Puberty is considered delayed if there is no sign of increase in testicular volume by the age of 14 years. In girls, puberty is considered delayed if there is no sign of breast bud development by the age of 14 years.
The most common cause of delayed puberty in both boys and girls is constitutional delay in growth and puberty(CDGP). It is a genetically determined condition that is poorly characterized.
Delayed puberty is okay, because it usually does not result in reduction of final height. It does however interfere with the participation of growing children in competitive sports. If children who are playing competitive sports have delayed puberty it does present as abnormal or abnormally low physical performance and capacity which can cause distress to the children. Girls generally do not have psychological issues due to delay in puberty, whereas boys can get some psychological distress due to delay in pubertal signs.
If your child is short or not growing well it makes sense to monitor their height and keep a regular follow-up. If there are features in boys like a small appearing penis or gynaecomastia in the pre-pubertal age group that is less than 9 years of age, it is better to take the child for evaluation by an Endocrinologist.
Delayed puberty is not associated with any endocrine dysfunction which is permanent; it does not usually result in a short final height.
The best doctor for treating delayed puberty is usually an Endocrinologist. Both adult and pediatric endocrinologists are usually well versed in management of delayed puberty
In order to establish a diagnosis of delayed puberty both gonadotropin levels that is LH and FSH; testosterone in boys; estrogen in girls; T4 and TSH are tested.
A diagnosis of delayed puberty is made with the help of laboratory test, physical examination and x-ray for bone age. If there is a strong suspicion of a serious endocrine disorder like hypogonadotropic hypogonadism, children are usually tested with a gonadotropin stimulation test with a GNRH receptor agonist -This is a specialized test which will help us identify what is the problem that the child is facing and this is likely to improve on its own or it may be a permanent deficiency of pubertal development due to certain genetic defects (hypogonadotropic hypogonadism).