Delayed puberty
Delayed puberty in males can be defined as lack of development of secondary sexual characteristics - pubic and axillary (armpit) hair, testicular and penile enlargement and a growth spurt. In contrast to precocious puberty (described below) this is commoner than in the female, and is more usually simply constitutional delay rather than being due to an underlying disorder. The trigger for pubertal development is related to the attainment of a certain body mass. Boys with delayed puberty tend to be short, with delayed bone maturity. There is often a family history of delayed puberty in a parent: confidence and self-esteem need to be boosted, because short adolescents who are accused of lingering in childhood by their larger peers can suffer terrible teasing. Some cases are not constitutional - any severe systemic disease (asthma, cystic fibrosis), pituitary failure, growth hormone deficiency, chromosome abnormality such as Kleinfelter’s syndrome (where the chromosome count is 47, XXY rather than 46,XY) or testicular failure due to maldescent or torsion (described below) - can all cause delayed puberty and may need to be excluded. Where possible, any underlying cause should be treated.
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