Delayed puberty

Delayed puberty is common, occurring in 3% of the population. It is seen much more frequently in boys than girls and in the majority of cases is due to constitutional delay in growth and puberty. These individuals do not need significant numbers of investigations and treatment is usually unnecessary. Regular monitoring is indicated to ensure puberty does progress in due course, with reassurance for the child and family that this is a common occurrence. A short course of low dose testosterone or oestrogen may be beneficial in inducing puberty if this is significantly delayed as this can be psychologically difficult. Puberty will usually then proceed spontaneously to completion.All girls with pubertal delay require karyotyping to exclude Turner syndrome. More detailed investigation would be indicated in individuals with any additional features such as: a history of pituitary hormone deficiencies, previous radiotherapy or chemotherapy, evidence of chronic disease, midline or dysmorphic features, learning difficulties, tall stature, gynaecomastia or anosmia, neonatal history of bilateral crypto-orchidism or small penis.For those patients requiring treatment, this involves commencement of low dose testosterone in boys or oestrogen in girls, with slowly increasing doses as puberty progresses.