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Precocious Puberty

January 24, 2022

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Puberty is the time of life when a child develops into an adult. The average age in girls is 10 ½ years (ranging from age 7½ to 8 to age 13), and in boys is 11 ½ years (ranging from ages 9 and 14). African American and Hispanic children tend to start puberty about six months earlier than white children. 

Precocious puberty is the appearance of any sign of secondary sex characteristics in girls younger than 7½ or 8 and in boys younger than age 9. In the United States, most children with early puberty have a variation of normal puberty, and no medical problem is present. Many children who go through puberty early or late have other family members who also went through puberty early or late, and differences in timing may be familial. However, girls younger than age 6-7 or any boys are at higher risk of having an endocrine problem that causes precocious puberty and requires treatment. 

Endocrine Connection 

At puberty, the gonads—ovaries in girls and testes in boys—start to function. Estrogen and testosterone from the gonads cause these physical changes: 

In girls:

  • The first sign is usually breast enlargement (thelarche), which may occur on one side initially. 
  • Pubic and underarm hair and adult body odor (pubarche/adrenarche) may develop before, during, or after breast development. 
  • The first menstrual period (menarche) usually occurs 2-3 years after first breast development. 
  • A growth spurt occurs earlier during puberty in girls than for boys. 
  • Fat deposition around hips and thighs 

In boys:

  • The first sign is testes enlargement (gonadarche). 
  • Noticeable pubic hair often develops after testes enlargement. 
  • Growth of the penis and scrotum occur at least one year after testes enlargement. 
  • A growth spurt occurs later in male puberty than in female puberty. 
  • Increased muscularity 

Puberty occurs when a part of the brain called the hypothalamus releases gonadotropin-releasing hormone (GnRH). This hormone stimulates the pituitary gland (a small gland at the base of the brain) to release two other hormones: luteinizing hormone (LH) and follicle-stimulating hormone (FSH). LH and FSH then stimulate the gonads to produce sex hormones—estrogen in girls and testosterone in boys—creating the changes above. Increased growth hormone production from the pituitary gland—as a results of sex hormones—leads to the pubertal growth spurt. 

The adrenal glands (two small glands located above the kidneys) also play a role in producing sex steroids (adrenarche). Their role, though, is usually less important than that of the gonads, but creates pubic/underarm hair and body odor. 

Many forms of precocious puberty are simply variants of normal. For instance, breast development in very young girls and pubic or underarm hair in young children, without other signs of puberty, usually do not signal an underlying medical problem. 

However, there are two main types of precocious puberty that are abnormal:

Central Precocious Puberty (CPP): CPP occurs when the hypothalamus releases GnRH and activates puberty early. In most girls with CPP, there is no underlying medical problem. In boys, the condition is less common and is more likely to have a link to a medical problem. Such problems include a tumor, brain trauma (such as a blow to the head, brain surgery, or radiation treatment to the head), or inflammation (such as meningitis). 

Peripheral Precocious puberty (PPP): PPP is rarer than CPP. It results from early production of sex hormones due to problems with the ovaries, testicles, or adrenal glands. Another cause can be external exposure to sex hormones (such as coming into contact with an adult using estrogen or testosterone cream). 

To make a diagnosis, your child’s doctor will take a medical history and perform a physical exam. Blood tests may be done to measure hormone levels. The doctor may order an x-ray of the hand to see if the child’s bones are maturing too fast. Sometimes a CT scan or MRI is ordered to check for a tumor. 

Rarely, blood might be sent to a lab to look for a change in a gene (genetic mutation) that could result in an uncommon type of precocious puberty. 

If your child has any sign of precocious puberty, visit a pediatric endocrinologist. This doctor is an expert in the treatment of hormone-related conditions in children. Precocious puberty requires tests to ensure there is no underlying medical cause. Your doctor will work with you to decide the best treatment option.

Near the end of puberty, growth in height stops. Because the bones of children with precocious puberty mature and stop growing earlier than normal, these children can be shorter than expected as adults. Precocious puberty can also cause emotional and social problems for children who are ahead of their peers in terms of sexual maturity. Report pubertal signs that are developing before age 7 ½ to 8 in girls and before age 9 in boys. 


  • Early breast development 
  • Early vaginal bleeding, especially bleeding before breast development 


  • Early enlargement of the testicles and penis 
  • Facial hair 
  • Deepening voice 

Both boys and girls: 

  • Early pubic or underarm hair 
  • Early or rapid height growth “spurt” 
  • Acne or adult body odor 

If your child has CPP, there are medications to prevent further pubertal development. If the problem is PPP, the treatment will depend on the underlying cause. It could involve medications, surgery (if there is a tumor), or removing the external source of the hormones (such as estrogen cream).

  • Is my child going through early puberty? 
  • If so, what is the cause of the early puberty? 
  • Does my child need medicine? 
  • What should I tell my child about these physical changes? 
  • Should we see a pediatric endocrinologist? 


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