{"id":25298,"date":"2025-09-10T13:07:32","date_gmt":"2025-09-10T12:07:32","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=25298"},"modified":"2025-09-23T10:38:42","modified_gmt":"2025-09-23T09:38:42","slug":"precocious-puberty-in-boys","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/paediatric-endocrinology-diabetes\/puberty\/precocious-puberty-in-boys\/","title":{"rendered":"Precocious puberty in boys"},"content":{"rendered":"\n<p>Precocious puberty in boys is defined as the onset of puberty before the age of 9 years.<\/p>\n\n\n\n<p>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 reach around 10mls and therefore are enlarged sufficiently to result in enough testosterone to cause a pubertal growth spurt or secondary sexual characteristics. It is often these later signs which may prompt families to present to healthcare professionals.<\/p>\n\n\n\n<p class=\"has-standard-black-color has-text-color has-link-color wp-elements-f7ba624adb7913ac8519433ab0f95be9\"><a><u>Initial assessment should include<\/u><\/a>:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>height and weight, plotted on&nbsp;<a href=\"https:\/\/www.rcpch.ac.uk\/resources\/growth-charts\" target=\"_blank\" rel=\"noreferrer noopener\">growth chart<\/a>, ideally plotting of both parents\u2019 height.<\/li>\n\n\n\n<li>clinical examination for signs of pubertal development including an estimation of testicular volumes.<\/li>\n\n\n\n<li>Clinical examination for secondary sexual characteristics, such as axillary and pubic hair, and penis enlargement.<\/li>\n\n\n\n<li>family history of pubertal timing where available.<\/li>\n\n\n\n<li class=\"has-alert-red-color has-text-color has-link-color wp-elements-2f8f4b28fb9f5d0ce1dbfb87a0612390\">Consideration of red flag symptoms, such as those of a space occupying lesion. Consideration of dysmorphic features or birthmarks.<\/li>\n<\/ul>\n\n\n\n<p>Signs of androgen exposure, such as pubic hair growth, greasy skin or body odour, in the absence of testicular enlargement, is more likely to represent <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/paediatric-endocrinology-diabetes\/puberty\/adrenarche\/\" target=\"_blank\" rel=\"noreferrer noopener\">adrenarche<\/a>.<\/p>\n\n\n\n<p><strong>C.M. &amp; E.B. 23-09-25<\/strong><br><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\"><strong>Who to refer:<\/strong><\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Boys with testicular volumes &gt;4mls before the age of 9 years.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Boys with growth acceleration (although bear in mind that growth acceleration is unlikely to occur until testicular volumes are &gt;10mls).<\/li>\n\n\n\n<li>If considering blood tests prior to referral then please include LH\/FSH\/testosterone and TFTs.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Who not to refer:<\/strong><strong><\/strong><\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Boys with pubertal onset <em>after<\/em> the age of 9 years with no other concerning features.<\/li>\n\n\n\n<li>Boys with <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/paediatric-endocrinology-diabetes\/puberty\/adrenarche\/\" target=\"_blank\" rel=\"noreferrer noopener\">adrenarche<\/a> and no red flags.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>How to refer:<\/strong><strong><\/strong><\/h4>\n\n\n\n<p>Please refer via SCI Gateway to RHCYP &#8211; Endocrinology<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>The Scottish paediatric endocrine group website contains useful&nbsp;<a href=\"https:\/\/www.speg.scot.nhs.uk\/patients-and-families\/information-leaflets\/\" target=\"_blank\" rel=\"noreferrer noopener\">SPEG parent information leaflets,<\/a>&nbsp;including on GNRH testing and precocious puberty.<br><br><a href=\"https:\/\/www.rcpch.ac.uk\/resources\/growth-charts\" target=\"_blank\" rel=\"noreferrer noopener\">RCPCH Growth Charts<\/a><\/p>\n\n\n\n<p><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Precocious puberty in boys is defined as the onset of puberty before the age of 9 years. 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 reach around 10mls and therefore<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":25163,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[1320],"class_list":["post-25298","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-precocious-puberty-in-boys"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/paediatric\/https-apps-nhslothian-scot-refhelp-paediatric-endocrinology-diabetes\/https-apps-nhslothian-scot-refhelp-puberty\/https-apps-nhslothian-scot-refhelp-precocious-puberty-in-boys\/\" rel=\"tag\">Precocious puberty in boys<\/a>","rttpg_excerpt":"Precocious puberty in boys is defined as the onset of puberty before the age of 9 years. 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 reach around 10mls and therefore","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/25298","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=25298"}],"version-history":[{"count":3,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/25298\/revisions"}],"predecessor-version":[{"id":25406,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/25298\/revisions\/25406"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/25163"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=25298"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=25298"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}