Failure to enter into puberty later than 14 years in boys is called delayed puberty. This time may vary in different people in different ways, like family history, race and culture, nutritional status, etc. Entering puberty will mean the appearance of beard, moustache, axillary, facial hair, enlargement of penis and testes.
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 called Testosterone.
Constitutional delay of growth and puberty is called late bloomers, they are normal but maturing late. They need to be identified and do not require specific treatment. One good clue, general physical growth is also delayed.
Malnutrition is a known cause as systemic chronic illness like Tuberculosis, Coeliac disease, Crohn’s disease, etc. Malabsorption syndrome of any cause can cause delay in growth and puberty.
The under production of Testosterone could be either because of problem in the pituitary gland or in the testes. If the problem lies in the pituitary gland less amount of LH and FSH are coming from top so Testes not able to make Testosterone, called hypogonadotrophic hypogonadism.
Any cause of high Prolactin like Prolactin secreting tumour can cause a similar problem.
If the problem is in the testes then despite Pituitary giving more and more LH and FSH, Testes can not produce Testosterone, called hypergonadotrophic hypogonadism.
They are: Kallaman’s syndrome: Sense of smell is also affected. Tumors of Pituitary gland or radiation in the region of the pituitary, rare Genetic issues can make Puberty delayed.
It is because of
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.
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 baseline 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.
Improving the nutrition in under nourished children is very important in that group. But if the problem is because of sex hormone deficiency then Testosterone can be replaced. We have four ways to give Testosterone, oral, injection, skin path or Implant.
Orally we do not prefer as it needs to be taken 4 times a day and in some cases it can cause liver side-effects. Patch, to be changed daily once, causes skin allergy in nearly 30% of people and it leaves pigmented patch in the area where you put.
Implants at this point are not available other than the UK and Australia, actually, a good way to replace Testosterone, it needs to be changed every six months.
We prefer intramuscular injection, to be given every 2 weeks, it is well-tolerated, chap and affordable.
We are at home for quite sometime now due to Covid 19 pandemic, trying our…
What is Trans fat? Trans fat is considered the worst type of fat we can…
As per the current practice in INDIA, when you are positive you will be in…
Red Bell Peppers Use bright bell peppers in Indian or continental cuisines to keep your…
What are sex hormones? Hormones which are secreted by the testis in males and ovaries…
How does Obesity worsen the general condition? Obesity is one of the major risk factors…