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What is Puberty? Puberty is the process that children undergo to develop into adults, with physical and sexual development. During puberty, children grow taller, gain muscle and weight, develop a strong skeleton, and graduate through predictable stages of behavior and brain development. These changes occur through the action of estrogens and androgens - female and male hormones - which rise due to the maturation of the adrenal glands, ovaries, and testicles.

What are adrenal glands? Adrenal glands are located just above the kidneys, and are responsible for underarm odor and pubic hair by way of adrenal androgens, or male hormones. Ovaries and testicles each produce estrogens and testosterone, but in different balances, with boys ending up producing 10-20 times the amount of testosterone that girls do, which accounts for the differences in hair pattern and musculature. Girls produce relatively more estrogens, and lower testosterone, accounting for breast, hip and vaginal development.

What is Tanner Stage? Endocrinologists and pediatricians communicate a child's development by their "Tanner stage", which refers to their pattern of hair, maturity of breasts, and testicular size. Stage I is a child's stage before puberty starts, and Stage V is adult maturity.  

At what age does puberty start? Ovaries and testicles start maturing at some point between 8-14 years old, in most children. When pubertal signs are present before 8 years old in a girl, or 9 years old in a boy, puberty is considered early, or precocious. When it's only pubic hair or odor, it is more often due to maturation of the adrenal glands, which is called precocious at these same ages, but due to different origin of hormone, has a separate diagnosis - called precocious adrenarche, or early adrenal gland maturation.


What causes puberty to start? Scientists aren't sure precisely what triggers the process of puberty to start, but it is clear that a few proteins in the hypothalamic area of the brain start rising in coordinated pulses to tell the pituitary gland to, in turn, pulse LH and FSH hormones. As levels of LH and FSH rise and pulse in a regular tempo, they cause the growth of the gonads - ovaries and testicles - and the maturation of the hormone producing cells within them. These hormones - estrogens and androgens - fuel the body's changes. Pubertal changes typically take about 4-5 years from beginning to end, with the majority of growth and change in development within the first 2-3 years.

What is precocious puberty? What is late puberty? When puberty starts early, or proceeds rapidly - or if it hasn't yet started by the time a child is approaching 14 years old - then blood tests are usually run to find out if the child is simply an early or late bloomer, or if there is a concerning reason for these changes to have occurred early or are delayed. Early and late puberty usually occur in families where puberty starts at similar ages.  But exposure to hormones in the environment, contact with adult creams to supplement hormonal levels, and an abnormally slow thyroid gland can all cause the appearance of puberty, even if it is not present. True precocious puberty may be due to a pituitary or brain growth. Late puberty can be caused by thyroid dysfunction, as well as other autoimmune or nutrition concerns, or potentially, dysfunction of the pituitary itself.


How can you tell if a child is in puberty? An endocrinologist checks the appearance of puberty with rates of growth and blood tests, along with a "bone age" x-ray, or maturity of the child's hand bones, to determine if: 1. there is true early or late puberty, and 2. if there is a concern about it. If there is clear early or late puberty, then there are treatment options available to suppress it from progressing, or to stimulate puberty to start. These options should be discussed with your pediatrician, and if available, a pediatric endocrinologist.

If you would like to schedule an appointment to learn more about early, late, or even typical puberty, please press the button below to learn more, to discuss your child's evaluation, and review your questions about your child's diagnosis.

Resources for learning around the web:

1. WebMD:

2. Mayo Clinic:

3. Stanford Childrens:

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Dr. Lerner Answers Questions from Parents like You

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Dr. Shulamit Lerner explains what you need to know
about your child's endocrine diagnosis,
through comprehensive teaching and interactive conversation,
so that you fully understand its causes and management.

Dr. Lerner works with parents to move
worry into knowledge, education into action.

Maybe your son is short, or your daughter has irregular periods.
Maybe your doctor diagnosed early puberty or a thyroid problem,
Maybe they've assured you all is normal and there's nothing else to do,
but you want to be sure, and there's no one else with experience in your area.

If your child is diagnosed with growth hormone deficiency, early puberty, a hormone imbalance/PCOS, Hashimoto thyroiditis, CAH, or pituitary injury, press the DIAGNOSIS tab above to learn more.
Learn the basics of your child's condition, how it is diagnosed, and what treatments are available.
Learn what you need to know, so that you can be a partner with the doctors in your child's care.

For more education that is specific to your child, you can schedule an appointment with Dr. Lerner.

Dr. Shulamit Lerner has helped thousands of children and families as a
board certified pediatrician and pediatric endocrinologist.

Now she brings her decades of expertise to parents worldwide who seek an interactive, personalized, and comprehensive conversation about their child's endocrine diagnosis.

She wants to provide support for you, your doctors, and other specialists by discussing your child's diagnosis and your concerns with you.

Using current medical guidelines and her decades of experience, she will teach you clearly and comprehensively, empowering you to make decisions to optimize your child's health, avoid costly and unnecessary treatment, and relieve your anxiety.

When you need more time and experience than your doctor can provide,
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