User:Mr. Ibrahem/Delayed puberty

Delayed puberty is a lacks of or incomplete development of sexual characteristics past the usual age of onset of puberty. In girls this is a lack of breast development by age 13 or not menstruating by age 16 while in boys it is the lack of testicle enlargement by age 14. There may or may not be an absence of acne, pubic hair, and body odor. Complications may include short height, osteoporosis, and psychological stress.

The most common cause, known as constitutional delay, is a temporary delay that runs in families. The next most common group is the result of long term health problems, like diabetes, anorexia, cystic fibrosis or malnutrition. The third group is failure of the gonads, resulting in hypergonadotropic hypogonadism, which can occur due to undescended testicles, gonadal dysgenesis, chemotherapy, Turner syndrome, or Klinefelter syndrome. The final group involves conditions that affect the hypothalamic pituitary gonadal axis such as Kallmann syndrome or brain tumors. Diagnosis may involve measuring blood FSH, LH, and testosterone or estradiol, as well as bone age X-rays.

Treatment is based on the underlying cause. A constitutional delay may be managed by simple reassurance or with short term use of hormones. People with long term problems are often treated with long-term hormone replacement, testosterone in males and estrogen with progesterone in females. Outcomes depend on the underlying condition.

Delayed puberty affects about 2% of adolescents. Males are more commonly affected than females. Constitutional delay is the cause of about 60% of cases in males and 30% of cases in girls. While the average age of menstruation may have decreased since the 1800s, the onset of other signs of puberty appears not to have changed much over time.