Early or Delayed Puberty

Puberty is the name for the time when your child's body begins to develop and change as he or she moves from being a child to an adult. Usually, puberty starts between ages 8 and 13 in girls and ages 9 and 15 in boys. When your body is ready to begin puberty, your child's pituitary gland (a pea-shaped gland located at the bottom of your brain) releases special hormones which affect different parts of their body. Boys experience production of testosterone (a hormone that stimulates sexual development) and sperm, whereas girls start to develop breasts and experience production of another hormone called oestrogen, which prepare her body to start her menstrual cycle.

Some children experience puberty earlier or later than others. There are several possible reasons for this. Causes of early puberty (also known as precocious puberty) in girls may be diverse. In some cases it could be a problem in the brain, such as a tumour, a head injury or an infection such as meningitis. It could also be a problem with the ovaries or thyroid gland, or it may simply run in your family. Early puberty in boys is less common and more probably associated with an underlying medical problem.

Causes of late puberty may be just that your child is maturing slower than average, and often runs in families. It could also be due to malnutrition (due to illness or otherwise) or it could be a long-term medical condition known as hypogonadism, in which the person produces few or no hormones.​​

Early puberty is when the symptoms of puberty, such as breast development, enlargement of the testicles and pubic hair growth, start before age of eight in girls and nine in boys.

Girls are said to have late puberty if:

  • She has not started to develop breasts by 13 years of age

  • Four years after the start of puberty, her breasts still haven’t reached a full stage of development

  • She hasn’t had her first period by 14 and a half years of age

Boys are said to have late puberty if:

  • He shows no signs of testicular development by 14 years of age

  • At least three of four years have passed since he has reached puberty but his penis and testicles haven't development to an adult level​

If your child is experiencing unusually early or late symptoms of puberty please make an appointment to consult with one of our expert medical staff working with the Children's Hospital at The Aga Khan University Hospital.

Your time with your doctor maybe limited, so make sure to prepare for your visit beforehand. Here are some tips to help get you started.

After giving your child a complete physical examination and analysing his or her medical history, your doctor working with the Children’s Hospital at The Aga Khan University Hospital may perform certain tests to diagnose early puberty, including the following:

  • A blood test to check hormonal and thyroid levels

  • A GnRHa (Gonadotropin-releasing Hormone agonist) stimulation test

  • A ‘bone age’ X-ray to determine if your child’s bones are growing at a normal rate

  • Imaging methods such as ultrasound to monitor organs and blood flow

  • Magnetic Resonance Imaging (MRI) to scan the brain and pituitary gland and produce detailed images of organs

To diagnose delayed puberty, your doctor at The Aga Khan University Hospital may prescribe the following tests:

  • Blood tests to measure hormone levels

  • Blood tests to measure if the pituitary gland can correctly respond to GnRH

  • Magnetic Resonance Imaging (MRI) of the brain and pituitary gland to check for abnormal development

Not all children with early puberty need medical treatment, especially if the onset of puberty is only slightly early. If early puberty is caused by a specific medical problem, treating the underlying problem can often stop the progression of precocious puberty. It can also be stopped by medical treatment to block the hormones that cause puberty. For example, medications may be used to treat early puberty. These medications suppress production of growth enhancing hormones.

Delayed puberty treatment usually involves hormone replacement therapies as formulated by your doctor working with the Children's Hospital at The Aga Khan University, Hospital.

The Aga Khan University Hospital offers various support services to help with managing or recovering from the disease or condition. These include but are not limited to nutrition, physiotherapy, rehabilitation, specialized clinics and some patient support groups. Your doctor or nurse will advise you accordingly.

The Aga Khan University Hospital offers financial assistance to those who are in need and fulfil the eligibility criteria. For further information, you can contact the Patient Welfare Department. You can find the contact number of the Patient Welfare Department in the 'Important Numbers' section on the website homepage.

The financial counselling staff is available during office hours, at the main PBSD (Patient Business Services Department), to answer your financial queries on treatments' costs and authorize admissions on partial deposit as per hospital policies allow. The financial counsellor in the emergency room is open 24/7. You can find the contact number of the Patient Business Services in the 'Important Numbers' section on the website homepage.

Your doctor and or nurse will give you specific instructions about the prescribed medication. Please ensure that you take or use the prescribed medicine as advised. It can be dangerous to your health if you self-prescribe. Please inform the doctor or nurse beforehand if you have experienced any adverse reactions to any medications in the past. If you experience any symptoms of drug poisoning, overdose or severe reaction please contact the Pharmacy Service at The Aga Khan University Hospital immediately. You can find the contact number of the Pharmacy Services in the 'Important Numbers' section on the website homepage.




The information provided on our website is for educational purposes and not intended to be a substitute for medical advice, diagnosis or treatment. You should always seek the advice of your doctor or other healthcare professional provider.