How Do Doctors Evaluate Delayed Puberty?

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

Your child might have an early morning blood test to help us measure your child’s hormone levels. Hormones, like estrogen, reach 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 pelvic ultrasound or head MRI.

What are the Differences Among Sex, Gender Expression and Gender Identity?

Sex, gender expression and gender identity might sound similar, but they are actually very different terms.

  • Sex refers to the biology (chromosomes [DNA], genitalia and hormones) that a person is born with.
  • Gender identity refers to how a person identifies, such as male, female, transgender or a number of other terms.
  • Gender expression refers to how a person expresses their gender through their appearance (clothing, hair, makeup, etc.), behavior, names, etc.

The language around gender changes all the time. If you are not sure what to call someone, just ask! Gender was once referred to as binary, or simply male and female. This is not true anymore. Gender is a spectrum and there are many terms a person can use to refer to their gender. Gender is also a lifelong process of self-discovery and expression.

At MGHfC, we welcome patients of all genders and sexes. If you have questions about gender and/or sex and how it relates to your child’s pubertal development, ask the care team.

Learn More