Delayed puberty in boys
Delayed sexual development - boys; Pubertal delay - boys; HypogonadismDelayed 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.
Causes
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 testes produce too little or no hormones. This is called hypogonadism.
Hypogonadism
Hypogonadism occurs when the body's sex glands (gonads) produce little or no hormones. In men, these glands are the testes. In women, these glands ...
Read Article Now Book Mark ArticleThis 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.
Parts of the brain involved in puberty
Hypogonadism is a condition in which the male testes or the female ovaries produce little or no sex hormones. Hypogonadotropic hypogonadism (HH) is a...
Read Article Now Book Mark ArticleCertain medical conditions or treatments can lead to hypogonadism:
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Celiac sprue
Celiac sprue
Celiac disease is an autoimmune condition that damages the lining of the small intestine. This damage comes from a reaction to eating gluten. This ...
Read Article Now Book Mark Article - Inflammatory bowel disease (IBD)
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Underactive thyroid gland
Underactive thyroid gland
Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone. This condition is often called underactive thyroid....
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Diabetes mellitus
Diabetes mellitus
Diabetes is a long-term (chronic) disease in which the body cannot regulate the amount of sugar in the blood.
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Cystic fibrosis
Cystic fibrosis
Cystic fibrosis is a disease that causes thick, sticky mucus to build up in the lungs, digestive tract, and other areas of the body. It is one of th...
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- Liver and kidney disease
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Anorexia (uncommon in boys)
Anorexia
Anorexia is an eating disorder that causes people to weigh less than is considered healthy for their age and height, usually by excessive weight loss...
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Autoimmune diseases, such as Hashimoto thyroiditis or Addison disease
Autoimmune diseases
An autoimmune disorder occurs when the body's immune system attacks and destroys healthy body tissue by mistake. There are more than 80 autoimmune d...
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Chemotherapy or radiation cancer treatment
Chemotherapy
The term chemotherapy is used to describe cancer-killing drugs. Chemotherapy may be used to:Cure the cancerShrink the cancerPrevent the cancer from ...
Read Article Now Book Mark Article - A tumor in the pituitary gland
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Klinefelter syndrome, a genetic disorder
Klinefelter syndrome
Klinefelter syndrome, also called 47,XXY, is a genetic condition that occurs in males when they have an extra X chromosome. This can cause problems ...
Read Article Now Book Mark Article - Absence of testes at birth (anorchia)
- Injury or trauma to the testicles due to testicular torsion
Testicular torsion
Testicular torsion is twisting of the spermatic cord, which supports the testes in the scrotum. When this occurs, blood supply is cut off to the tes...
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Symptoms
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:
Puberty changes
Puberty is when your body changes, when you develop from being a boy to a man. Learn what changes to expect so that you feel more prepared....
Read Article Now Book Mark Article- 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
- 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:
- Blood test to check for levels of certain growth hormones, sex hormones, and thyroid hormones
- LH response to GnRH blood test
LH response to GnRH blood test
LH response to GnRH is a blood test to help determine if your pituitary gland can correctly respond to gonadotropin releasing hormone (GnRH). LH sta...
Read Article Now Book Mark Article - Chromosomal analysis or other genetic testing
Chromosomal analysis
Karyotyping is a test to examine chromosomes in a sample of cells. This test can help identify genetic problems as the cause of a disorder or diseas...
Read Article Now Book Mark Article - MRI of head for tumors
- Ultrasound of the pelvis or testicles
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.
Treatment
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.
Support Groups
More information and support to understand more about your child's growth can be found at:
The MAGIC Foundation - www.magicfoundation.org
Outlook (Prognosis)
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.
Possible Complications
A low level of sex hormones may cause:
- Erection problems (impotence)
Erection problems
An erection problem occurs when a man cannot get or keep an erection that is firm enough for intercourse. You may not be able to get an erection at ...
Read Article Now Book Mark Article - Infertility
Infertility
Infertility means you cannot get pregnant (conceive). There are 2 types of infertility:Primary infertility refers to couples who have not become preg...
Read Article Now Book Mark Article - Low bone density and fractures later in life (osteoporosis)
- Weakness
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
A referral to a pediatric endocrinologist may be recommended for boys with delayed puberty.
References
Allan CA, McLachlan RI. Androgen deficiency disorders. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 139.
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.
Krueger C, Shah H. Adolescent medicine. In: Kleinman K, McDaniel L, Molloy M, eds. The Harriet Lane Handbook : The Johns Hopkins Hospital. 22nd ed. Philadelphia, PA: Elsevier; 2021:chap 5.
Styne DM. Physiology and disorders of puberty. In Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 26.
Review Date: 7/3/2022
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.