the cause of delayed puberty.
If there is a family history of late puberty, often no treatment is needed. In time, puberty will begin on its own.
If delayed puberty is due to a disease, such as underactive thyroid gland, treating it may help puberty to develop normally.
Hormone therapy may help start puberty if:
- Puberty fails to develop
- The child is very distressed because of the delay
The provider will give a shot (injection) of testosterone (male sex hormone) in the muscle every 4 weeks. Growth changes will be monitored. The provider will increase the dose slowly until puberty is reached.
Delayed puberty that runs in the family will resolve itself.
Treatment with sex hormones can trigger puberty. Hormones can also be given if needed to improve fertility.
A low level of sex hormones may cause:
When to Contact a Medical Professional
Contact your provider if:
- Your child shows a slow growth rate
- Puberty does not begin by 14 years of age
- Puberty begins, but does not progress normally
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Haddad NG, Eugster EA. Delayed puberty. In: Jameson JL, De Groot LJ, de Kretser DM, et al. eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 122.
Styne DM, Grumbach MM. Physiology and disorders of puberty. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 13th ed. Philadelphia, PA: Elsevier; 2016:chap 25.