Puberty Disorders

Precocious Puberty, Delayed Puberty, and Other Disorders

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Puberty is the time when a child’s body matures and prepares to become capable of reproducing. Sometimes, these changes don't occur as they should, or they may occur too early or too late. Our pediatric endocrinologists work to discover the cause of concerns about your child's puberty and develop a customized treatment plan. We offer a full range of services to maintain your child’s health and well-being as they develop into adulthood.

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What are Puberty Disorders?

Precocious Puberty
Puberty that begins too early, typically before age 8 in boys and 9 in girls.

Premature Development
Conditions in which specific areas develop without other signs of puberty, such as isolated breast development (premature thelarche), pubic hair (premature adrenarche), or the start of menstrual periods (premature menarche).

Delayed Puberty
Delayed puberty can be caused by hormone deficiencies or by chronic illnesses such as diabetes, inflammatory bowel disease, cystic fibrosis, and kidney disease.

Turner or Klinefelter Syndromes
Genetic disorders that disrupt puberty, such as Turner or Klinefelter syndromes.

Other Conditions
Other conditions that can arise during puberty, such as polycystic ovary syndrome (menstrual irregularity, excess hair growth, acne, and obesity in girls) and gynecomastia (breast development in boys).

Gender Identity Concerns
Gender identity concerns that may appear or intensify as your child approaches adolescence.

Our Locations

Duke Health offers locations throughout the Triangle. Find one near you.


Your pediatric endocrinologist will explain your child’s condition, discuss possible treatment options, and let you know what you and your child can expect during treatment. Hormone therapies may require multiple office visits, so our clinical administrator will help coordinate appointments and assist you with the insurance process.

Hormone Suppression Therapy

Early puberty can be slowed or stopped with medicine that keeps the pituitary gland from producing certain hormones. Your child may get injections every few months, or a surgical implant that blocks hormones for a year. The implant is a small, flexible tube of medicine that a surgeon inserts just under the skin through a tiny incision. This can be done in your doctor’s office using local anesthesia. The implant can be replaced after a year or removed at any time, depending on your child’s care plan. Your doctor will discuss your options and help you decide what’s right for your child. 

Hormone Replacement Therapy

Delayed puberty caused by a hormone deficiency is treated with replacement of sex hormones. This may include oral hormone replacement taken by mouth, patches placed on the skin, or regular injections.  Your care team will explain the hormone that’s involved. You’ll learn what to expect, and how often your child will need treatment.

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Your pediatric endocrinologist will examine your child and evaluate their physical growth and health history. The evaluation may show that your child is simply developing at a different rate than their peers. Or it may reveal a condition that requires care. Our pediatric endocrinologists will recommend tests to diagnose your child's condition, and a treatment plan to promote your child’s health and prepare them to enter young adulthood.

Blood and Urine Tests

Check hormone levels and other information about your child’s health. 

Bone-Age X-Ray

X-rays of the hand and wrist show the maturity of your child’s skeletal system. It’s a painless test that uses minimal radiation. It can help predict how much your child will grow, when they'll enter puberty, and how tall they'll be.

MRI of the Brain

May be ordered if your doctor suspects a pituitary gland problem.


This imaging technique uses sound waves to look at your child's reproductive organs.

Best Children's Hospital in NC

Duke Children's Hospital & Health Center is proud to be nationally ranked in 10 pediatric specialties.

Why Choose Duke

A Team of Specialists
We work closely with other specialists to deliver comprehensive care. We carefully evaluate your child to determine the cause of their puberty disorder and customize their treatment. Our pediatric endocrinologists work closely with specialists in pediatrics, gynecology, urology, surgery, and other areas to make sure your child gets complete care.

Latest Treatments, Access to Cutting-Edge Research
Your child will receive the latest treatments from doctors who are on the leading edge of adolescent medicine. Our pediatric endocrinologists are also researchers who are helping to advance care for children with puberty disorders.