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Pubertal Disorders

Summary

Delayed puberty occurs when a child does not show signs of puberty by the expected age—typically by 13 years in girls and 14 years in boys. It is more common in boys and can be caused by temporary (functional) factors such as chronic illness, poor nutrition, or excessive exercise, or by underlying medical conditions affecting hormone production (organic causes).

Many children with delayed puberty are first noticed due to slower-than-expected growth rather than a lack of puberty signs. A thorough medical evaluation is important to determine the cause. In some cases, puberty will start on its own with time, while others may require treatment.

Diagnosis and When to Seek Help

You may want to consult a doctor if your child:

  • Has not started puberty by age 13 (girls) or 14 (boys)
  • Is much shorter than peers and growing slowly
  • Shows no signs of breast development (girls) or testicular enlargement (boys)
  • Has a family history of delayed puberty
  • Has other health conditions that may affect growth and puberty

Doctors assess growth patterns, pubertal development, and hormone levels through blood tests and imaging studies. In some cases, distinguishing between a normal delay and a medical condition may take time.

Management

Treatment depends on the cause of the delay:

  • Constitutional (self-limited) delay: Often runs in families and does not require treatment. Doctors may monitor the child over time. A short course of sex hormones may be considered if the delay is causing distress.
  • Hormone deficiencies or medical conditions: If puberty does not start naturally, hormone therapy may be needed. Boys may receive testosterone, and girls may receive estrogen to help start puberty. In some cases, long-term hormone therapy is required.

Follow-Up and Monitoring

Children with delayed puberty need regular follow-ups to track their growth and development. If puberty does not progress as expected, further tests and treatment adjustments may be needed.

For most children, delayed puberty is temporary and resolves with time. If you are concerned about your child’s growth or development, speak with a doctor for guidance and reassurance.

History and Exam

Key diagnostic factor

  • Presence of risk factors
  • Boys: testes volume < 4 mL
  • Girls: absent breast development
  • Absent pubic/axillary hair

Other diagnostic factors

  • Short stature
  • Dysmorphic features

Risk factors

  • Family history of delayed puberty
  • Congenital pituitary structural abnormalities
  • Gene mutations
  • Chromosomal disorders

Diagnostic Investigations

1st investigations to order

  • Tanner staging
  • Measurement of testicular size
  • Non-dominant wrist X-ray
  • Basal follicle-stimulating hormone (FSH) and luteinising hormone (LH)

Investigations to consider

  • Luteinising hormone-releasing hormone stimulation test (LHRH)
  • Inhibin B
  • Anti-Mullerian hormone (AMH)
  • Human chorionic gonadotrophin (hCG) stimulation test

Emerging Tests

  • Overnight gonadotrophin profile
  • Genetic sequencing
  • Measurement of LH following stimulation with kisspeptin

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      Social and emotional functioning refers to a child’s ability to understand, express, and manage their emotions, as well as to interact effectively with others. These skills are fundamental for building positive relationships, developing empathy, and coping with the everyday challenges of growing up.

      Children who experience difficulties in social and emotional functioning may struggle with recognizing their own feelings or those of others, regulating emotional responses, or responding appropriately in social situations. This can lead to challenges such as anxiety, low self-esteem, difficulty making friends, or misunderstandings with peers and adults.

      In the school environment, social and emotional difficulties can impact a child’s engagement, cooperation, and overall learning experience. Emotional distress may manifest as withdrawal, irritability, or disruptive behaviour, which can further affect academic progress and peer relationships.

      Assessment of social and emotional functioning as part of a neuropsychological evaluation typically includes behavioural observations, standardized rating scales, and information gathered from parents, teachers, and sometimes the child. This comprehensive approach helps identify strengths and areas for support in emotional regulation, social skills, and adaptive behaviours.

      Understanding a child’s social-emotional profile allows for the development of tailored strategies to enhance emotional wellbeing, build resilience, and improve social communication. Early intervention and supportive environments can empower children to navigate their emotions more effectively, fostering confidence and meaningful connections. 

      At Offspring Health, we aim to provide transparent information about the costs involved in neurodevelopmental and educational assessments.

      Neuropsychological assessments typically involve multiple sessions that usually take between 8 and 16 hours in total, depending on the complexity and individual needs. Our hourly rate is $260, so the total cost typically ranges between $2,300 and $4,230.

      Fees generally cover:

      • Initial consultation and history gathering
      • Testing sessions where your child will complete various fun and interactive tasks
      • Liaison with schools or health professionals as needed
      • Comprehensive case analysis and report preparation
      • Feedback sessions with families and, where applicable, educators or other professionals

      Please note that standard neuropsychological assessments are generally not covered by Medicare. However, some assessments and therapy services may be funded through the National Disability Insurance Scheme (NDIS) for eligible participants. We recommend discussing funding options with your NDIS planner or support coordinator prior to booking. Private health insurance may offer partial rebates depending on your level of coverage.

      What’s the next step?

      Please phone reception for a discussion about your needs or email psychology@offspringhealth.com