PUBERTY

Early Puberty

Puberty is  consider normal when there is  breast development in girls  at age 8 or after and testicular change in boys at age 9 or after. Any pubertal changes in girls before age 8 and in boys  before age 9 is considered early.  In boys any testicular change  before age 9 is an endocrine emergency and needs to see a pediatric endocrinologist ASAP. Evaluation consists of blood work and imaging.  Treatment  depends on how young the child is , the stage of puberty , considerations of final height . It may range  from conservative monitoring to pubertal blocking.

Delayed puberty

 Puberty is considered to be delayed if a girl has no breast development till age 13 and   in boys is when there is no increase in testicle size by age 14 or more than five years between testicular enlargement and the completion of puberty.  Delayed menses is when a girl has not had menses two and a half years post breast  development or by age 15 years. Evaluation consists of bloodwork and imaging . Treatment consists of hormonal therapy to initiate puberty.