Puberty and Your Endocrinologist

Puberty and Your Endocrinologist


Puberty is known as the time of life when your body begins to change and develop from a child into a young adult.. Girls develop breasts and boys starting to look more like men. Puberty is a defining developmental stage of every child's life, both physically and psychologically.  

This developmental stage is characterized by increased secretion of special hormones (gonadal hormones) in the pituitary gland (a pea-shaped gland located at the bottom of your brain). These hormones contribute to the development of secondary sexual characteristics (hair and breast growth) and the acceleration of reproductive functions. Depending on whether you're a boy or a girl, these hormones go to work on different parts of the body.

Puberty begins as early as age seven and as late as age 13 in girls, and between ages 9 and 14 in boys. The word adolescence is used widely to refer to a time of puberty, but the term is often used to convey an added connotation of the cognitive, psychological, and social changes taking place.

For boys, hormones travel through the blood and tell the testes, the two egg-shaped glands in the scrotum (the sac that hangs under the penis), to begin making testosterone and sperm. Testosterone is the hormone that causes most of the changes in a boy's body during puberty, and men need sperm to be able to reproduce. In girls, these hormones target the two ovaries, which contain eggs. The hormones cause the ovaries to start making another hormone, called estrogen. Together, these hormones prepare a girl's body to start her period and be able to become pregnant someday.

For a parent, discovering that your child is entering puberty early can be alarming. However, concerns about the normalcy of pubertal development and menstrual patterns are among the most common questions posed to every physician caring for children. What is early puberty? Why is it happening? Can your child really handle the effects both physically and psychologically? These are all valid questions and concerns.

What is Early Puberty?

Puberty starts, typically, in girls between ages 8 and 13, and in boys between ages 9 and 14. Early puberty leads to an early growth spurt and early bone maturation, usually for reasons we don't understand. Girls who show significant signs of puberty and its progression before age seven and boys before age 9 are considered precocious. According to research and studies, about 1 out of 5,000 children are affected by early puberty. The signs of early puberty and puberty are usually the same. It's the timing that's different. Growth spurts are another sign of early puberty in both boys and girls. The signs of early puberty include:

In girls:

  • Breast development (which is often the first sign)
  • Menstruation (typically not until two to three years after the earlier symptoms start)

In boys:

  • Growth of the testicles, penis, and scrotum
  • A deepening voice (usually late sign of puberty)

Types of Early Puberty:

There are two types of precocious puberty, central and peripheral puberty:

Central precocious puberty: This is the more common type. The process is identical to normal puberty but happens early. The pituitary gland is prompted to produce hormones, called gonadotropins. These hormones in turn stimulate the testicles or ovaries to make the sex steroids, testosterone or estrogen. It's these sex hormones that cause the changes of puberty, such as breast development in girls. 

Peripheral precocious puberty: This is a different and more rare condition. The hormones estrogen and testosterone trigger these symptoms, but the brain and pituitary gland are not involved. It's usually a local problem from within the ovaries, testicles, or adrenal gland, but can also be caused by a severely under active thyroid gland.

There are other conditions that might look like early puberty to parents, and sometimes even to pediatricians, but aren't. These include: 

Premature adrenarche (PA):  This is one of the most common diagnoses made in children referred to a specialist for signs of early puberty. Its key features are: 1) Appearance of pubic and/or underarm hair in girls younger than 8 years or boys younger than 9 years, 2) Adult-type underarm odor, often requiring use of deodorants, 3) Absence of breast development in girls or of genital enlargement in boys (which, if present, often point to the diagnosis of true precocious puberty), 4) Many children are greater than average in height.

PA is caused by an earlier-than-normal increase in production of weak male-type hormones (mainly one called DHEA) from the adrenal glands. The adrenal glands are located on top of the kidneys and are best known for producing the hormones cortisol and adrenaline. It is normal for production of these hormones to increase (something we call adrenarche) and for pubic hair to appear after age 8 in girls or 9 in boys. The reason why this increase occurs earlier in some children is not known.

Premature thelarche: This is known as early breast development at a young age. It often appears in girls who are just a few years old. While troubling for parents, it resolves on its own and is not true early puberty. It does not require treatment but should be evaluated.

Premature pubarche: This is known as the early development of some pubic or underarm hair at an early age. It can be caused by premature adrenarche, when the adrenal glands start releasing hormones early. Again, while it might seem alarming, it's generally not a problem and not an early sign of puberty. However, because this may represent the first sign of an abnormal and excess release of adrenal hormones, it should be evaluated.

Each person is unique, so it makes sense that children don't all develop in the same way or time frame. During puberty, everybody changes at their own pace. In a few cases, kids who are developing very early or who are very late in starting may need to be evaluated or treated. 

If you are a parent who is concerned about the possibility that your child may not be developing or starting puberty when they are supposed to, schedule a visit with your doctor. Your pediatric endocrinologist knows all about puberty and can help determine if your child is developing normally.

Call Endocrine Kids in Novi, Michigan at (248) 347-3344 to request an appointment with Dr. Jacalyn Bishop, or request an appointment online.