Delayed Puberty in Boys

1. What is delayed puberty?

Failure to enter into puberty later than 16 years is called delayed puberty.

2. What are the causes of delayed puberty?

These can be divided into general causes and specific causes. Constitutional delay of growth and puberty, chronic childhood diseases and under nutrition are the general causes. The specific causes are related to under production of sex hormones.

3. What the problems related to sex hormone production?

The under production of sex hormones could be either because of problem in the pituitary gland or in the testes. If the problem lies in the pituitary gland then it is called hypogonadotrophic hypogonadism. If the problem is in the testes then it is called hypergonadotrophic hypogonadism.

4. What are the causes for the hypogonadotrophic hypogonadism?

They are:

  1. Kallaman’s syndrome: Sense of smell is also affected
  2. Tumors or radiation in the region of pituitary
  3. Genetic problem

5. Why does hypergonadotrophic hypogonadism happen?

It is because of

  1. Klinefelter’s syndrome
  2. Destruction of testes because of local radiotherapy, chemotherapy, testicular torsion, infection.

6. What are the features of delayed puberty?

The boys fail to develop facial hair i.e. beard and mustache, fail to experience pubertal growth spurt and their testes and penis also fail to enlarge.

7. What tests are done to know the cause?

The doctor orders for several hormones and scans. Some are done after giving stimulating hormones. LH and FSH, the two pituitary hormones responsible for stimulating testes to secrete the male sex hormone – Testosterone, are measured at base line and post GnRH injection. Blood levels of testosterone at base line and after hCG injection are done. To detect the genetic defect karyotyping is done. This test tells about the genetic makeup of the individual. MRI scan of the brain and/or abdomen are also done.

8. How to treat these patients?

Improving the nutrition in under nourished children is very important in that group. But if the problem is because of sex hormone deficiency then Inj. Testoviron can be given. To begin with the physician gives a small dose and then he increases it to reach 250mg every 4 weeks.

This article is prepared by Dr Rajiv Joshi
( and Dr A Bhattacharyya