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Delayed Puberty

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Puberty — that’s when kids start moving toward adulthood. They don’t all reach it at the same time. But what happens when your teen is still waiting?

Changes from puberty usually happen gradually. It typically begins between ages 8 and 13 for children assigned female at birth (AFAB). For kids assigned male at birth (AMAB), it usually starts between ages 9 and 14. When your child experiences late (delayed) puberty, it can leave you both with a lot of questions and worries. Will it ever start? What happens if it doesn’t? Who can help?

Cleveland Clinic Children’s has the answers and reassurance you and your child need. Our experts will work with your teen to uncover what’s causing delayed puberty. Then, they’ll build a personalized treatment plan that focuses on your child’s needs.

Why Choose Cleveland Clinic Children's for Delayed Puberty Care?

Caring approach:

Kids like to keep up with their friends. So, it may frustrate your child if they’re not developing at the same pace. When treating delayed puberty, we reach beyond the medical diagnosis and take care of your child’s emotional and mental health needs, too.

Patient-centered care:

Your child may not always feel comfortable talking about their delayed puberty and treatments with family. That’s where our child life specialists and child psychologists come in. These specially trained providers know what it takes to connect with teens on their level to help them feel more at ease with treatment.

Collaborative care:

An underlying health condition can often cause your child to experience delayed puberty. So, they may have a team of skilled providers from different specialties. This team works together to plan and manage every aspect of your child’s care, always keeping them at the center of all they do. Meet our team.

Trusted experts:

Families travel from all over the U.S. and the globe to get care at Cleveland Clinic Children’s. From routine testing to larger procedures and everything in between, you can rest easier knowing your child is in the best possible hands.

Virtual visits:

When you and your child need a quick touch base with their provider, you may not need an in-person appointment. Ask if you can schedule a convenient virtual visit instead. Your child will get the same great care without leaving home.

National recognition:

Cleveland Clinic Children’s is a trusted healthcare leader. We’re recognized throughout the U.S. for our expertise and care.

Evaluating Delayed Puberty at Cleveland Clinic Children’s

If a biological parent had delayed puberty, there’s a chance their children might also be late bloomers. Eating disorders in children can sometimes delay puberty. So can underlying medical conditions like:

If your child shows few or no signs of puberty by age 13 for kids AFAB and 14 for AMAB, it’s time to get things checked out. Some of these are:

Increased leg, armpit and pubic hair
Growth spurts
Oily skin and acne
Deepening voice (AMAB)
Testicle and penis growth (AMAB)
Breast development (AFAB)
Getting periods (AFAB)

What to expect during your child’s first visit

Your child’s provider uses the first appointment to get to know your child and understand what’s been going on. They understand it may be a stressful time for your child (and you) and will try to make the visit as comfortable as possible.

You and your child can expect to answer many questions about their health and your family’s medical history. Your child will also have a physical exam. And their provider will order tests to help them better pinpoint what’s delaying puberty.

They’ll use blood tests to check hormone levels and how well their thyroid gland works. Blood tests can also help your team find other signs of delayed puberty, including genetic changes. Your child may also have an MRI or X-ray to check bone growth and development.

Depending on what their provider feels the underlying cause may be, your child may also have tests to confirm that diagnosis or rule out similar conditions. These could include lung, kidneys and digestive system tests or more blood work.

Meet Our Delayed Puberty Team

Our team-based approach lets us deliver the most personalized care. Your child’s care team may have:

If an underlying health condition is causing your child’s delayed puberty, they’ll also see specialists in these areas. All their providers will work together to plan and manage their care.

Providers Who Treat Delayed Puberty

Locations

We offer care for delayed puberty at the following locations in Northeast Ohio.

Treating Delayed Puberty at Cleveland Clinic Children’s

There are many possible reasons why your child is experiencing delayed puberty. Their combined care team will treat those underlying causes.

If your child inherits late puberty from either parent, we may do watchful waiting. We’ll keep a close eye on things and see if puberty starts without treatment. In some cases, we may take steps to jumpstart your child’s delayed puberty.

Hormone therapy

Many kids who have delayed puberty will need hormone therapy. How we approach your child’s treatment depends on their diagnosis and whether they’re assigned male or female at birth.

If your child is AFAB, they may also need:

Estrogen therapy to stimulate breast development and menstruation
Cyclic progesterone to induce periods

If they’re AMAB, we may recommend:

Testosterone injections to induce puberty changes

Taking the Next Step

It can be hard to see your child fall behind when it comes to reaching puberty. The good news? Delayed puberty is treatable. And at Cleveland Clinic Children’s, we’ll uncover why your child isn’t developing like they should. Then we’ll craft a personalized treatment plan focusing on the reasons behind this delay and ways to move development forward. And through it all, our team is here to support your child (and you) through every step of this journey.