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Primary Care Liaison

Delayed puberty

  • Introduction

    • For girls, normal range of onset of puberty is between 8-13 years of age, with the onset of puberty being defined by presence of breast development
    • For boys, normal range of onset of puberty is between 9-14 years of age, with onset of puberty being defined by testicular volumes of 4mL and above
    • Common reasons for delayed puberty include familial/genetics and chronic illness

    When to refer

    • Absence of breast development in a girl at age ≥13yrs or primary amenorrhoea at age 15yrs
    • Testicular volumes <4ml in a boy at age ≥14yrs

    Initial work up (if investigations thought to be warranted)

    • Thyroid function tests, coeliac serology, FBE, UEC, liver function tests, FSH, LH, oestradiol or testosterone
    • Bone age X-ray

      Referral information needed

    • Clinical history / associated illnesses or possible reasons for pubertal delay
    • Height and weight (and date of assessment)
    • Pubertal assessment according to Tanner staging
    • History of pubertal timing in parents (particularly menarche in mother) if available
    • Copies of pathology and bone age X-ray results

    Contact information

    • For clinical advice, the endocrinology fellow or endocrinologist on call can be contacted through the hospital switch board (03) 9345 5522
    • Outpatient booking enquiry information (03) 9345 6180


    • Guideline developed by RCH Endocrinology Department