Approach to the Patient with Delayed Puberty
Sasha R Howard, MD PhD
Centre for Endocrinology, William Harvey Research Institute, QMUL
Delayed puberty is defined as the onset of puberty at 2-2.5 standard deviations later than the mean age for the general population, translating to achievement of Tanner genital stage 2 after 14 years in males and breast stage 2 after 13 years in females. Delayed pubertal progression or failure to complete puberty are additional features to assess. The etiology of delayed puberty is divided into 3 main categories: self-limited or constitutional delay; primary or hypergonadotropic hypogonadism; and hypogonadotropic hypogonadism, which can be further divided into functional, acquired, and congenital causes. Management is dependent on the underlying cause. Treatment ranges, from expectant observation or short courses of sex steroid supplementation, to long term sex steroid or gonadotropin regimens to facilitate the development of secondary sexual characteristics and optimize fertility potential. Functional forms of hypogonadism often benefit from therapies that address the underlying cause.