Precocious Puberty/Early Puberty

Precocious puberty, or early puberty, means puberty that begins before age 8 in girls and children assigned female at birth and before age 9 in boys and children assigned male at birth. The cause of early puberty depends on the type. Treatment for the condition includes medications that can turn off production of certain hormones.

Overview

What is precocious puberty?

Precocious puberty means early puberty. It’s the term for puberty that begins much earlier than usual — before age 8 in girls and children assigned female at birth (AFAB) and before age 9 in boys and children assigned male at birth (AMAB).

Puberty is the process during which your child has a growth spurt and develops the sexual and physical features of an adult. In your child’s brain, their hypothalamus releases chemicals (hormones) that cause their pituitary gland to release hormones called gonadotropins. Gonadotropins stimulate the growth of the sex glands (gonads). In boys and children AMAB, the gonads are the testicles, which release testosterone. In girls and children AFAB, the gonads are the ovaries, which release estrogen.

Puberty usually starts between the ages of 8 and 13 in girls and children AFAB and between the ages of 9 and 14 years in boys and children AMAB. Children affected by precocious puberty undergo this process much earlier.

Types of precocious puberty

There are two main types of precocious puberty: central precocious puberty and peripheral precocious puberty.

Central precocious puberty

Central precocious puberty is the more common type. It occurs when your child’s brain releases sex hormones (androgens) too early. Other names for central precocious puberty include gonadotropin-dependent precocious puberty and true precocious puberty.

Peripheral precocious puberty

Peripheral precocious puberty occurs as a result of problems with your child’s reproductive organs (ovaries or testicles) or adrenal glands. Sometimes it results from hormone exposure from the environment. Other names for peripheral precocious puberty include gonadotropin-independent precocious puberty and peripheral precocity.

Who is affected by precocious puberty?

Any child can develop precocious puberty. The condition happens more often in girls and children AFAB than in boys and children AMAB.

How common is precocious puberty?

Early puberty affects about 20 out of every 10,000 girls and children AFAB. It affects less than 5 in every 10,000 boys and children AMAB.

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Symptoms and Causes

What causes precocious puberty?

Precocious puberty has different causes depending on the type.

Central precocious puberty

Central precocious puberty occurs when your child’s brain releases androgens too early. In most cases, the cause of this — especially in girls and children AFAB — is unknown. Causes may include:

Peripheral precocious puberty

Issues with your child’s reproductive organs or adrenal glands cause peripheral precocious puberty. Causes may include:

Sometimes exposure to hormones from sources outside your child’s body cause peripheral precocious puberty. For instance, exposure to products such as creams, medications or supplements containing estrogen, testosterone or androgen.

What are the signs of precocious puberty?

The signs and symptoms of precocious puberty in both sexes include acne, body odor and a growth spurt. Precocious puberty also causes sexual characteristics to develop early. In girls and children AFAB, these include:

Early puberty in boys and children AMAB may cause:

  • A deepening voice.
  • Facial, pubic and underarm hair.
  • Enlargement of the penis and testicles.
  • Muscle development.

What are the risk factors for this condition?

Precocious puberty tends to affect certain groups more often. Children who are at a higher risk of developing the condition include:

  • Girls and children assigned female at birth (AFAB).
  • Children with overweight or obesity.
  • Black children.
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What complications are associated with precocious puberty?

Early puberty may cause a growth spurt in a child, but when puberty ends, the child stops growing. Therefore, they may be shorter than other children of the same age. Precocious puberty may also be embarrassing for children who are developing more quickly than other children.

These issues can lead to behavioral, emotional and social issues. Children may have trouble with anxiety and depression. They may be at a higher risk of developing substance use disorders and engaging in high-risk behaviors.

Diagnosis and Tests

How is precocious puberty diagnosed?

Your child’s healthcare provider will perform a physical examination and ask questions about your child’s medical history.

They may order an X-ray of your child’s hand and wrist to check their bone age. If your child’s body overproduces reproductive hormones, their bones mature earlier than normal, which suggests precocious puberty.

Your child’s provider may also order blood tests to measure your child’s hormone levels. These tests will check your child’s pituitary hormones — luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These hormones control puberty. They’ll also check the levels of your child’s sex hormones.

Your child’s provider may recommend a brain MRI (magnetic resonance imaging). This test can help rule out issues in your child’s brain, such as tumors.

Your child’s provider may order a pelvic ultrasound if they suspect your child has peripheral precocious puberty. This test checks for ovarian or adrenal tumors in your child’s pelvis and adrenal glands. These growths sometimes cause early puberty in girls and children AFAB.

Based on their findings, your child’s provider may refer you to a pediatric endocrinologist.

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Management and Treatment

How is precocious puberty treated?

Precocious puberty treatment depends on the type.

Central precocious puberty

Turning off the pituitary gland’s production of LH and FSH is the main goal of central precocious puberty treatment. Turning off production will slow down the signs of puberty and delay menstruation. Treatment typically includes a GnRH agonist (puberty blocker), a synthetic (human-made) hormone that works by halting the production of reproductive or growth hormones. Your child’s provider will give your child an injection of the medication at regular intervals until it’s safe for puberty to begin.

Peripheral precocious puberty

Eliminating the source of reproductive hormones is the treatment for peripheral precocious puberty. Some children need surgery to remove a tumor or another mass that’s causing the symptoms of early puberty. Others may need medication such as a steroid called a glucocorticoid. Removing an outside source of reproductive hormones, such as estrogen creams, may be enough to stop early puberty.

Prevention

Can precocious puberty be prevented?

You can’t prevent most early puberty cases. Limiting your child’s exposure to reproductive hormones from outside sources may prevent it. These sources may include estrogen or testosterone creams, lotions or other medications.

Outlook / Prognosis

What is the prognosis (outlook) for people who have precocious puberty?

Your child’s outcome will depend on several factors, including:

  • Bone age.
  • Age of onset (how old they were when precocious puberty started).
  • How quickly precocious puberty developed.
  • Your child’s treatment plan.

Early treatment with medications or surgery usually stops precocious puberty. This treatment allows a child to develop and grow into adulthood at a normal rate.

Living With

When should I call my child’s healthcare provider about precocious puberty?

Call your child’s healthcare provider if they’re showing any signs of precocious puberty, especially if they’re younger than 8 years old.

What questions should I ask my child’s healthcare provider?

  • Is my child experiencing early puberty?
  • Why is my child going through precocious puberty?
  • What treatments do you recommend for my child?
  • Does my child need medication to control this condition?
  • Are there any support groups for children going through early puberty?
  • Do we need to see a pediatric endocrinologist?

Additional Common Questions

Why are girls and children assigned female at birth (AFAB) developing earlier?

In the United States, it may seem like more and more girls are hitting puberty early. This trend may be related to the increasing rate of obesity in the country. Researchers link a higher body mass index (BMI) to early breast development. Eating a lot of processed, high-fat foods may cause early puberty.

Race and ethnicity also play a part in the early timing of puberty. Black and Hispanic girls and children AFAB typically begin puberty earlier than other ethnic groups. Because obesity typically affects these groups more prevalently, this may add to the increase in cases of early puberty.

A note from Cleveland Clinic

Puberty can be a stressful time in a child’s life — especially when it comes early. But if your child is showing signs of early puberty, it can be even more stressful. If you see any signs of precocious puberty in your child, reach out to their healthcare provider right away. They can help you decide if treatment is necessary.

Medically Reviewed

Last reviewed by a Cleveland Clinic medical professional on 10/20/2023.

Learn more about our editorial process.

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