Editing Delayed puberty (section)

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| name = Delayed puberty
| synonyms = Late Puberty
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| causes = Genetic; Malnutrition
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'''Delayed puberty''' is when a person lacks or has incomplete development of specific [[sexual characteristics]] past the usual age of onset of [[puberty]].<ref name=":3" /> The person may have no physical or [[hormone|hormonal]] signs that puberty has begun. In the United States, girls are considered to have delayed puberty if they lack breast development by age 13 or have not started menstruating by age 15.<ref name=":3" /><ref name=":1" /> Boys are considered to have delayed puberty if they lack enlargement of the testicles by age 14.<ref name=":1">{{Cite book | first = Fred F | last = Ferri | name-list-style = vanc |title=Ferri's clinical advisor 2019 : 5 books in 1 |isbn=9780323550765 |oclc=1040695302| date = 2018-05-26 | publisher = Elsevier Health Sciences }}</ref> Delayed puberty affects about 2% of adolescents.<ref>{{cite journal | vauthors = Howard SR, Dunkel L | title = The Genetic Basis of Delayed Puberty | language = en | journal = Neuroendocrinology | volume = 106 | issue = 3 | pages = 283–291 | date = 2018 | pmid = 28926843 | doi = 10.1159/000481569 | s2cid = 4772278 | doi-access = free }}</ref><ref name=":11">{{cite journal | vauthors = Klein DA, Emerick JE, Sylvester JE, Vogt KS | title = Disorders of Puberty: An Approach to Diagnosis and Management | journal = American Family Physician | volume = 96 | issue = 9 | pages = 590–599 | date = November 2017 | pmid = 29094880 }}</ref>

Most commonly, puberty may be delayed for several years and still occur normally, in which case it is considered constitutional delay of growth and puberty, a common variation of healthy physical development.<ref name=":1" /> Delay of puberty may also occur due to various causes such as [[malnutrition]], various [[systemic disease]]s, or defects of the [[reproductive system]] ([[hypogonadism]]) or the body's responsiveness to [[sex hormone]]s.<ref name=":1" />

Initial workup for delayed puberty not due to a chronic condition involves measuring serum [[Follicle-stimulating hormone|FSH]], [[Luteinizing hormone|LH]], [[testosterone]]/[[estradiol]], as well as bone age radiography.<ref name=":11" /> If it becomes clear that there is a permanent defect of the reproductive system, treatment usually involves replacement of the appropriate hormones ([[testosterone]]/[[dihydrotestosterone]] for boys,<ref name="pmid11600557">{{cite journal | vauthors = Saad RJ, Keenan BS, Danadian K, Lewy VD, Arslanian SA | title = Dihydrotestosterone treatment in adolescents with delayed puberty: does it explain insulin resistance of puberty? | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 86 | issue = 10 | pages = 4881–6 | date = October 2001 | pmid = 11600557 | doi = 10.1210/jcem.86.10.7913 | s2cid = 24606172 | doi-access = free }}</ref> [[estradiol]] and [[progesterone]] for girls).<ref name=":6" />