Analysis and Treatment of Delayed Puberty in Males and Females

Have you noticed that your son or daughter is delayed in showing signs of puberty compared to their peers? Have they passed the normal age of puberty without any physical changes appearing? This may be due to delayed puberty, a condition that requires attention and careful medical evaluation.In this guide from “Dili Medical,” we explain everything you need to know about delayed puberty testing in males and females, its possible causes, the most important examinations, and how to manage and treat it.

What is delayed puberty?

Delayed puberty is the absence of expected signs of puberty in a child at the normal age:

• In girls: if breast development has not started by age 13
• In boys: if testicular enlargement has not started by age 14

The delay may be mild and temporary, or it may indicate a medical or hormonal problem that requires medical evaluation.

Normal signs of puberty

✅ In girls:

• Breast development
• Appearance of pubic and underarm hair
• Onset of menstruation (usually between ages 9–15)

✅ In boys:

• Enlargement of the testes and penis
• Voice deepening
• Appearance of facial and body hair
• Muscle development and growth spurt in height

When is delayed puberty considered abnormal?

It is considered abnormal if no signs of puberty appear after:

• 13 years in girls
• 14 years in boys

Or if puberty begins and then suddenly stops — in these cases, medical evaluation and testing are required.

What is a delayed puberty evaluation (tests)?

Delayed puberty testing is a set of hormonal and physical examinations used to identify the cause of delayed development of secondary sexual characteristics. It includes:

1. Clinical examination

• Measuring height and weight and comparing them to age standards
• Assessing breast or testicular development and body hair
• Reviewing family history (e.g., delayed puberty in parents)

2. Basic hormonal tests (in both boys and girls)

3. Additional tests (depending on the case)

• Karyotype analysis: to detect genetic disorders such as Turner syndrome or Klinefelter syndrome
• DHEA-S test: to evaluate adrenal gland function
• GnRH stimulation test: to determine whether the cause is in the brain (hypothalamus/pituitary) or in the gonads

4. Imaging tests

• X-ray of the hand and wrist: to determine “bone age” compared to chronological age
• MRI scan: to detect tumors or abnormalities in the pituitary gland or hypothalamus
• Pelvic ultrasound (for girls): to examine the uterus and ovaries