Delayed Puberty

Overview

Puberty is a natural milestone. For some children it begins later than expected. When puberty has not started by about age 13 in girls or 14 in boys, clinicians often describe the pattern as delayed. Development is personal, yet patterns matter. A slow start can reflect normal family timing, or it can point to a medical reason that deserves attention.

Families want clarity, not guesses. Children want reassurance, not labels. At The Endocrine Co. we bring both. We listen to your child’s story, review growth and development, and study the details that simple checklists miss. Our goal is to distinguish variation from condition, normal lag from true delay, reassurance from the need for treatment.

Common Signs That Raise Questions

Some children grow at a steady pace, others pause before a surge. Concern rises when several of the following are present together:

• Absence of breast development by 13 in girls or testicular enlargement by 14 in boys
• Little or no growth spurt compared with peers
• Short stature for age or a drop in growth percentile
• Late or absent menstruation by age 15
• Few body hair changes or voice changes after expected ages
• Low energy, cold sensitivity, or other symptoms that hint at thyroid or hormone concerns

One sign may be a variation. Several signs together call for evaluation. The purpose is not to chase a diagnosis. The purpose is to understand the pattern and support healthy development.

Possible Causes

Delayed puberty can be constitutional, meaning the child is simply a late bloomer who will catch up. It can also reflect a medical factor that slows hormone signals or growth. Both possibilities are real. Only a careful workup can tell which applies to your child.

Common Non-pathologic Pattern

• Constitutional delay of growth and puberty: a family pattern of later development with normal adult height expected.

Endocrine and Medical Factors

• Hypogonadotropic hypogonadism: reduced signals from the brain to the ovaries or testes.
• Primary gonadal conditions: the ovaries or testes do not respond well to signals.
• Thyroid disorders: hypothyroidism can slow growth and pubertal timing.
• Chronic illness or nutrition concerns: inflammatory disease, celiac disease, relative energy deficiency, or significant undernutrition.
• Genetic conditions: Turner syndrome, Klinefelter syndrome, or other chromosomal findings.
• Excess exercise or stress: intense training or sustained stress can alter hormone rhythms.

Some causes resolve with time and support. Others respond to targeted therapy. The distinction guides the plan.

How The Endocrine Co. Evaluates Delayed Puberty

Quick visits create uncertainty. Thoughtful visits create understanding. Our evaluation is thorough and child-centered.

What to Expect

• Detailed history: growth pattern, nutrition, activity, sleep, stress, and family timing of puberty.
• Physical exam: growth measurements and pubertal staging in a respectful, age-appropriate setting.
• Growth chart review: trends over years rather than single data points.
• Laboratory testing: hormones such as LH, FSH, estradiol or testosterone, thyroid function, and other labs as indicated.
• Bone age imaging: an X-ray of the hand and wrist to estimate biological maturity.
• Targeted studies: celiac screening, inflammatory markers, or genetic testing when history suggests a need.

Testing answers the “what.” Conversation answers the “so what.” We take time to explain results in plain language and align next steps with your child’s needs and your family’s goals.

Treatment Options

Some children need time, others need a nudge. Both approaches can be correct, depending on the reason for delay.

Monitoring With Guidance

• Regular follow up to watch growth velocity and pubertal milestones
• Nutrition support that protects growth and bone health
• Training and activity plans that respect energy balance

Medical Treatment When Appropriate

• Short course sex-steroid priming: low-dose estrogen for girls or testosterone for boys to initiate change when evaluation supports this step.
• Treating the underlying cause: thyroid replacement for hypothyroidism, therapy for chronic illness, or targeted care for genetic conditions.
• Fertility preservation and counseling when indicated: coordinated care with specialists as needed.

The aim is progress, not haste. The plan is personalized, not one size fits all. We measure benefits, monitor safety, and adjust as your child grows.

Emotional Support for Children and Families

Growth affects height. Puberty affects identity. Medical facts matter, and feelings matter as well. Children compare themselves with peers. Parents carry worry between appointments. We address both sides.

• Age-aware education: simple explanations for kids, clearer detail for teens, practical guidance for parents.
• Confidence building: timelines differ, goals remain shared. We celebrate milestones and set realistic expectations.
• School and activity notes when helpful: support for sports or physical education while evaluation is underway.
• Referrals for counseling when needed: integrated support for anxiety, body image, or peer stress.

Families do not need more alarms. They need a path. Our role is to offer a plan that is steady, understandable, and hopeful.

Frequently Asked Questions

Is delayed puberty always a problem?

No. Many children are late bloomers who reach full adult height and development without medication. Others have a medical reason that benefits from treatment. Evaluation clarifies which pattern applies.

When should we seek a pediatric endocrinology visit?

If puberty has not started by 13 in girls or 14 in boys, or if growth has slowed for more than a year, a visit is reasonable. Earlier evaluation is helpful when there are additional symptoms such as fatigue, cold sensitivity, or significant weight changes.

Will my child need hormone therapy?

Some children do well with monitoring. Others benefit from a short course of hormone therapy to initiate development. The decision depends on test results, growth history, and family goals.

How long does treatment take?

Courses can be brief, measured in months rather than years, when the purpose is to initiate change. Ongoing therapy is considered when an underlying condition requires sustained support. We set expectations together and review progress at each visit.

Can nutrition or training delay puberty?

Significant undernutrition and very high training loads can affect hormone signals. Balanced fueling supports healthy growth. We provide practical plans that fit real life.

Next Steps

If your child shows signs of delayed puberty, start with a conversation. Bring growth records if available. Share questions and concerns. We will listen, evaluate, and explain the options in clear terms.

Explore related topics: Growth Problems, Thyroid Disorders, Children's Health.

Ready to schedule? Contact The Endocrine Co. to request a visit in our Orlando clinic or to learn about virtual options where appropriate.