Delayed puberty

The onset of puberty is usually regarded as delayed at 13 years in girls and 14 years in boys. The initial approach requires a detailed history and clinical examination to exclude other medical or psychological problems. The presence or absence or pubertal signs should be documented. Investigations should be targeted at ruling out any medical causes and determining whether the delay is due to central gonadotrophin deficiency or a gonadal disorder. Physiological or constitutional delay is more common in boys but is a diagnosis of exclusion. Treatment may be given using low doses of sex steroids, testosterone or oestradiol initially in a short course of between 3 and 6 months, but continuing in escalating doses mimicking the normal course of puberty, watching regularly for the spontaneous resumption of progress and gonadotrophin secretion. Counselling, reassurance and support are key elements in the management of adolescents with delayed puberty.