Children's Hospital Colorado

Puberty Disorders

What are puberty disorders?

Puberty is the process in which children's bodies change into adult bodies and become capable of reproduction. In girls, the onset of puberty usually happens between the ages of 8 and 13, and in boys, between the ages of 9 and 14.

Sometimes, puberty starts early (precocious puberty). Other times, it starts late (delayed puberty). Early or late starts do not always require treatment. In some cases, we may use medicines to help control this timing and put kids on track with their peers. This helps end the social and emotional difficulty of being far ahead of or far behind their friends. It also helps families that may struggle to support their children through these challenging times.

Puberty timing is also important because it affects a child's growth. This is because puberty hormones spark a growth spurt, which at first, causes the bones to grow. Then, the growth plates close. Growth plates are the areas at the ends of the bones, which is where the body turns cartilage — the same soft material you feel in your nose — into bone to make the bone longer.

When the body is done growing, these growth plates close. When children have a puberty growth spurt too early, their growth plates may also close too early. This means children with early puberty seem tall at first, but then stop growing sooner than their friends, and they end up shorter than expected. Treatment can prevent this early growth and early end to growth.

What causes puberty disorders?

Puberty begins when the brain produces the hormone called gonadotropin-releasing hormone (GnRH). It prompts the pituitary gland to produce hormones called gonadotropins (LH and FSH). These gonadotropins then signal the ovaries to produce the hormone estrogen (in females) or the testicles to produce the hormone testosterone (in males).

There are two types of precocious puberty: central and peripheral. Central is the most common type. The brain begins hormone production that mimics the normal stages of puberty. The cause is often unknown, though sometimes there is an underlying condition. Peripheral precocious puberty is rare and does not involve the brain or pituitary gland. It happens when there’s a problem with the ovaries, testicles or other glands.

Delayed puberty usually runs in families or has unknown causes. We call this constitutional delay of growth and puberty. It is often a diagnosis of exclusion, meaning we can find no other cause.

Who gets puberty disorders?

Early or late puberty often runs in families. Some factors can make children more likely to experience early puberty. These include being female, African American or struggling with excess weight. Another factor is exposure to products that contain estrogen or testosterone.

Low body fat can be a cause of late puberty. This can happen with high athleticism, chronic illness, eating disorders or low appetite from ADHD medication. Sometimes, it’s due to problems with the ovaries, testicles or brain.