What next: Boy fathers?
puberty
puberty resource and reference pages for parents
This section of FatherMag.com is intended as a resource for parents who want to learn more about how puberty progresses. Often, questions arise because a suggestion has been made to accelerate or delay the rate of puberty in a child whose body is perceived to be changing into that of an adult too early or too late.
The sexualization of childhood: Do parents have to accept early puberty? In a word, no. Safe and effective means to control the onset of puberty have been available for thirty years. Many parents would exercise this control, but they usually fail to recognize the signs before it is too late.
Adrenogenital symptoms such as rapid growth, body odor, underarm hair and pubic hair are signals of an already advanced stage of adrenarche, which precedes the onset of true central puberty. The mildest therapies to control the onset of puberty are available early in this adrenarche phase, long before true central puberty begins.
In girls, Herman-Giddens, et al found puberty to be occurring at a much earlier age than just a few years ago.[1] Adolescent boys seem to be completing puberty at the usual age, but in younger boys (eight to twelve years of age), sexual characteristics are evident at a profoundly earlier age (Tanner stage 2 in up to 58.2% of nine-year-old boys versus 0.62% a few years ago).[2] This change to an earlier puberty is quite literally the sexualization of childhood in a physical sense. Accelerated pubertal timing occurs most frequency in those population groups at the bottom of the economic scale, in contrast to the once held notion that all early puberty results from "good nutrition."
The visible markers of sexual maturation are a slow and lagging indicator of high sex hormone levels in the bloodstream. In order to morph a child's body into one with adult sexual markers, internally produced sex steroids must usually build at heightened levels for several years. This buildup of adult sex hormones in a child's blood occurs long before the first outward signs are recognized by the untrained eye of parents. Because of this time lag parents usually underestimate the brewing steroid power that lies behind the first visible changes of pubescence.
Whether due to the effect of endocrine disruptors or other causes, early or late puberty can be emotionally difficult. Yet the issues here not just ones of convenience. There are genuine health concerns, and most parents of children with early puberty are so late in seeking treatment that irreversible damage is done to their child's health.
The damage caused by early puberty is not just physical. Very young children lack the socialization and self restraint that we expect of older children. No matter what you tell them, young children tend to judge things by the concept that whatever FEELS good, IS good. A young child filled with adult levels of sex hormones easily becomes involved in sexually charged situations that an older and more emotionally mature adolescent would avoid.
Health effects associated with early puberty in girls:
- greater lifelong risk of breast cancer, metabolic syndrome X, PCOS
- age inappropriate behavior, skin acne, hirsutism
- greater risk of becoming willingly involved in incest and other illicit sexual encounters
- by attracting the attention of older males, fertile young girls may also be more at risk of becoming the victim of a forced sexual encounter
- premature risk of pregnancy and sexually transmitted disease (STD)
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In addition, many of the risks that boys face (listed below) also apply to girls.
Assessment of pubertal status
In girls, the formation of breast buds is normally the earliest indicator of sexual maturation. In the absence of breast buds, early pubic hair may be a sign of adrenarche rather than true puberty.
Tanner staging: girls
Health effects associated with early puberty in boys:
- early virilization, resulting in a greater lifelong risk of testicular cancer
- problems due to lack of self-control: the combination of testosterone and social immaturity may make it difficult or impossible for the child to control his own behavior
- greatly increased risks of academic failure/expulsion, incarceration, alcohol and other drug abuse, accident, suicide
- age inappropriate sexual behavior leads to illicit sexual involvements with other children and adults
- increased legal and medical risks, including paternity/child support liabilities, STDs
- the behavioral effect of high androgen levels in young boys is sometimes diagnosed as attention deficit hyperactivity disorder ADD/ADHD
- and in the most extreme cases (such as full adult sex hormone levels in a boy less than ten years old):
- very early puberty will produce a tall child who abruptly ceases growth before reaching adult height; this condition is untreatable once the bone growth plates close.
- particularly in boys, very early puberty should always be investigated carefully, as it sometimes indicates the presence of a brain tumor or other serious disease
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In addition, many of the risks that girls face (listed previously) also apply to boys.
Assessment of pubertal status
In boys, an increase in testicular volume is normally the earliest indicator of sexual maturation, though in the absence of testicular enlargement, the first traces of pubic hair may be a sign of adrenarche which is soon followed by true puberty.
Tanner staging: boys
In mail to FatherMag.com, parents complain of doctors who try to put a "they're just growing up early" spin on early puberty. By delaying treatment, or by withholding medical treatment from all but the most extreme cases, some medical professionals may leave parents with psychotherapy as the only means to help their children cope with the excesses of early puberty.
Once a sympathetic physician is found, treatment may still be delayed by a long sequence of testing and case assessment. Meanwhile, irreversible changes are left to advance in children who are years away from being ready to cope with adult sexual characteristics. To be effective, treatment must be applied early, before the HPG axis is triggered into starting the production of hormones that will lead to full central puberty and adult sexual characteristics. Unfortunately, many parents do not realize that adult hormones are rising until is too late to prevent activation of the HPG axis. GNRH analogs have been effective as the traditional puberty blockers, but kisspeptin antagonists show promise as perhaps opening new treatment options that are both easy to implement and effective.
Ref.:
- Herman-Giddens ME, Slora EJ, Wasserman RC, et al.
Secondary sexual characteristics and menses in young girls seen in office practice: a study from the Pediatric Research in Office Settings network.
Pediatrics.
1997;99:505-512.
- Herman-Giddens ME, Wang L, Koch G.
Secondary sexual characteristics in boys: estimates from the National Health and Nutrition Examination Survey III, 1988-1994.
Arch Pediatr Adolesc Med.
2001;155:1022-1028
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