Delayed puberty in the context of "Hypogonadism"

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⭐ Core Definition: Delayed puberty

Delayed puberty is when a person lacks or has incomplete development of specific sexual characteristics past the usual age of onset of puberty. The person may have no physical or hormonal signs that puberty has begun. In the United States, girls are considered to have delayed puberty if they lack breast development by age 13 or have not started menstruating by age 15. Boys are considered to have delayed puberty if they lack enlargement of the testicles by age 13.5 . Delayed puberty affects about 2% of adolescents.

Most commonly, puberty may be delayed for several years and still occur normally, in which case it is considered constitutional delay of growth and puberty, a common variation of healthy physical development. Delay of puberty may also occur due to various causes such as malnutrition, various systemic diseases, or defects of the reproductive system (hypogonadism) or the body's responsiveness to sex hormones.

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Delayed puberty in the context of Puberty

Puberty is the process of physical changes through which a child's body matures into an adult body capable of sexual reproduction. It is initiated by hormonal signals from the brain to the gonads: the ovaries in a female, the testicles in a male. In response to the signals, the gonads produce hormones that stimulate libido and the growth, function, and transformation of the brain, bones, muscle, blood, skin, hair, breasts, and sex organs. Physical growth—height and weight—accelerates in the first half of puberty and is completed when an adult body has been developed. Before puberty, the external sex organs, known as primary sexual characteristics, are sex characteristics that distinguish males and females. Puberty leads to sexual dimorphism through the development of the secondary sex characteristics, which further distinguish the sexes.

On average, females begin puberty at age 10½ and complete puberty at ages 15–17; males begin at ages 11½–12 and complete puberty at ages 16–17. The major landmark of puberty for females is menarche, the onset of menstruation, which occurs on average around age 12½. For males, first ejaculation, spermarche, occurs on average at age 13. In the 21st century, the average age at which children, especially females, reach specific markers of puberty is lower compared to the 19th century, when it was 15 for females and 17 for males (with age at first periods for females and voice-breaks for males being used as examples). This can be due to any number of factors, including improved nutrition resulting in rapid body growth, increased weight and fat deposition, or exposure to endocrine disruptors such as xenoestrogens, which can at times be due to food consumption or other environmental factors. However, more modern archeological research suggests that the rate of puberty as it occurs now is comparable to other time periods. Growth spurts began at around 10–12, but markers of later stages of puberty such as menarche had delays that correlated with severe environmental conditions such as poverty, poor nutrition, and air pollution. Puberty that starts earlier than usual is known as precocious puberty, and puberty which starts later than usual is known as delayed puberty.

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Delayed puberty in the context of Precocious puberty

In medicine, precocious puberty is puberty occurring at an unusually early age. In most cases, the process is normal in every aspect except the unusually early age and simply represents a variation of normal development. There is early development of secondary sex characters and gametogenesis also starts earlier. Precocious puberty is of two types: true precocious puberty and pseudoprecocious puberty. In a minority of children with precocious puberty, the early development is triggered by a disease such as a tumor or injury of the brain.

Even when there is no underlying disease, unusually early puberty can have adverse effects on social behavior and psychological development (having more mature knowledge than one's peers, feeling inadequate, trying to attend and establish friendships with older people, depression). Affected children also face shorter adult height potential and possible lifelong health risks. Central precocious puberty can be treated by suppressing the pituitary hormones that induce sex steroid production. The opposite condition is delayed puberty.

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