Feature Article

A guide to puberty disorders

Thomas Campbell, Jennifer Batch



Puberty may be abnormal in its onset, sequence and/or duration. For GPs who care for children and adolescents, it is necessary to be able to identify individuals who require further assessment.

Key Points

  • Puberty begins between 8 and 13 years of age in most girls and between 9 and 14 years of age in most boys. Puberty beginning outside these age ranges is assumed to have a pathological basis until proven otherwise.
  • The first sign of puberty in girls is thelarche (in about 90% of girls).
  • The first sign of puberty in boys is an increase in testicular size to 4 mL in volume or 2.5 cm in length.
  • Treatment of any causative CNS or peripheral pathology is the initial priority in patients with precocious puberty. Pubertal suppression using regular depot injections of a long acting GnRH analogue may be appropriate in children with central precocious puberty.
  • Hypogonadism in boys and girls with delayed puberty may require treatment by replacement of the absent or reduced sex steroid. Constitutional delay of puberty may require treatment for psychological reasons.