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Puberty is considered delayed when the child has not begun puberty when two standard deviations or about 95% of children from similar backgrounds have. [7] [8] [9]In North American girls, puberty is considered delayed when breast development has not begun by age 13, when they have not started menstruating by age 15, [2] and when there is no increased growth rate. [8]
Another consideration is the potential impact on psychological well-being. While many individuals experience relief from gender dysphoria, the delay in physical development might also cause anxiety or social difficulties in some cases, particularly in environments where peers are progressing through puberty.
Hypogonadism is often discovered during evaluation of delayed puberty, but ordinary delay, which eventually results in normal pubertal development, wherein reproductive function is termed constitutional delay. It may be discovered during an infertility evaluation in either men or women. [8]
Research has showed that the average age of starting puberty continues to drop over time: One study published in 2020 shows that the average starting age of puberty for girls has decreased by ...
It is normally difficult to distinguish a case of Kallmann syndrome (KS)/hypogonadotropic hypogonadism (HH) from a straightforward constitutional delay of puberty. However, if puberty has not started by either age 14 (girls) or 15 (boys) years and one or more of the non-reproductive features mentioned below is present, then a referral to ...
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Starting puberty significantly early — younger than age 8 in girls, 9 in boys — may have health effects lasting into adulthood, including higher risks of breast cancer, diabetes and heart disease.
Diagnosis commonly occurs in adolescence due to delayed puberty or amenorrhea. Some individuals may have some breast development, secondary amenorrhea, or ovarian follicles on imaging rather than the expected streak or hypoplastic ovaries.