Normal and Delayed Puberty

Abstract

Puberty is the developmental stage of physical and psychological maturation in which reproductive capacity is attained. The onset of puberty is driven by the activation of the hypothalamic–pituitary–gonadal axis after the break that restrains this axis during the majority of childhood is released. This review will cover the clinical assessment of puberty, variation in the timing of puberty, and the complex factors that regulate the onset and timing of puberty. In addition, the presentation, diagnosis, and differential diagnosis of male delayed puberty will be discussed. Male delayed puberty is common, affecting up to three percent of the population. The main differential diagnoses of delayed puberty in males include self-limited delayed puberty (DP), idiopathic hypogonadotropic hypogonadism (IHH), and hypergonadotropic hypogonadism. Treatment of isolated CDGP involves expectant observation or short courses of low-dose sex steroid supplementation. More complex and involved management is required in males with hypogonadism to achieve both the development of secondary sexual characteristics and to maximize the potential for fertility.