Disorders of Puberty


Puberty is the process a child’s body goes through as it develops into an adult’s body.

Puberty starts when the body begins producing extra amounts of hormones, leading to physical and emotional changes. In girls, these changes include breast development, pubic hair growth, the beginning of menstrual periods, and a growth spurt.

While every girl will grow and develop at a different rate, the normal onset of puberty is between the ages of 8 and 13. 

A puberty disorder is when these processes and changes don’t occur as they normally should.

Patients can be seen by Texas Children's experts in Pediatric and Adolescent Gynecology.

Causes & Risk Factors

Causes may include:

  • Heredity
  • Hormonal disorders – including polycystic ovary syndrome (POS)
  • Genetic disorders
  • Problems in the pituitary or thyroid glands that produce the hormones necessary for body growth and development
  • Chromosome disorders that interfere with normal growth processes
  • Eating disorders
  • Excessive exercise
  • Tumors
  • Infections
  • Chemotherapy
  • Other underlying medical condition or injury 

Symptoms & Types

Symptoms may include:

  • Lack of breast development by age 13
  • Lack of pubic hair by age 14
  • More than 5 years between breast development and first period
  • Period hasn’t started by age 16
  • Breast growth, period, pubic hair and other signs of puberty occur before age 7 or 8

Types of Puberty Disorders:

  • Delayed puberty – puberty hasn’t started by age 13
  • Precocious puberty – puberty begins too early, before age 7 or 8 in girls
  • Contrasexual pubertal development – development of male characteristics in females
  • Premature thelarche – breast development without any other signs of puberty
  • Premature menarch – periods start without any other signs of puberty
  • Premature adrenarche – appearance of pubic hair without any other signs of puberty

Diagnosis & Tests

Diagnosis starts with a detailed medical history and a thorough physical exam, including pelvic and breast exams when necessary.

Diagnostic testing may include:

  • X-ray of the hand/wrist – to determine bone age
  • Blood tests – to measure hormone levels and check for chromosomal abnormalities and other conditions
  • MRI (magnetic resonance imaging) or CT scan – to rule out abnormalities in the brain or pituitary gland
  • Thyroid testing
  • Ultrasound – to examine the health of the ovaries and adrenal glands

Treatment & Care

Treatment depends on the individual, their symptoms and the underlying cause of the puberty disorder.

Treatment may include:

  • Observation and regular checkups – in cases where the disorder will likely resolve on its own
  • Hormone therapy
  • Surgery – for anatomical corrections
  • Counseling – to help children and families deal with the emotional and social challenges of disorders of puberty