Introduction

This guideline relates to delayed puberty in paediatric patients.

• 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

Wait time for appointments 

Specialist Clinic wait times

Services available closer to home

Alternative paediatric services available in Victoria

• Monash Children's Hospital

Pre-referral work up/management

• Blood sampling: thyroid function tests, coeliac serology, FBE, UEC, liver function tests, FSH, LH, oestradiol or testosterone
• Bone age X-ray

Referral criteria/required information

• 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  
  

How to refer     

Specialist Clinic referral 

Please complete the above and submit via:

• Facsimile (03) 9345 5034 or
• Email screferrals@rch.org.au
• Urgent referral or clinical query call ED admitting officer, endocrinology fellow or endocrinologist on-call (03) 9345 5522

Acknowledgements

The development of this guideline was coordinated by the Department of Endocrinology. Guideline reviewed in July 2025.