Delayed Puberty in Boys: Diagnosis and Treatment

Boys will typically go through puberty as they grow and develop into young adults. Sometimes boys go through puberty later than we expect. Learn about delayed and normal puberty in boys.

How Do Doctors Evaluate Delayed Puberty in Boys?

Our evaluation of your son’s delayed puberty begins with a discussion about your son’s signs of puberty and a physical exam. If your son has signs of delayed puberty, we will have him get an X-ray of his left hand and wrist called a bone age. A bone age tells us how much his bones have matured. It can also help us figure out much he has left to grow.

Your son might have an early morning blood test to help us measure his hormone levels. Hormones, like testosterone, are at their highest levels first thing in the morning. Additional blood testing done at the same time might include FSH, LH, cortisol, ACTH, thyroid hormone studies, growth factors and a prolactin level. We also do genetic evaluations if they are needed. Depending on the results of the laboratory testing further radiology testing may include a head MRI.

How Do Doctors Treat Delayed Puberty in Boys?

Delayed puberty does not always have to be treated. We treat if your son is bothered by his lack of pubertal signs. We treat delayed puberty by giving your son injections (shots) of testosterone just under the skin once a month. If he doesn’t start showing first signs of puberty after having injections for 6-12 months, then we will consider increasing the dose over time.

What Is the Outlook for My Son's Delayed Puberty?

Your son will typically do well if he has delayed puberty, but eventually starts showing signs of puberty on his own. Treatment with short-term testosterone injections will not affect his ability to enter puberty on his own. He will reach a normal adult height, have normal bone strength and show all of the physical signs of puberty. His chances of being fertile enough to have children in the future are also normal.

If your son has to have long-term testosterone injections, it might affect his chances of being fertile enough to have children in the future. If this happens, we can give special medications that might help when he reaches an appropriate age to have children.

How Can I Help My Son with Delayed Puberty?

You can reassure your son that these changes are not different from other children – they are just happening later. Your son might be self-conscious about these later changes. This is an important time to listen and respond to questions and concerns he might have. You should continue to treat your son appropriately for his age and continue to help him with self-esteem.