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Are you behind in pubertal development compared to your peers? Is your child a late bloomer? You will want to know what causes delayed puberty, if there is any reason to worry, and what can be done about it. 

What Is Delayed Puberty?

The secretion of gonadotropin-releasing hormone by the hypothalamus, a portion of the brain that produces many of our most essential hormones, marks the start of puberty. This secretion sets a hormonal rollercoaster that results in the production of the hormones estrogen (females) and testosterone (males) in motion, which ultimately leads to the development of secondary sex characteristics.

Later pubertal development typically represents nothing more than a variation of normal.

Delayed puberty can be diagnosed in boys who have experienced no testicle enlargement by the age of 14 or who take more than five years to complete their genital growth. In girls, delayed puberty can be diagnosed when they are not developing breasts by age 13, have not started their menstrual period by 16, or take longer than five years to get their period after breast development has commenced

Diagnosing Delayed Puberty

The diagnosis of delayed puberty is made with the help of blood tests, bone age X-rays, a physical examination, and in some cases an MRI scan. These tests are performed to rule out certain medical conditions. Where the adolescent is otherwise healthy, no immediate treatment may be recommended and they will rather be advised to return for further examination at a later date. 

Treatment For Delayed Puberty

Where chronic medical conditions — such as diabetes or cystic fibrosis — are the underlying cause of delayed puberty, proper management of these conditions can help induce puberty. 

Should conditions that influence hormone production (Klinefelter syndrome in boys, Turner syndrome in girls) be the cause of delayed puberty, hormone therapy can help secondary sex characteristics develop. 

Adolescents who have what is known as a constitutional delay, that is, delayed puberty without a particular medical cause, do not medically speaking require treatment. They may, however, feel very self-conscious and unhappy about their delayed puberty, and it is for this reason that many doctors are very willing to prescribe hormone treatment. Boys over the age of 14 with delayed puberty can be put on a course of testosterone, while girls can be offered estrogen replacement. 

When hormone therapy is started, these teens' own hormones will usually kick in and take over very soon, which means they won't be on the treatment for very long. 

What Should You Do Now?

If you think that you are dealing with delayed puberty or you are the parent of a "late bloomer", first review the diagnostic criteria for delayed puberty to see if they apply. If they do, a trip to your family doctor or pediatrician is the first recommended step. These primary care providers can set the ball rolling by referring the affected adolescent to an endocrinologist, a hormone specialist, who can review the situation more closely. 

You can discuss your worries and hopes with the endocrinologist, and even when they are able to assure you that the delayed puberty is due to a constitutional delay rather than a medical problem, you will be able to discuss the pros and cons of hormone therapy to get puberty going. 

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