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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.

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.

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.  

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.


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.

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.


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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More About Shulamit Lerner

Dr. Lerner provides a scientifically-based review of a child's medical care, and attends to a family's need to be educated about their child's endocrine condition.  She aims to understand an individual child's health and environment, to tailor education for their parents. As needed, she works as a partner with parents and a local pediatrician or pediatric endocrinologist to suggest exploring an alternate diagnosis or other appropriate course of therapy. 


Shulamit Lerner grew up in several states in the Northeastern United states, graduating from the Massachusetts Institute of Technology and the Albert Einstein College of Medicine. She trained in general pediatrics through a combined program at Montefiore and Jacobi Medical Centers, followed by a fellowship at Columbia University's Morgan Stanley Children's Hospital of New York-Presbyterian to specialize in Pediatric Endocrinology.


For the following ten years, Dr. Lerner remained at Columbia, teaching, conducting research, and seeing patients in both upper Manhattan and Riverdale. In 2015, she started her private practice, in which she has been able to provide more time and improved communication with families. Dr. Lerner has a particular interest in exercise and nutrition, encouraging her patients to take steps toward a lifestyle that meets their body's needs for optimal well-being.   She is delighted to learn from and work with all medical practitioners, including integrative specialists, to maintain the teamwork required to optimize care of an individual child.  She enjoys researching connections between other pediatric conditions and their effects on a child's endocrine health. With Endocrine Explained, Dr. Lerner is thrilled to be available to teach families around the globe, bringing up-to-date, interactive, comprehensive, and personalized education about a child's condition to their family.