Puberty

What is puberty?

Puberty is when your child’s body begins to develop and change as they transition into adulthood. It’s the time in your child’s life when they go through the physical changes to reach sexual maturity and are capable of reproduction. The stages of puberty follow a definite path with a progression of physical changes. The emotional changes of puberty may not progress at the same pace as the physical changes. Both the physical and emotional changes of puberty begin and end at different ages for each child.

Puberty starts when a part of your child’s brain called the hypothalamus begins producing a hormone called gonadotropin-releasing hormone (GnRH). The hypothalamus sends GnRH to another part of the brain called the pituitary gland. GnRH stimulates the pituitary gland to release two more hormones — luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These hormones travel to the sex organs (ovaries and testes), triggering them to begin releasing sex hormones (estrogen and testosterone). These messenger hormones cause the telltale signs of puberty to begin.

When do boys start puberty?

Boys begin puberty sometime between the ages of 9 and 14. Boys hit puberty about two years later than girls. However, Black and Hispanic boys tend to enter puberty a bit earlier than white boys. If your son starts showing signs of puberty before age 9, it’s worth asking his pediatrician about these early changes. Similarly, if no signs of puberty have happened by age 15, it’s worth asking his pediatrician about this delay.

What are the stages of puberty for boys?

A tool called the Tanner stages outlines the stages of puberty for boys and when they’re likely to occur. There are separate Tanner stages for penis/testicles and pubic hair. For parents, the Tanner stages can serve as an excellent guide to the changes you can expect to see in your son. There are five stages of puberty for boys.

Stage 1 is prepubertal. In this stage, boys haven’t experienced any visible changes.

In Stage 2, physical changes begin. Between the ages of 9 and 14, boys typically begin to experience:

• Genital development (growth of their testicles and scrotum).
• Growth of sparse hair around their penis and under their arms.
• An increase in height (typically about 2 to 2^½ inches per year), which could bring growing pains.

In Stage 3, physical changes speed up. Between the ages of 10 and 16, boys experience:

• Continued growth of their penis and testicles, as well as possible “wet dreams.” Wet dreams are ejaculation at night while they sleep.
• Darkening, coarsening pubic hair in the shape of a triangle in their genital area.
• Continued increase in height (about 2^¾ to just over 3 inches per year).
• More sweating, which can lead to body odor.
• Vocal changes (and cracking in the process).
• Increased muscle mass.

Some breast development, or gynecomastia, occurs in about 50% of all teenage boys, but it typically resolves by the end of puberty. It’s most common between the ages of 11 and 15. If this becomes an issue physically or socially, you should talk with your child’s healthcare provider.

In Stage 4, puberty hits full stride. Between the ages of 11 and 16 years, boys experience:

• Growth in penis size and darkening of the skin on their scrotum and testicles. Red ridges on their testicles called rugae will begin to develop.
• Body hair growth that reaches adult levels. Pubic hair remains in a coarse triangle.
• A peak growth spurt that averages nearly 4 inches per year.
• Development of acne.
• Continued cracking of the voice.

Stage 5 is the final phase. Puberty ends in this stage. Boys finish their growth and physical development. Many may not develop facial hair until this step in the process. Pubic hair may extend out to their thighs, and some boys may have a line of hair up to their belly button. Most boys finish growing by age 17, but some may continue growing through their early 20s.

What kind of emotions do boys go through during puberty?

When your son enters puberty, you may or may not see some emotional upheaval. Increased testosterone coupled with social pressures may cause moody behavior, emotional outbursts and family discord. Parents can typically ride out these issues. Listen actively, and ask when your son wants your opinion and when he just wants to be heard. Keep telling him you love him and are there for him. Step in whenever there are issues of safety or morality, setting loving limits in those instances.

If serious emotional problems arise — signs of anxiety, depression or extreme mood swings— it’s important to have him evaluated by his healthcare provider. This can display itself as him withdrawing, choosing not to do things he used to enjoy, isolation from friends and family, or a drop in grades. Emotional issues could be a sign of a mood disorder or other psychological concerns. Medication and/or therapy may be useful in these instances.

What if puberty hits really early or late?

Not everyone is on the same timetable. Some boys begin to see changes very early, which is called precocious puberty. Others may not see changes until later, which is often referred to as delayed puberty.

Early (precocious) puberty: If your son shows signs of puberty before the age of 9, make a call to his healthcare provider. This may signal a pituitary gland problem or neurological issue. Your son’s healthcare provider should evaluate him as soon as you suspect a problem.

Possible causes for early puberty include:

• The pituitary gland “turning on” hormones too early.
• Hypothyroidism (an underactive thyroid gland).
• A tumor on the adrenal gland or elsewhere.

If the problem is hormonal, an endocrinologist can prescribe puberty blockers to halt puberty until the time is right. Puberty blockers are medications that prevent your child’s body from producing the sex hormones that cause the physical changes of puberty. If your son’s healthcare provider suspects another problem, your son may be referred for further testing.

Delayed puberty: If your son starts puberty after age 14 or isn’t progressing through puberty, you’ll also want to check with his healthcare provider. Your son may just be a late bloomer — particularly if his father was as well.

But hormone or endocrine abnormalities can also delay puberty. If your child’s healthcare provider suspects an underlying problem, your son will likely be referred to a specialist for more testing.

When do girls start puberty?

Girls generally begin puberty about two years earlier than boys. Puberty for girls usually starts between the ages of 8 and 13. However, Black and Hispanic girls tend to start puberty earlier than white girls (age 7^½ instead of 8).

What are the stages of puberty for girls?

The Tanner stages also outlines the stages of puberty for girls and when they’re likely to occur. There are separate Tanner stages for breasts and pubic hair. The Tanner stages can serve as an excellent guide to the changes you can expect to see in your daughter. There are five stages of puberty for girls.

Stage 1 is prepubertal. In this stage, girls haven’t experienced any visible changes.

In Stage 2, physical changes begin. Between the ages of 8 and 13, girls typically experience:

• Their breasts begin to bud, and their areolas (pigmented area around the nipple) enlarge.
• Scant pubic hair appears.
• Height increases by about 2^¾ inches per year.

In Stage 3, physical changes speed up. Between the ages of 9 and 14:

• Their breasts continue budding.
• Underarm hair begins to grow, and pubic hair continues to grow. Pubic hair is coarse, curly and in the shape of a triangle.
• A growth spurt of more than 3 inches per year occurs.
• Their skin becomes oilier, and acne develops.

In Stage 4, puberty hits full stride. Between the ages of 10 and 15:

• Their breasts continue growing, and their nipples start to protrude.
• Pubic hair is still in a triangle, and there are now too many hairs to count.
• Growth may continue at the rate of about 2^¾ inches per year.
• Problems with acne may continue.

Periods (menstruation) typically start around age 12 (usually around the same age their mother’s and sisters’ periods began). Some girls, especially those with disordered eating, start later.

Stage 5 is the final phase. Development typically ends in this stage. Girls reach physical adulthood. Pubic hair may extend out to their thighs, and some girls may have a line of hair up to their belly button. Most girls attain their peak height by age 16, but some may continue growing through age 20.

What kind of emotions do girls go through during puberty?

All girls go through emotional changes during puberty. Some are affected more than others as estrogen and progesterone cycle through their bodies.

The combination of social and school pressures and moodiness can cause emotional outbursts and conflict with parents. You may think your sweet girl has turned into a mean girl. When you see her actions impacting others, it’s worth providing her with a safe space to “feel all her feels,” or share her emotions.

Step in whenever there are issues of safety or morality, and otherwise provide safe harbor for her to explore her new identity. Avoid being a helicopter parent or a “snowplow,” shoveling all stress out of her way. Allowing her to learn from her mistakes, as long as they’re not life-threatening ones, shows your confidence in her ability to problem-solve for herself.

If you see signs of anxiety, depression or other mental health challenges, share your concerns with her healthcare provider. Sometimes, prescribing hormonal therapy, such as birth control medication, can ease symptoms and improve mood. Other times, she may need counseling or other medications to help manage moods and build skills to develop resiliency and fine-tune her strengths.

What if puberty hits really early or late?

Not everyone will through go puberty at the same time. Some girls begin to see changes very early, which is called precocious puberty. Other girls may not see changes until later, which is sometimes called delayed puberty.

Precocious (early) puberty: A few red flags signal unusual development in girls. These include:

• Showing signs of puberty before their 8th birthday.
• Body changes that progress very quickly.
• Body changes that occur “out of order,” such as starting periods before developing breasts.
• A major disconnect between pubic hair development and breast development (such as no pubic hair but fully developing breasts, or vice versa).

If these occur, mention it to your child’s healthcare provider. Simple testing can help determine the cause of precocious puberty, such as:

• The pituitary gland may have “turned on” the hormones too early.
• A tumor may be developing on the adrenal gland or elsewhere.
• Your daughter may have been exposed to estrogen (through estrogen cream, for instance).

Your child’s healthcare provider may simply wait and monitor your daughter’s progress, or refer her to a specialist for tests. If needed, an endocrinologist can prescribe puberty blockers to halt puberty until the appropriate time. Puberty blockers are medications that prevent your child’s body from producing the sex hormones that cause the physical changes of puberty.

Delayed puberty: If your daughter starts puberty very late or doesn’t seem to be progressing through puberty, it’s also worth asking her healthcare provider about it. She may just be a late bloomer, especially if her mother was.

However, hormonal problems or disordered eating are other possibilities. If your child’s healthcare provider suspects an underlying problem, they may refer your child to a specialist for testing and management.

A note from Cleveland Clinic

Puberty can be a very exciting but challenging time in your child’s life. Along with physical changes, your child may also experience many emotional changes. Most children start puberty between the ages of 8 and 14. If you have any concerns about your child’s development, reach out to their healthcare provider. They can evaluate your child and determine if they’re developing properly.