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Puberty is the process of physical changes through which a
child A child () is a human being between the stages of childbirth, birth and puberty, or between the Development of the human body, developmental period of infancy and puberty. The term may also refer to an unborn human being. In English-speaking ...
's body matures into an adult body capable of
sexual reproduction Sexual reproduction is a type of reproduction that involves a complex life cycle in which a gamete ( haploid reproductive cells, such as a sperm or egg cell) with a single set of chromosomes combines with another gamete to produce a zygote tha ...
. It is initiated by hormonal signals from the
brain The brain is an organ (biology), organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It consists of nervous tissue and is typically located in the head (cephalization), usually near organs for ...
to the
gonad A gonad, sex gland, or reproductive gland is a Heterocrine gland, mixed gland and sex organ that produces the gametes and sex hormones of an organism. Female reproductive cells are egg cells, and male reproductive cells are sperm. The male gon ...
s: the
ovaries The ovary () is a gonad in the female reproductive system that produces ova; when released, an ovum travels through the fallopian tube/oviduct into the uterus. There is an ovary on the left and the right side of the body. The ovaries are endocr ...
in a female, the
testicle A testicle or testis ( testes) is the gonad in all male bilaterians, including humans, and is Homology (biology), homologous to the ovary in females. Its primary functions are the production of sperm and the secretion of Androgen, androgens, p ...
s in a male. In response to the signals, the gonads produce hormones that stimulate libido and the growth, function, and transformation of the brain,
bone A bone is a rigid organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red and white blood cells, store minerals, provide structure and support for the body, ...
s,
muscle Muscle is a soft tissue, one of the four basic types of animal tissue. There are three types of muscle tissue in vertebrates: skeletal muscle, cardiac muscle, and smooth muscle. Muscle tissue gives skeletal muscles the ability to muscle contra ...
, blood,
skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other animal coverings, such as the arthropod exoskeleton, have different ...
,
hair Hair is a protein filament that grows from follicles found in the dermis. Hair is one of the defining characteristics of mammals. The human body, apart from areas of glabrous skin, is covered in follicles which produce thick terminal and ...
,
breast The breasts are two prominences located on the upper ventral region of the torso among humans and other primates. Both sexes develop breasts from the same embryology, embryological tissues. The relative size and development of the breasts is ...
s, and
sex organ A sex organ, also known as a reproductive organ, is a part of an organism that is involved in sexual reproduction. Sex organs constitute the primary sex characteristics of an organism. Sex organs are responsible for producing and transporting ...
s. Physical growth—height and weight—accelerates in the first half of puberty and is completed when an adult body has been developed. Before puberty, the external sex organs, known as primary sexual characteristics, are sex characteristics that distinguish males and females. Puberty leads to
sexual dimorphism Sexual dimorphism is the condition where sexes of the same species exhibit different Morphology (biology), morphological characteristics, including characteristics not directly involved in reproduction. The condition occurs in most dioecy, di ...
through the development of the secondary sex characteristics, which further distinguish the sexes. On average, females begin puberty at age 10½ and complete puberty at ages 15-17; males begin at ages 11½-12 and complete puberty at ages 16-17. The major landmark of puberty for females is
menarche Menarche ( ; ) is the first menstrual cycle, or first menstruation, menstrual bleeding, in female humans. From both social and medical perspectives, it is often considered the central event of female puberty, as it signals the possibility of fe ...
, the onset of menstruation, which occurs on average around age 12½. For males, first
ejaculation Ejaculation is the discharge of semen (the ''ejaculate''; normally containing sperm) from the penis through the urethra. It is the final stage and natural objective of male sexual stimulation, and an essential component of natural conception. ...
, spermarche, occurs on average at age 13. In the 21st century, the average age at which children, especially females, reach specific markers of puberty is lower compared to the 19th century, when it was 15 for females and 17 for males (with age at first periods for females and voice-breaks for males being used as examples). This can be due to any number of factors, including improved nutrition resulting in rapid body growth, increased weight and fat deposition, or exposure to endocrine disruptors such as xenoestrogens, which can at times be due to food consumption or other environmental factors. However, more modern archeological research suggests that the rate of puberty as it occurs now is the intended way. Growth spurts began at around 10-12, but markers of later stages of puberty such as menarche had delays that correlated with severe environmental conditions such as poverty, poor nutrition, and air pollution. Puberty that starts earlier than usual is known as precocious puberty, and puberty which starts later than usual is known as
delayed puberty Delayed puberty is when a person lacks or has incomplete development of specific sexual characteristics past the usual age of onset of puberty. The person may have no physical or hormone, hormonal signs that puberty has begun. In the United States ...
. Notable among the morphologic changes in size, shape, composition, and functioning of the pubertal body, is the development of secondary sex characteristics, the "filling in" of the child's body; from girl to woman, from boy to man. Derived from the
Latin Latin ( or ) is a classical language belonging to the Italic languages, Italic branch of the Indo-European languages. Latin was originally spoken by the Latins (Italic tribe), Latins in Latium (now known as Lazio), the lower Tiber area aroun ...
' (age of maturity), the word ''puberty'' describes the physical changes to sexual maturation, not the psychosocial and cultural maturation denoted by the term ''adolescent development'' in
Western culture Western culture, also known as Western civilization, European civilization, Occidental culture, Western society, or simply the West, refers to the Cultural heritage, internally diverse culture of the Western world. The term "Western" encompas ...
, wherein
adolescence Adolescence () is a transitional stage of human Developmental biology, physical and psychological Human development (biology), development that generally occurs during the period from puberty to adulthood (typically corresponding to the age o ...
is the period of mental transition from childhood to adulthood, which overlaps much of the body's period of puberty.


Differences between male and female puberty

Two of the most significant differences between puberty in females and puberty in males are the age at which it begins, and the major sex steroids involved, the
androgen An androgen (from Greek ''andr-'', the stem of the word meaning ) is any natural or synthetic steroid hormone that regulates the development and maintenance of male characteristics in vertebrates by binding to androgen receptors. This includes ...
s and the
estrogen Estrogen (also spelled oestrogen in British English; see spelling differences) is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three ...
s. Although there is a wide range of normal ages, females typically begin the process of puberty around age 10½; males at ages 11½—12. Puberty generally ends between 15—17 for females and 16–17 for males. Females attain reproductive maturity about four years after the first physical changes of puberty appear. In contrast, males accelerate more slowly but continue to grow for about six years after the first visible pubertal changes.Garn, SM. Physical growth and development. In: Friedman SB, Fisher M, Schonberg SK., editors. Comprehensive Adolescent Health Care. St Louis: Quality Medical Publishing; 1992. Retrieved on 2009-02-20 For males, the
androgen An androgen (from Greek ''andr-'', the stem of the word meaning ) is any natural or synthetic steroid hormone that regulates the development and maintenance of male characteristics in vertebrates by binding to androgen receptors. This includes ...
testosterone Testosterone is the primary male sex hormone and androgen in Male, males. In humans, testosterone plays a key role in the development of Male reproductive system, male reproductive tissues such as testicles and prostate, as well as promoting se ...
is the principal sex hormone; while testosterone is produced, all males' changes are characterized as virilization. A substantial product of testosterone metabolism in males is the
estrogen Estrogen (also spelled oestrogen in British English; see spelling differences) is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three ...
estradiol. The conversion of testosterone to estradiol depends on the amount of body fat and estradiol levels in males are typically much lower than in females. The male "growth spurt" also begins later, accelerates more slowly, and lasts longer before the epiphyses fuse. Although males are on average shorter than females before puberty begins, adult men are on average about taller than women. Most of this sex difference in adult heights is attributable to a later onset of the growth spurt and a slower progression to completion, a direct result of the later rise and lower adult male levels of estradiol. The hormonal maturation of females is considerably more complicated than in males. The main steroid hormones, testosterone, estradiol, and progesterone as well as prolactin play important physiological functions in puberty. The production of gonadal steroids in females starts with production of testosterone, which is typically quickly converted to estradiol inside the ovaries. However the rate of conversion from testosterone to estradiol (driven by FSH/LH balance) during early puberty is highly individual, resulting in very diverse development patterns of secondary sexual characteristics. Production of progesterone in the ovaries begins with the development of ovulatory cycles in females (during the lutheal phase of the cycle), before puberty low levels of progesterone are produced in the adrenal glands of both males and females. Estradiol levels rise earlier and reach higher levels in women than in men. While estradiol promotes growth of the breasts and
uterus The uterus (from Latin ''uterus'', : uteri or uteruses) or womb () is the hollow organ, organ in the reproductive system of most female mammals, including humans, that accommodates the embryonic development, embryonic and prenatal development, f ...
, it is also the principal hormone driving the pubertal growth spurt and epiphyseal maturation and closure.


Puberty onset

Puberty is preceded by
adrenarche Adrenarche is an early stage in sexual maturation that happens in some higher primates (including humans), typically peaks at around 20 years of age, and is involved in the development of pubic hair, body odor, skin oiliness#Oily skin, skin oiline ...
, marking an increase of adrenal androgen production between ages 6–10. Adrenarche is sometimes accompanied by the early appearance of axillary and pubic hair. The first androgenic hair resulting from adrenarche can be also transient and disappear before the onset of true puberty. The onset of puberty is associated with high GnRH pulsing, which precedes the rise in sex hormones, LH and FSH. Exogenous GnRH pulses cause the onset of puberty. Brain tumors which increase GnRH output may also lead to premature puberty. The cause of the GnRH rise is unknown.
Leptin Leptin (from Ancient Greek, Greek λεπτός ''leptos'', "thin" or "light" or "small"), also known as obese protein, is a protein hormone predominantly made by adipocytes (cells of adipose tissue). Its primary role is likely to regulate long ...
might be the cause of the GnRH rise. Leptin has receptors in the hypothalamus which synthesizes GnRH. Individuals who are deficient in leptin fail to initiate puberty. The levels of leptin increase with the onset of puberty, and then decline to adult levels when puberty is completed. The rise in GnRH might also be caused by genetics. A study discovered that a mutation in genes encoding both neurokinin B as well as the neurokinin B receptor can alter the timing of puberty. The researchers hypothesized that neurokinin B might play a role in regulating the secretion of kisspeptin, a compound responsible for triggering direct release of GnRH as well as indirect release of LH and FSH.


Effects of early and late puberty onset

Several studies about puberty have examined the effects of an early or a late onset of puberty in males and females. In general, females who enter puberty late experience positive outcomes in adolescence and adulthood, while females who enter puberty early experience negative outcomes. Males who have earlier pubertal timing generally have more positive outcomes in adulthood but more negative outcomes in adolescence, while the reverse is true for later pubertal timing.


Females

Outcomes have generally indicated that early onset of puberty in females can be psychologically damaging. The main reason for this detrimental effect is the issue of body image. As they physically develop, gaining weight in several areas of the body, early-maturing females usually look larger than females who have not yet entered puberty. A result of the social pressure to be thin, the early-maturing females develop a negative view of their body image. In addition, people may tease the females about their visible breasts, forcing the early-maturing female to hide her breasts by dressing differently. Embarrassment about a more developed body may also result in the refusal to undress for gym. These experiences lead to lower self-esteem, more depression and poorer body image in these early-maturing females. Furthermore, as physical and emotional differences set them apart from people in their same age group, early-maturing females develop relationships with older people. For instance, some early-maturing females have older malefriends, "attracted to the females' womanly physique and femaleish innocence." While having an older malefriend might improve popularity among peers, it also increases the risk of alcohol and drug use, increased sexual relations (often unprotected), eating disorders and bullying. Generally, later onset of puberty in females produces positive outcomes. They exhibit positive behaviors in adolescence that continue to adulthood.


Males

In the past, early onset of puberty in males has been associated with positive outcomes, such as leadership in high school and success in adulthood. However, recent studies have revealed that the risks and problems of early maturation in males might outweigh the benefits. Early-maturing males develop "more aggressive, law-breaking, and alcohol abusing" behaviors, which result in anger towards parents and trouble in school and with the police. Early puberty also correlates with increased sexual activity and a higher instance of teenage pregnancy, both of which can lead to depression and other psychosocial issues. On the other hand, late-maturing males develop lower self-esteem and confidence and generally have lower popularity among peers, due to their less-developed physiques. Also, they experience problems with anxiety and depression and are more likely to be afraid of sex than other males.


Changes in males

In males, puberty begins with the enlargement of the testicles and scrotum. The penis also increases in size, and a male develops pubic hair. A male's testicles also begin making
sperm Sperm (: sperm or sperms) is the male reproductive Cell (biology), cell, or gamete, in anisogamous forms of sexual reproduction (forms in which there is a larger, female reproductive cell and a smaller, male one). Animals produce motile sperm ...
. The release of
semen Semen, also known as seminal fluid, is a bodily fluid that contains spermatozoon, spermatozoa which is secreted by the male gonads (sexual glands) and other sexual organs of male or hermaphrodite, hermaphroditic animals. In humans and placen ...
, which contains sperm and other fluids, is called
ejaculation Ejaculation is the discharge of semen (the ''ejaculate''; normally containing sperm) from the penis through the urethra. It is the final stage and natural objective of male sexual stimulation, and an essential component of natural conception. ...
. During puberty, a male's erect penis becomes capable of ejaculating semen and impregnating a female. A male's first ejaculation is an important milestone in his development. On average, a male's first ejaculation occurs at age 13. Ejaculation sometimes occurs during sleep; this phenomenon is known as a nocturnal emission.


Testicular size

In males, testicular enlargement is the first physical manifestation of puberty (and is termed gonadarche). Testes in prepubertal males change little in size from about 1 year of age to the onset of puberty, averaging about 2–3 cm in length and about 1.5–2 cm in width. The size of the testicles is among the parameters of the Tanner scale for male genitals, from stage I which represents a volume of less than 1.5 ml, to stage V which represents a testicular volume of greater than or equal to 20 ml. Testicular size reaches maximal adult size about 6 years after the onset of puberty. While 18–20 cm3 is an average adult size, there is wide variation in testicular size in the normal population. After the male's testicles have enlarged and developed for about one year, the length and then the breadth of the shaft of the
penis A penis (; : penises or penes) is a sex organ through which male and hermaphrodite animals expel semen during copulation (zoology), copulation, and through which male placental mammals and marsupials also Urination, urinate. The term ''pen ...
will increase and the
glans penis In male human anatomy, the glans penis or penile glans, commonly referred to as the glans, (; from Latin ''glans'' meaning "acorn") is the bulbous structure at the Anatomical terms of location#Proximal and distal, distal end of the human penis ...
and corpora cavernosa will also start to enlarge to adult proportions.


Erections

Erection An erection (clinically: penile erection or penile tumescence) is a Physiology, physiological phenomenon in which the penis becomes firm, engorged, and enlarged. Penile erection is the result of a complex interaction of psychological, neural, ...
s during sleep or when waking up are medically known as nocturnal penile tumescence and colloquially referred to as ''morning wood''. The penis can regularly get erect during sleep and men or males often wake up with an erection. Once a male reaches his teenage years, erections occur much more frequently due to puberty. Erections can occur spontaneously at any time of day, and if clothed may cause a bulge or "hump". This can be disguised or hidden by wearing close-fitting underwear, a long shirt and baggier clothes. Erections are common for male prepubescent children and infants, and can even occur before birth. Spontaneous erections, also known as involuntary or unwanted erections, are normal. Such erections can be embarrassing if they happen in public, such as a classroom or living room.


Foreskin retraction

During puberty, if not before, the tip and opening of a male's
foreskin In male Human body, human anatomy, the foreskin, also known as the prepuce (), is the double-layered fold of Human skin, skin, Mucous membrane, mucosal and Muscle tissue, muscular tissue at the distal end of the human penis that covers the glans ...
becomes wider, progressively allowing for retraction down the shaft of the
penis A penis (; : penises or penes) is a sex organ through which male and hermaphrodite animals expel semen during copulation (zoology), copulation, and through which male placental mammals and marsupials also Urination, urinate. The term ''pen ...
and behind the glans, which ultimately should be possible without pain or difficulty. The membrane that bonds the inner surface of the foreskin with the glans disintegrates and releases the foreskin to separate from the glans. The foreskin then gradually becomes retractable. Research by Øster (1968) found that with the onset and continuation of puberty, the proportion of males able to pull back their foreskins increased. At ages 12–13, Øster found that only 60% of males were able to retract their foreskins; this increased to 85% by ages 14–15, and 95% by 16–17. He also found that 1% of those unable to fully retract experienced phimosis at ages 14–17, the remainder were partially able to. The findings were supported by further research by Kayaba ''et al'' (1996) on a sample of over 600 males, and Ishikawa and Kawakita (2004) found that by age 15, 77% of their sample of males could retract their foreskins. Beaugé (1997) reports that males may assist the development of retractile foreskin by manual stretching. Once a male is able to retract his foreskin, penile hygiene should become an important feature of his routine body care. Although the
American Academy of Pediatrics The American Academy of Pediatrics (AAP) is the largest professional association of pediatricians in the United States. It is headquartered in Itasca, Illinois, and maintains an office in Washington, D.C. The AAP has published hundreds of poli ...
states there is "little evidence to affirm the association between circumcision status and optimal penile hygiene", various studies suggest that males be educated about the role of hygiene, including retracting the foreskin while urinating and rinsing under it and around the glans at each bathing opportunity. Regular washing under the foreskin was found by Krueger and Osborn (1986) to reduce the risk of numerous penile disorders, however Birley et al. (1993) reports excessive washing with soap should be avoided because it dries the oils out of the tissues and can cause non-specific dermatitis.


Body and facial hair

In the months and years following the appearance of pubic hair, other areas of skin that respond to androgens may develop androgenic hair. The usual sequence is: underarm (axillary) hair, perianal hair, upper lip hair, sideburn (preauricular) hair, periareolar hair, and the beard area. As with most human biological processes, this specific order may vary among some individuals. Arm, leg, chest, abdominal, and back hair become heavier more gradually. There is a large range in amount of body hair among adult men, and significant differences in timing and quantity of hair growth among different racial groups. Facial hair is often present in late adolescence, but may not appear until significantly later. Facial hair will continue to get coarser, darker and thicker for another 2–4 years after puberty. Some men do not develop full facial hair for up to 10 years after the completion of puberty.


Voice change and Adam's apple

Under the influence of androgens, the
larynx The larynx (), commonly called the voice box, is an organ (anatomy), organ in the top of the neck involved in breathing, producing sound and protecting the trachea against food aspiration. The opening of larynx into pharynx known as the laryngeal ...
(or voice box) grows in both sexes. This growth is far more prominent in males, causing the male voice to drop and deepen, sometimes abruptly but rarely "overnight", about one
octave In music, an octave (: eighth) or perfect octave (sometimes called the diapason) is an interval between two notes, one having twice the frequency of vibration of the other. The octave relationship is a natural phenomenon that has been referr ...
, because the longer and thicker
vocal folds In humans, the vocal cords, also known as vocal folds, are folds of throat tissues that are key in creating sounds through Speech, vocalization. The length of the vocal cords affects the pitch of voice, similar to a violin string. Open when brea ...
have a lower
fundamental frequency The fundamental frequency, often referred to simply as the ''fundamental'' (abbreviated as 0 or 1 ), is defined as the lowest frequency of a Periodic signal, periodic waveform. In music, the fundamental is the musical pitch (music), pitch of a n ...
. Before puberty, the larynx of males and females is about equally small.


Changes in females


Breast development

The first physical sign of puberty in females is usually a firm, tender lump under the center of the areola of one or both
breast The breasts are two prominences located on the upper ventral region of the torso among humans and other primates. Both sexes develop breasts from the same embryology, embryological tissues. The relative size and development of the breasts is ...
s, occurring on average at about 10½ years of age. This is referred to as
thelarche Thelarche, also known as breast budding, is the onset of secondary breast development, often representing the beginning of pubertal development. It is the stage at which male and female breasts differentiate due to variance in hormone levels; howe ...
. By the widely used Tanner staging of puberty, this is stage 2 of breast development (stage 1 is a flat, prepubertal breast). Within 6–12 months, the swelling has clearly begun in both sides, softened, and can be felt and seen extending beyond the edges of the areolae. This is stage 3 of breast development. By another 12 months (stage 4), the breasts are approaching mature size and shape, with areolae and
nipple The nipple is a raised region of tissue on the surface of the breast from which, in lactating females, breast milk, milk from the mammary gland leaves the body through the lactiferous ducts to Breastfeeding, nurse an infant. The milk can flow th ...
s forming a secondary mound. In most young women, this mound disappears into the contour of the mature breast (stage 5), although there is so much variation in sizes and shapes of adult breasts that stages 4 and 5 are not always separately identifiable.


Pubic hair

Pubic hair Pubic hair (or pubes , ) is terminal hair, terminal body hair that is found in the sex organ, genital area and pubic region of adolescent and adult humans. The hair is located on and around the sex organs, and sometimes at the top of the inside ...
is often the second noticeable change in puberty, usually within a few months of thelarche. It is referred to as
pubarche Pubarche () refers to the first appearance of pubic hair at puberty. It is one of the earliest physical changes of puberty and can occur independently of complete puberty. It is usually the second sign of puberty, after thelarche in females and gon ...
. The pubic hairs are usually visible first along the labia. The first few hairs are described as Tanner stage 2. Stage 3 is usually reached within another 6–12 months, when the hairs are too numerous to count and appear on the pubic mound as well. By stage 4, the pubic hairs densely fill the "pubic triangle". Stage 5 refers to spread of pubic hair to the thighs and sometimes as abdominal hair upward towards the
navel The navel (clinically known as the umbilicus; : umbilici or umbilicuses; also known as the belly button or tummy button) is a protruding, flat, or hollowed area on the abdomen at the attachment site of the umbilical cord. Structure The u ...
. In about 15% of females, the earliest pubic hair appears before breast development begins.


Vagina, uterus, ovaries

Perineal skin keratinizes due to effect of estrogen increasing its resistance to infection. The mucosal surface of the
vagina In mammals and other animals, the vagina (: vaginas or vaginae) is the elastic, muscular sex organ, reproductive organ of the female genital tract. In humans, it extends from the vulval vestibule to the cervix (neck of the uterus). The #Vag ...
also changes in response to increasing levels of
estrogen Estrogen (also spelled oestrogen in British English; see spelling differences) is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three ...
, becoming thicker and duller pink in color (in contrast to the brighter red of the prepubertal vaginal mucosa). Mucosa changes into a multilayered structure with superficial layer of squamous cells. Estrogen increase glycogen content in vaginal epithelium, which in future plays important part in maintaining vaginal pH. Whitish secretions (physiologic leukorrhea) are a normal effect of estrogen as well. In the two years following thelarche, the
uterus The uterus (from Latin ''uterus'', : uteri or uteruses) or womb () is the hollow organ, organ in the reproductive system of most female mammals, including humans, that accommodates the embryonic development, embryonic and prenatal development, f ...
,
ovaries The ovary () is a gonad in the female reproductive system that produces ova; when released, an ovum travels through the fallopian tube/oviduct into the uterus. There is an ovary on the left and the right side of the body. The ovaries are endocr ...
, and the follicles in the ovaries increase in size. The ovaries usually contain small follicular cysts visible by
ultrasound Ultrasound is sound with frequency, frequencies greater than 20 Hertz, kilohertz. This frequency is the approximate upper audible hearing range, limit of human hearing in healthy young adults. The physical principles of acoustic waves apply ...
.


Menstruation and fertility

The first menstrual bleeding is referred to as
menarche Menarche ( ; ) is the first menstrual cycle, or first menstruation, menstrual bleeding, in female humans. From both social and medical perspectives, it is often considered the central event of female puberty, as it signals the possibility of fe ...
, and typically occurs about two years after
thelarche Thelarche, also known as breast budding, is the onset of secondary breast development, often representing the beginning of pubertal development. It is the stage at which male and female breasts differentiate due to variance in hormone levels; howe ...
. The average age of menarche is 12½ in the
United States The United States of America (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 U.S. state, states and a federal capital district, Washington, D.C. The 48 ...
. Most American females experience their first period at 11, 12 or 13, but some experience it earlier than their 11th birthday and others after their 14th birthday. In fact, anytime between 8 and 16 is normal. In
Canada Canada is a country in North America. Its Provinces and territories of Canada, ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, making it the world's List of coun ...
, the average age of menarche is 12.72, and in the
United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Northwestern Europe, off the coast of European mainland, the continental mainland. It comprises England, Scotlan ...
it is 12.9. The time between menstrual periods (menses) is not always regular in the first two years after menarche. Ovulation is necessary for fertility, but may or may not accompany the earliest menses. In postmenarchal females, about 80% of the cycles were anovulatory in the first year after menarche, 50% in the third year and 10% in the sixth year. Initiation of ovulation after menarche is not inevitable. A high proportion of females with continued irregularity in the menstrual cycle several years from menarche will continue to have prolonged irregularity and anovulation, and are at higher risk for reduced fertility.


Body shape, fat distribution, and body composition

During this period, also in response to rising levels of estrogen, the lower half of the
pelvis The pelvis (: pelves or pelvises) is the lower part of an Anatomy, anatomical Trunk (anatomy), trunk, between the human abdomen, abdomen and the thighs (sometimes also called pelvic region), together with its embedded skeleton (sometimes also c ...
and thus
hips In vertebrate anatomy, the hip, or coxaLatin ''coxa'' was used by Celsus in the sense "hip", but by Pliny the Elder in the sense "hip bone" (Diab, p 77) (: ''coxae'') in medical terminology, refers to either an anatomical region or a joint ...
widen (providing a larger birth canal). Fat tissue increases to a greater percentage of the body composition than in males, especially in the typical female distribution of breasts, hips, buttocks, thighs, upper arms, and pubis. Progressive differences in fat distribution as well as sex differences in local skeletal growth contribute to the typical female body shape by the end of puberty. On average, at 10 years, females have 6% more body fat than males.


Body odor and acne

Rising levels of
androgen An androgen (from Greek ''andr-'', the stem of the word meaning ) is any natural or synthetic steroid hormone that regulates the development and maintenance of male characteristics in vertebrates by binding to androgen receptors. This includes ...
s can change the
fatty acid In chemistry, in particular in biochemistry, a fatty acid is a carboxylic acid with an aliphatic chain, which is either saturated and unsaturated compounds#Organic chemistry, saturated or unsaturated. Most naturally occurring fatty acids have an ...
composition of perspiration, resulting in a more "adult"
body odor Body odor or body odour (BO) is present in all animals and its intensity can be influenced by many factors (behavioral patterns, survival strategies). Body odor has a strong genetic basis, but can also be strongly influenced by various factors, ...
. This often precedes thelarche and pubarche by one or more years. Another androgen effect is increased secretion of oil (
sebum A sebaceous gland or oil gland is a microscopic exocrine gland in the skin that opens into a hair follicle to secrete an oily or waxy matter, called sebum, which lubricates the hair and skin of mammals. In humans, sebaceous glands occur ...
) from the skin. This change increases the susceptibility to
acne Acne ( ), also known as ''acne vulgaris'', is a long-term Cutaneous condition, skin condition that occurs when Keratinocyte, dead skin cells and Sebum, oil from the skin clog hair follicles. Typical features of the condition include comedo, ...
, a skin condition that is characteristic of puberty. Acne varies greatly in its severity.


Visual and other effects of hormonal changes

Testosterone will cause an enlargement of the
clitoris In amniotes, the clitoris ( or ; : clitorises or clitorides) is a female sex organ. In humans, it is the vulva's most erogenous zone, erogenous area and generally the primary anatomical source of female Human sexuality, sexual pleasure. Th ...
and possibly has important effects on the growth and maturation of the vestibular bulbs, corpora cavernosa of the clitoris and urethral sponge. Changes of the vulva initiated by estradiol as well as its direct effects also appear to influence the functioning of the lower urinary tract.


Underarm hair

Hair growth develops under the arms, starting out sparse before thickening and darkening over time.


Variations

In a general sense, the conclusion of puberty is reproductive maturity. Criteria for defining the conclusion may differ for different purposes: attainment of the ability to reproduce, achievement of maximal adult height, maximal gonadal size, or adult sex hormone levels. Maximal adult height is achieved at an average age of 15 years for an average female and 18 years for an average male. Potential fertility (sometimes termed ''nubility'') usually precedes completion of growth by 1–2 years in females and 3–4 years in males. Stage 5 typically represents maximal gonadal growth and adult hormone levels.


Age of onset

The definition of the onset of puberty may depend on perspective (e.g., hormonal versus physical) and purpose (establishing population normal standards, clinical care of early or late pubescent individuals, etc.). A common definition for the onset of puberty is physical changes to a person's body. These physical changes are the first visible signs of neural, hormonal, and gonadal function changes. The age at which puberty begins varies between individuals; usually, puberty begins between 10 and 13 years of age. The age at which puberty begins is affected by both genetic factors and by environmental factors such as nutritional state and social circumstances. An example of social circumstances is the Vandenbergh effect; a juvenile female mouse who has significant interaction with adult male mice will enter puberty earlier than juvenile females who are not socially overexposed to adult males. The average age at which puberty begins may be affected by
ethnicity An ethnicity or ethnic group is a group of people with shared attributes, which they Collective consciousness, collectively believe to have, and long-term endogamy. Ethnicities share attributes like language, culture, common sets of ancestry, ...
as well. For example, the average age of
menarche Menarche ( ; ) is the first menstrual cycle, or first menstruation, menstrual bleeding, in female humans. From both social and medical perspectives, it is often considered the central event of female puberty, as it signals the possibility of fe ...
in various populations surveyed has ranged from 12 to 18 years. The earliest average onset of puberty is for African-American females and the latest average onset for high altitude subsistence populations in Asia. However, much of the higher age averages reflect nutritional limitations more than genetic differences and can change within a few generations with a substantial change in diet. The median age of menarche for a population may be an index of the proportion of undernourished females in the population, and the width of the spread may reflect unevenness of wealth and food distribution in a population. Researchers have identified an earlier age of the onset of puberty. However, they have based their conclusions on a comparison of data from 1999 with data from 1969. In the earlier example, the sample population was based on a small sample of white females (200, from Britain). The later study identified as puberty as occurring in 48% of African-American females by age nine, and 12% of white females by that age. Based on a publication from The Ribbon, a newsletter of the Cornell University Program on Breast Cancer and Environmental Risk Factors in New York States ((BCERF), Vol 6, No. 1, Winter 2001.) One possible cause of a delay in the onset of puberty past the age 14 in females and 15 in males is Kallmann syndrome, a form of hypogonadotropic hypogonadism (HH). Kallmann syndrome is also associated with a lack of sense of smell ( anosmia). Kallmann syndrome and other forms of HH affect both men and women. It is caused by a failure in HPG axis at puberty which results in low or zero gonadotropin ( LH and FSH) levels with the subsequent result of a failure to commence or complete puberty, secondary
hypogonadism Hypogonadism means diminished functional activity of the human gonad, gonads—the testicles or the ovary, ovaries—that may result in diminished biosynthesis, production of sex hormones. Low androgen (e.g., testosterone) levels are referred t ...
and
infertility In biology, infertility is the inability of a male and female organism to Sexual reproduction, reproduce. It is usually not the natural state of a healthy organism that has reached sexual maturity, so children who have not undergone puberty, whi ...
.


Historical shift

The average age at which the onset of puberty occurs has dropped significantly since the 1840s. A 2006 study in Denmark found that puberty, as evidenced by breast development, started at an average age of 9 years and 10 months, a year earlier than when a similar study was done in 1991. Scientists believe the phenomenon could be linked to obesity or exposure to chemicals in the food chain, and is putting females at greater long-term risk of breast cancer.


Genetic influence and environmental factors

Various studies have found direct genetic effects to account for at least 46% of the variation of timing of puberty in well-nourished populations. The genetic association of timing is strongest between mothers and daughters. The specific
gene In biology, the word gene has two meanings. The Mendelian gene is a basic unit of heredity. The molecular gene is a sequence of nucleotides in DNA that is transcribed to produce a functional RNA. There are two types of molecular genes: protei ...
s affecting timing are not yet known. Among the candidates is an
androgen receptor The androgen receptor (AR), also known as NR3C4 (nuclear receptor subfamily 3, group C, member 4), is a type of nuclear receptor that is activated by binding any of the androgenic hormones, including testosterone and dihydrotestosterone, in th ...
gene. Researchers have hypothesized that early puberty onset may be caused by certain hair care products containing estrogen or placenta, and by certain chemicals, namely phthalates, which are used in many cosmetics, toys, and plastic food containers.


Hormones and steroids

There is theoretical concern, and animal evidence, that environmental hormones and chemicals may affect aspects of prenatal or postnatal sexual development in humans.
Bisphenol A Bisphenol A (BPA) is a chemical compound primarily used in the manufacturing of various plastics. It is a colourless solid which is Solubility, soluble in most common organic solvents, but has very poor solubility in water. BPA is produced on a ...
(BPA) is a chemical used to make plastics, and is frequently used to make baby bottles, water bottles, sports equipment, medical devices, and as a coating in food and beverage cans. Scientists are concerned about BPA's behavioral effects on fetuses, infants, and children at current exposure levels because it can affect the prostate gland, mammary gland, and lead to early puberty in females. BPA mimics and interferes with the action of estrogen—an important reproduction and development regulator. It leaches out of plastic into liquids and foods, and the
Centers for Disease Control and Prevention The Centers for Disease Control and Prevention (CDC) is the National public health institutes, national public health agency of the United States. It is a Federal agencies of the United States, United States federal agency under the United S ...
(CDC) found measurable amounts of BPA in the bodies of more than 90 percent of the U.S. population studied. The highest estimated daily intakes of BPA occur in infants and children. Many plastic baby bottles contain BPA, and BPA is more likely to leach out of plastic when its temperature is increased, as when one warms a baby bottle or warms up food in the microwave.


Nutritional influence

Nutrition Nutrition is the biochemistry, biochemical and physiology, physiological process by which an organism uses food and water to support its life. The intake of these substances provides organisms with nutrients (divided into Macronutrient, macro- ...
al factors are the strongest and most obvious environmental factors affecting timing of puberty.


Obesity influence and exercise

Scientific researchers have linked early
obesity Obesity is a medical condition, considered by multiple organizations to be a disease, in which excess Adipose tissue, body fat has accumulated to such an extent that it can potentially have negative effects on health. People are classifi ...
with an earlier onset of puberty in females. They have cited obesity as a cause of breast development before nine years and menarche before twelve years. Early puberty in females can be a harbinger of later health problems.


Physical and mental illness

Mental illnesses occur in puberty. The brain undergoes significant development by
hormone A hormone (from the Ancient Greek, Greek participle , "setting in motion") is a class of cell signaling, signaling molecules in multicellular organisms that are sent to distant organs or tissues by complex biological processes to regulate physio ...
s which can contribute to mood disorders such as
major depressive disorder Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive depression (mood), low mood, low self-esteem, and anhedonia, loss of interest or pleasure in normally ...
,
bipolar disorder Bipolar disorder (BD), previously known as manic depression, is a mental disorder characterized by periods of Depression (mood), depression and periods of abnormally elevated Mood (psychology), mood that each last from days to weeks, and in ...
,
dysthymia Dysthymia ( ), known as persistent depressive disorder (PDD) in the DSM-5-TR and dysthymic disorder in ICD-11, is a psychiatric condition marked by symptoms that are similar to those of major depressive disorder, but which persist for at leas ...
and
schizophrenia Schizophrenia () is a mental disorder characterized variously by hallucinations (typically, Auditory hallucination#Schizophrenia, hearing voices), delusions, thought disorder, disorganized thinking and behavior, and Reduced affect display, f ...
. Females aged between 15 and 19 make up 40% of
anorexia nervosa Anorexia nervosa (AN), often referred to simply as anorexia, is an eating disorder characterized by Calorie restriction, food restriction, body image disturbance, fear of gaining weight, and an overpowering desire to be thin. Individuals wit ...
cases.


Neurohormonal process

The endocrine reproductive system consists of the hypothalamus, the pituitary, the
gonad A gonad, sex gland, or reproductive gland is a Heterocrine gland, mixed gland and sex organ that produces the gametes and sex hormones of an organism. Female reproductive cells are egg cells, and male reproductive cells are sperm. The male gon ...
s, and the
adrenal gland The adrenal glands (also known as suprarenal glands) are endocrine glands that produce a variety of hormones including adrenaline and the steroids aldosterone and cortisol. They are found above the kidneys. Each gland has an outer adrenal corte ...
s, with input and regulation from many other body systems. True puberty is often termed "central puberty" because it begins as a process of the
central nervous system The central nervous system (CNS) is the part of the nervous system consisting primarily of the brain, spinal cord and retina. The CNS is so named because the brain integrates the received information and coordinates and influences the activity o ...
. A simple description of hormonal puberty is as follows: # The brain's hypothalamus begins to release pulses of GnRH. # Cells in the anterior pituitary respond by secreting LH and FSH into the circulation. # The
ovaries The ovary () is a gonad in the female reproductive system that produces ova; when released, an ovum travels through the fallopian tube/oviduct into the uterus. There is an ovary on the left and the right side of the body. The ovaries are endocr ...
or testes respond to the rising amounts of LH and FSH by growing and beginning to produce estradiol and
testosterone Testosterone is the primary male sex hormone and androgen in Male, males. In humans, testosterone plays a key role in the development of Male reproductive system, male reproductive tissues such as testicles and prostate, as well as promoting se ...
. # Rising levels of estradiol and testosterone produce the body changes of female and male puberty. The onset of this neurohormonal process may precede the first visible body changes by 1–2 years.


Components of the endocrine reproductive system

The arcuate nucleus of the hypothalamus is the driver of the reproductive system. It has neurons which generate and release pulses of GnRH into the portal venous system of the pituitary gland. The arcuate nucleus is affected and controlled by neuronal input from other areas of the brain and hormonal input from the
gonad A gonad, sex gland, or reproductive gland is a Heterocrine gland, mixed gland and sex organ that produces the gametes and sex hormones of an organism. Female reproductive cells are egg cells, and male reproductive cells are sperm. The male gon ...
s, adipose tissue and a variety of other systems. The pituitary gland responds to the pulsed GnRH signals by releasing LH and FSH into the blood of the general circulation, also in a pulsatile pattern. The gonads ( testes and
ovaries The ovary () is a gonad in the female reproductive system that produces ova; when released, an ovum travels through the fallopian tube/oviduct into the uterus. There is an ovary on the left and the right side of the body. The ovaries are endocr ...
) respond to rising levels of LH and FSH by producing the
steroid A steroid is an organic compound with four fused compound, fused rings (designated A, B, C, and D) arranged in a specific molecular configuration. Steroids have two principal biological functions: as important components of cell membranes t ...
sex hormones,
testosterone Testosterone is the primary male sex hormone and androgen in Male, males. In humans, testosterone plays a key role in the development of Male reproductive system, male reproductive tissues such as testicles and prostate, as well as promoting se ...
and
estrogen Estrogen (also spelled oestrogen in British English; see spelling differences) is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three ...
. The
adrenal gland The adrenal glands (also known as suprarenal glands) are endocrine glands that produce a variety of hormones including adrenaline and the steroids aldosterone and cortisol. They are found above the kidneys. Each gland has an outer adrenal corte ...
s are a second source for steroid hormones. Adrenal maturation, termed
adrenarche Adrenarche is an early stage in sexual maturation that happens in some higher primates (including humans), typically peaks at around 20 years of age, and is involved in the development of pubic hair, body odor, skin oiliness#Oily skin, skin oiline ...
, typically precedes gonadarche in mid-childhood.


Major hormones

* Neurokinin B (a tachykinin peptide) and kisspeptin (a neuropeptide), both present in KNDy neurons of the hypothalamus, are critical parts of the control system that switches on the release of GnRH at the start of puberty. * GnRH ( gonadotropin-releasing hormone) is a peptide
hormone A hormone (from the Ancient Greek, Greek participle , "setting in motion") is a class of cell signaling, signaling molecules in multicellular organisms that are sent to distant organs or tissues by complex biological processes to regulate physio ...
released from the hypothalamus which stimulates gonadotrope cells of the anterior pituitary. * LH (luteinizing hormone) is a larger
protein Proteins are large biomolecules and macromolecules that comprise one or more long chains of amino acid residue (biochemistry), residues. Proteins perform a vast array of functions within organisms, including Enzyme catalysis, catalysing metab ...
hormone secreted into the general circulation by gonadotrope cells of the anterior pituitary gland. The main target cells of LH are the Leydig cells of testes and the theca cells of the
ovaries The ovary () is a gonad in the female reproductive system that produces ova; when released, an ovum travels through the fallopian tube/oviduct into the uterus. There is an ovary on the left and the right side of the body. The ovaries are endocr ...
. LH secretion changes more dramatically with the initiation of puberty than FSH, as LH levels increase about 25-fold with the onset of puberty, compared with the 2.5-fold increase of FSH. * FSH ( follicle stimulating hormone) is another protein hormone secreted into the general circulation by the gonadotrope cells of the anterior pituitary. The main target cells of FSH are the ovarian follicles and the Sertoli cells and spermatogenic tissue of the testes. *
Testosterone Testosterone is the primary male sex hormone and androgen in Male, males. In humans, testosterone plays a key role in the development of Male reproductive system, male reproductive tissues such as testicles and prostate, as well as promoting se ...
is a
steroid A steroid is an organic compound with four fused compound, fused rings (designated A, B, C, and D) arranged in a specific molecular configuration. Steroids have two principal biological functions: as important components of cell membranes t ...
hormone produced primarily by the Leydig cells of the testes, and in lesser amounts by the theca cells of the ovaries and the adrenal cortex. Testosterone is the primary mammalian
androgen An androgen (from Greek ''andr-'', the stem of the word meaning ) is any natural or synthetic steroid hormone that regulates the development and maintenance of male characteristics in vertebrates by binding to androgen receptors. This includes ...
and the "original"
anabolic steroid Anabolic steroids, also known as anabolic-androgenic steroids (AAS), are a class of drugs that are structurally related to testosterone, the main male sex hormone, and produce effects by binding to the androgen receptor (AR). Anabolism, Anaboli ...
. It acts on
androgen receptor The androgen receptor (AR), also known as NR3C4 (nuclear receptor subfamily 3, group C, member 4), is a type of nuclear receptor that is activated by binding any of the androgenic hormones, including testosterone and dihydrotestosterone, in th ...
s in responsive tissue throughout the body. * Estradiol is a
steroid A steroid is an organic compound with four fused compound, fused rings (designated A, B, C, and D) arranged in a specific molecular configuration. Steroids have two principal biological functions: as important components of cell membranes t ...
hormone produced by aromatization of testosterone. Estradiol is the principal human
estrogen Estrogen (also spelled oestrogen in British English; see spelling differences) is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three ...
and acts on estrogen receptors throughout the body. The largest amounts of estradiol are produced by the granulosa cells of the
ovaries The ovary () is a gonad in the female reproductive system that produces ova; when released, an ovum travels through the fallopian tube/oviduct into the uterus. There is an ovary on the left and the right side of the body. The ovaries are endocr ...
, but lesser amounts are derived from testicular and adrenal testosterone. * Adrenal
androgen An androgen (from Greek ''andr-'', the stem of the word meaning ) is any natural or synthetic steroid hormone that regulates the development and maintenance of male characteristics in vertebrates by binding to androgen receptors. This includes ...
s are steroids produced by the zona reticulosa of the adrenal cortex in both sexes. The major adrenal androgens are dehydroepiandrosterone, androstenedione (which are precursors of testosterone), and dehydroepiandrosterone sulfate which is present in large amounts in the blood. Adrenal androgens contribute to the androgenic events of early puberty in females. * IGF1 ( insulin-like growth factor 1) rises substantially during puberty in response to rising levels of growth hormone and may be the principal mediator of the pubertal growth spurt. *
Leptin Leptin (from Ancient Greek, Greek λεπτός ''leptos'', "thin" or "light" or "small"), also known as obese protein, is a protein hormone predominantly made by adipocytes (cells of adipose tissue). Its primary role is likely to regulate long ...
is a protein hormone produced by adipose tissue. Its primary target organ is the hypothalamus. The leptin level seems to provide the
brain The brain is an organ (biology), organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It consists of nervous tissue and is typically located in the head (cephalization), usually near organs for ...
a rough indicator of adipose mass for purposes of regulation of appetite and energy metabolism. It also plays a permissive role in female puberty, which usually will not proceed until an adequate body mass has been achieved.


Endocrine perspective

The endocrine reproductive system becomes functional by the end of the first trimester of fetal life. The testes and ovaries become briefly inactive around the time of birth but resume hormonal activity until several months after birth, when incompletely understood mechanisms in the brain begin to suppress the activity of the arcuate nucleus. This has been referred to as maturation of the prepubertal "gonadostat", which becomes sensitive to negative feedback by sex steroids. The period of hormonal activity until several months after birth, followed by suppression of activity, may correspond to the period of infant sexuality, followed by a latency stage, which
Sigmund Freud Sigmund Freud ( ; ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a clinical method for evaluating and treating psychopathology, pathologies seen as originating fro ...
described. Neurons of the arcuate nucleus secrete gonadotropin releasing hormone (GnRH) into the blood of the pituitary portal system. An American physiologist, Ernst Knobil, found that the GnRH signals from the hypothalamus induce pulsed secretion of LH (and to a lesser degree, FSH) at roughly 1–2 hour intervals. The LH pulses are the consequence of pulsatile GnRH secretion by the arcuate nucleus that, in turn, is the result of an oscillator or signal generator in the central nervous system ("GnRH pulse generator"). In the years preceding physical puberty, Robert M. Boyar discovered that the gonadotropin pulses occur only during sleep, but as puberty progresses they can be detected during the day. By the end of puberty, there is little day-night difference in the amplitude and frequency of gonadotropin pulses. Some investigators have attributed the onset of puberty to a resonance of oscillators in the brain. By this mechanism, the gonadotropin pulses that occur primarily at night just before puberty represent beats. An array of "autoamplification processes" increases the production of all of the pubertal hormones of the hypothalamus, pituitary, and gonads.


Stages

*
adrenarche Adrenarche is an early stage in sexual maturation that happens in some higher primates (including humans), typically peaks at around 20 years of age, and is involved in the development of pubic hair, body odor, skin oiliness#Oily skin, skin oiline ...
(approximately ages 6—8) * gonadarche (approximately age 10½ in females and age 11½ in males) *
thelarche Thelarche, also known as breast budding, is the onset of secondary breast development, often representing the beginning of pubertal development. It is the stage at which male and female breasts differentiate due to variance in hormone levels; howe ...
(approximately age 10½ in females) *
pubarche Pubarche () refers to the first appearance of pubic hair at puberty. It is one of the earliest physical changes of puberty and can occur independently of complete puberty. It is usually the second sign of puberty, after thelarche in females and gon ...
(approximately age 11 in females and age 12 in males) *
menarche Menarche ( ; ) is the first menstrual cycle, or first menstruation, menstrual bleeding, in female humans. From both social and medical perspectives, it is often considered the central event of female puberty, as it signals the possibility of fe ...
(approximately age 12½ in females) * spermarche (approximately age 13 in males)


See also

* Adolescent sexuality * Child sexuality * Menopause * Andropause *
Delayed puberty Delayed puberty is when a person lacks or has incomplete development of specific sexual characteristics past the usual age of onset of puberty. The person may have no physical or hormone, hormonal signs that puberty has begun. In the United States ...
*
Eunuch A eunuch ( , ) is a male who has been castration, castrated. Throughout history, castration often served a specific social function. The earliest records for intentional castration to produce eunuchs are from the Sumerian city of Lagash in the 2 ...
* Hebephilia * Kallmann syndrome * Precocious puberty * Puberphonia * Puberty blocker * Seclusion of girls at puberty * Secondary sex characteristic


References


Sources

* * * * * *


Further reading

* * * Ducros, A. and Pasquet, P. "Evolution de l'âge d'apparition des premières règles (ménarche) en France". ''Biométrie Humaine'' (1978), 13, 35–43. * * Newer data suggesting that lower age thresholds for evaluation should be used. * Plant TM, Lee PA, eds. ''The Neurobiology of Puberty''. Bristol: Society for Endocrinology, 1995. Proceedings of the latest (4th) International Conference on the Control of the Onset of Puberty, containing summaries of current theories of physiological control, as well as GnRH analog treatment. * Sizonenko, PC
Role of sex steroids during development—integration
. in Bourguignon, Jean Pierre & Tony M. Plant. The Onset of Puberty in Perspective: Proceedings of the 5th International Conference on the Control of the Onset of Puberty, Held in Liège, Belgium, 26–28 September 1999. Elsevier. Amsterdam & New York 2000. . pp 299–306. * Highly useful growth charts with integrated standards for stages of puberty. *

''ScienceDaily'', December 1, 2005


External links


Support for teens
(archive)
University of Maryland guide to puberty and adolescence

Growing Up Sexually: A World Atlas

Pictures and detailed information about breast development during puberty

Puberty in females: interactive animation of Tanner stages

Puberty in males: interactive animation of Tanner stages
{{Authority control Adolescence Human development Human female endocrine system Sexuality and age