{"id":25307,"date":"2025-09-10T14:53:16","date_gmt":"2025-09-10T13:53:16","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=25307"},"modified":"2025-09-23T10:50:26","modified_gmt":"2025-09-23T09:50:26","slug":"delayed-puberty-in-boys","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/paediatric-endocrinology-diabetes\/puberty\/delayed-puberty-in-boys\/","title":{"rendered":"Delayed Puberty in Boys"},"content":{"rendered":"\n<p>Delayed puberty is defined as the lack of any pubertal signs by the age of 14 years in boys.<\/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 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.<\/p>\n\n\n\n<p>Initial assessment should include:<\/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 (self examination is adequate)<\/li>\n\n\n\n<li>family history of pubertal timing where available.<\/li>\n\n\n\n<li>Consideration of possibility of delayed puberty secondary to chronic disease.<\/li>\n<\/ul>\n\n\n\n<p><strong>C.M. &amp; E.B. 23-09-25<\/strong><\/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 who have not achieved testicular volumes of 4mls or higher by age 14 years<\/li>\n\n\n\n<li>lack of pubic and axillary hair growth and linear growth falling off centiles by age 14 years<\/li>\n\n\n\n<li>Suspected delayed puberty secondary to chronic disease (please indicate whether there is suspicion of this)<\/li>\n\n\n\n<li>If bloods are being checked prior to referral please include \u2013 LH, FSH, testosterone, prolactin, TFTs, coeliac screen.<\/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 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.<\/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><a href=\"https:\/\/bestpractice.bmj.com\/topics\/en-gb\/1126\" target=\"_blank\" rel=\"noreferrer noopener\">Delayed Puberty, BMJ Best Practice<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.rcpch.ac.uk\/resources\/growth-charts\" target=\"_blank\" rel=\"noreferrer noopener\">RCPCH Growth Charts<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>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<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":25163,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[1322],"class_list":["post-25307","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-delayed-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-delayed-puberty-in-boys\/\" rel=\"tag\">Delayed Puberty in Boys<\/a>","rttpg_excerpt":"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","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/25307","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=25307"}],"version-history":[{"count":2,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/25307\/revisions"}],"predecessor-version":[{"id":25408,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/25307\/revisions\/25408"}],"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=25307"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=25307"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}