Delayed puberty is defined as the lack of any pubertal signs by the age of 14 years in boys.
The first sign of puberty in boys is enlargement of the testes, with 4ml volume or higher being in keeping with puberty commencing. It may be a further 12-24 months before testicular volumes have enlarged sufficiently to result in enough testosterone to cause a pubertal growth spurt or secondary sexual characteristics. Most patients seek medical advice because of slow growth, rather than slow pubertal development.
Initial assessment should include:
- height and weight, plotted on growth chart, ideally plotting of both parents’ height
- clinical examination for signs of pubertal development including an estimation of testicular volumes (self examination is adequate)
- family history of pubertal timing where available.
- Consideration of possibility of delayed puberty secondary to chronic disease.
Who to refer:
- Boys who have not achieved testicular volumes of 4mls or higher by age 14 years
- lack of pubic and axillary hair growth and linear growth falling off centiles by age 14 years
- Suspected delayed puberty secondary to chronic disease (please indicate whether there is suspicion of this)
- If bloods are being checked prior to referral please include – LH, FSH, testosterone, prolactin, TFTs, coeliac screen.
Who not to refer:
- Boys who are under the age of 14 years, unless there are other confounding factors in the history. In this case we are happy to discuss.
How to refer:
Please refer via SCI Gateway to RHCYP – Endocrinology.
