Puberty that happens late is called delayed puberty. This means a child's physical signs of sexual maturity don't appear by age 12 to 13 in girls or age 13 to 14 in boys. This includes breast or testicle growth but can also include pubic hair and voice changes. These are known as secondary sexual characteristics.

Gender words are used here to talk about anatomy and health risk. Use this information in a way that works best for you and your doctor as you talk about your care.

Delayed puberty most often has no known cause. In some cases, it may run in families. In other cases, it may be caused by any of these:

• Chromosomal problems
• Genetic disorder
• Chronic illness
• Tumors of the pituitary gland or hypothalamus
• Underactive pituitary gland (hypopituitarism)
• Underactive thyroid (hypothyroidism)
• Abnormal development of the reproductive system
• Inability of the body to use androgen hormones (complete androgen insensitivity syndrome)
• Too much exercise
• Severe lack of eating (anorexia) or an issue with absorption of food

A child is at risk for delayed puberty if they have any of these:

• Parents or siblings with delayed puberty
• Chronic health conditions
• Congenital syndrome
• An eating disorder

The symptoms are a lack of secondary sexual characteristics.

Common signs in girls can include:

• No breast growth by age 12.
• More than 5 years between first breast growth and first menstrual period.
• No menstrual period by age 15.

Common signs in boys can include:

• No testicular enlargement by age 14.
• No pubic hair by age 15.
• More than 5 years to complete adult genital growth.

The signs of delayed puberty can be like other health conditions. Make sure your child sees their doctor for a diagnosis.

In addition to a complete health history and physical exam, a diagnosis of delayed puberty may include:

• Blood tests. These are done to check hormone levels, look for chromosomal problems, and check for chronic disorders that may delay puberty. These may include diabetes, celiac disease, hypercortisolism, or anemia.
• X-ray. This test uses a small amount of radiation to make images of tissues inside the body. An X-ray may be done of the left hand and wrist. This can estimate your child's bone age. With delayed puberty, bone age is often less than calendar age.
• CT scan. This test uses a series of X-rays and a computer to make detailed images of the body. A CT scan can show bones, muscles, fat, and organs. CT scans are more detailed than regular X-rays.
• MRI. This test uses large magnets and a computer to make detailed images of tissues in the body without the use of X-rays.

Your child's doctor will consider your child's age, overall health, and other factors when advising treatment.

Treatment for delayed puberty depends on the cause of the problem. In many cases, when the cause is treated, puberty proceeds normally. If the delayed puberty is inherited, no treatment is usually needed. In some cases, treatment may be done with hormone therapy. This helps to cause secondary sexual characteristics to occur. In other cases, surgery may be done to correct a physical problem.

Delayed puberty can cause embarrassment and stress for adolescents.

In time, most adolescents with delayed puberty will develop normally and not have ongoing problems. Some causes will need treatment with hormones. Emotional support can help adolescents deal with their delayed puberty.

Contact your child's doctor if your child shows signs of delayed puberty.

• Puberty that happens late is called delayed puberty. This means a child's physical signs of sexual maturity don't appear by age 12 to 13 in girls or age 13 to 14 in boys.
• This includes breast or testicular growth, pubic hair, and voice changes. These are known as secondary sexual characteristics.
• Delayed puberty may run in families.
• Treatment depends on the cause of the problem. In many cases, when the cause is treated, puberty proceeds normally.
• Delayed puberty can cause embarrassment and stress for adolescents. Emotional support can help adolescents deal with their delayed puberty.

Tips to help you get the most from a visit to your child's doctor:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your doctor gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child's condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child's doctor after office hours. This is important if your child becomes ill and you have questions or need advice.