Delayed puberty (male)

Causes

Appropriate Tests

 

Defined as absence of initiation of secondary sexual development by 14 years.

Cessation of pubertal development may occur in some disorders.

History including family history; physical examination including tests of olfaction; assessment of bone age; Luteinising hormone, Follicle stimulating hormone, Prolactin, Thyroid stimulating hormone, Testosterone, Dehydroepiandrosterone sulphate (DHEA sulphate). See also Testicular failure

Constitutional delay

Gonadotrophin releasing hormone stimulation test (consult pathologist): if the boy is within 6 months of spontaneous puberty, the response to the test will be pubertal, rather than prepubertal.

Hypogonadotrophic / Hypogonadism

See Pituitary/hypothalamic disorders.

Gonadotrophin releasing hormone deficiency

 

  • Kallmann syndrome

 

Hypopituitarism / Hypothyroidism

 

Hypergonadotrophic / Hypogonadism

Primary testicular failure.

Chromosomal abnormality

 

  • Klinefelter syndrome

Usually impaired progression of puberty.

Testicular functional damage

 

  • Viral orchitis

 

  • Cytotoxic drugs/irradiation

 

  • Tumour

See Testicular mass

  • Vanishing testis syndrome

 

Severe chronic illness

Severe nutritional deficiency, including

 

  • Anorexia nervosa

 

  • Gross zinc deficiency

Zinc.