WHAT IS PUBERTY ?​
 

  • Puberty is the stage of life where a child’s body begins to develop and change as they move into adulthood

  • These changes, both physiological and behavioural, occur between the ages of 8 to 16 years, in all humans, and it prepares their bodies for reproduction 

  • Males experience development of facial hair, hyper-pigmentation of sexual organs, and hoarseness of voice

  • Females undergo initiation of menstruation, increase in breasts size due to maturity of mammillary glands and darkening of the nipples during puberty

  • Hormonal changes associated with puberty impact an individual’s mental and emotional health, including social behaviour

Why does Puberty occur?​

  • The process of puberty is kick started when a stimulatory hormone, known as Gonadotropin Releasing Hormone (if you didn’t read that, GnRH for short), is released from the hypothalamus of the brain 

  • GnRH stimulates the pituitary gland to release follicle-stimulating hormone (FSH) and luteinising hormone (LH)

  • FSH and LH are released from the anterior pituitary gland

  • LH and FSH act differently in male and female bodies, leading to an increase in the body levels of testosterone and estrogen, respectively​

The hypothalamus and pituitary gland and their role in puberty

Puberty is a confusing time and the hormonal flow makes it even more difficult. Most of these physical and behavioural changes are difficult to understand. Kids generally require a lot of support, love, care and understanding to help them sail through this phase easily.

PHYSICAL CHANGES DURING PUBERTY

 

First Signs of Puberty

  • The breasts begin to grow in size among girls

  • In boys, the testes mature and descend to the scrotum from abdomen. This leads to the increase in size of testicles. The scrotum's skin also becomes loose and it darkens.

  • Hair growth begins in both genders, with some growth on the legs and arms and major growth in underarms and pelvic region
     

Later Signs of Puberty

  • Around 2 years after beginning puberty, girls usually have their first "period"

  • Boys may have "wet dreams" (involuntary ejaculations of semen as they sleep)

  • Boys experience “cracking” of voice, which gets permanently deeper

  • Girls and boys go through a growth spurt, gaining height and weight significantly

  • Girls and boys often develop acne on face, chest, upper back and shoulders 

BEHAVIOURAL CHANGES DURING PUBERTY

  • Exhibition of sexual behaviour

    • Increased frequency of masturbation

    • Sexual arousal and erections caused due to smell or sight of a potential sexual partner

    • Dreams/fantasies resulting in sexual stimulation and nocturnal emissions (wet dreams)

  • Increased desire to be sexually appealing, arising from intense competitiveness among peers

  • Frequent crushes and infatuations about potential partners

  • Unexplained mood swings

  • Low self-esteem and depression arising from a perceived inability to be sexually attractive

  • Aggressive and rebellious behaviour as they experience the need for greater freedom from the cocoon of their home

 

MEDICAL COMPLICATIONS DURING PUBERTY

 

There are two major medical conditions which require immediate attention:

  • Early onset of puberty (precocious puberty)

  • Delayed puberty

Precocious Puberty

Precocious puberty is defined as the early onset of puberty. This means that the symptoms will start showing

  • In boys, before 10 years of age

  • In girls, before 8 years of age

 

Diagnostic tests for Precocious Puberty

There are a couple of test that the doctor may refer to diagnose early onset of puberty

  • Bone X-Ray - This is performed to detect the age of the child from the bones. Early onset of puberty will show signs of increased skeletal growth

  • Estradiol Test - This test detects the level of estrogen in the blood. High levels of estrogen indicate the occurrence of puberty in girls

  • Testosterone Test - This test detects the level of testosterone in the blood. High levels of testosterone indicate the occurrence of puberty in boys

  • Medical History - Doctor will inspect the body of the child and may ask for any history of precocious puberty, in the family

  • Thyroid Test - An increased thyroid level can be associated with the early onset of pubertyThyroid tests are performed to detect the level of the thyroid hormones in the body of the child

  • GnRH Stimulation Test - The hormone which initiates puberty (GnRH) is administered by the doctor on the childAny increase in the level of other reproductive hormones will indicate an issue with the hypothalamus

 

Treatment of Precocious Puberty

The doctor will assess the age of the child who has attained puberty and the extent of the increase in the hormone levels to decide whether the child requires treatment or not. There are a couple of treatment options available:
 

  • GnRH Analogue Therapy - Once a month, an injection of Lupron Depot or Trelstar, Triptodour kit is administered to the child. This slows down the effect of increased GnRH levels
    This treatment is only provided to children where the GnRH stimulation test indicates that the premature puberty occurred due to increased GnRH productionThe injection is administered until the child attains the age for normal onset of puberty 

  • Histrelin Implant - This is another type of GnRH analogue therapy. The Histrelin implant ensures that the levels of GnRH remain low in children with precocious pubertyThe implant is replaced every year until normal age of puberty is attained

Providing support to children with precocious puberty is important as these children tend to feel insecure from other kids of their age. Sometimes, other kids might also mock them, making them even more uncomfortableFinding a counsellor for the child to talk to, while undergoing treatment, is recommended.
 

Delayed Puberty

Delayed puberty is defined as the late onset of puberty. This means that the symptoms will start showing

  • In boys, after the age of 14

  • In girls, after the age of 13

 

Diagnostic tests for Delayed Puberty

There are a couple of test that the doctor may refer to diagnose delayed onset of puberty

  • Bone X-Ray - This is performed to detect the age of the child from the bones. The doctor will check for any signs of pubertal skeletal growth of the child

  • Estradiol Test - This test detects the level of estrogen in the blood. Low levels of estrogen indicates hormonal imbalance

  • Testosterone Test - This test detects the level of testosterone in the blood. Low levels of testosterone indicates hormonal imbalance

  • Medical History - Doctor will inspect the child's body and may ask for any history of delayed puberty, in the family

  • MRI Scan - For seriously delayed cases, an MRI scan is performed to check the functionality of the pituitary and hypothalamus glands

 

Treatment of Delayed Puberty

Most children do not require treatment for delayed puberty. It eventually develops. The doctor will still track the progress of the child. In some cases, hormone therapy might be used for children with lower levels of sex hormones. Patches/injections/pills of estrogen (in girls) or testosterone (in boys) are administered in the body to stimulate puberty. In other cases, treatment of any underlying causes, like genetic disorders, brain disorder etc will be performed by the doctor.