Hello and welcome to the Zero to Finals podcast. My name is Tom and in this episode I'm going to be

talking to you about delayed puberty. And if you want to follow along with written notes on this topic,

you can follow along at zero tofinals.com slash delayed puberty or in the development section of the

zero to finals pediatrics book.

So let's get straight into it.

Firstly, let's talk about normal puberty.

Puberty starts aged 8 to 14 in girls and 9 to 15 in boys.

It takes about four years from start to finish.

Girls have their pubertal growth butt earlier in puberty than boys.

In girls, puberty starts with the development of breast buds, then pubic hair, and finally

starting menstrual periods around two years from the start of puberty.

In boys, puberty starts with enlargement of the testicles,

then the penis, gradual darkening of the scrotum, development of pubic hair, and deepening of voice.

The tanner scale can be used to determine the pubertal stage based on the examination findings of sexual characteristics.

Let's start talking about delayed puberty.

Firstly, we need to talk about hypogonadism.

Hypogonadism refers to a lack of the sex hormones, estrogen and testosterone.

And these sex hormones normally rise prior to and during puberty.

A lack of these sex hormones causes a delay in puberty.

This is fundamentally due to one of two reasons.

Hypogonadotrophic hypogonadism, where there's a deficiency in LH and FSAH, and

hypergonadotrophic hypogonadism, where there's a lack of response to LH and FSAH by the gonads,

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