Puberty Timing Remains Unchanged

  • Peter A. Lee
  • Christopher P. Houk
Part of the Contemporary Endocrinology book series (COE)


It has been presumed by the media and the public that puberty is occurring earlier now than in past decades. This is the result of reports of earlier breast development in girls (Tanner stage 2, Br2) and earlier genital development (Tanner genital stage 2, G2) in boys. Nonetheless, owing to the lack of representative data, the intra- and inter-observer variability in Tanner staging, and the fact that initial sex hormone-driven physical changes do not always indicate the onset of puberty, bona fide evidence of an earlier pubertal onset is not available. The gold standard verifying pubertal onset involves documentation of hormonal responsiveness of the hypothalamic–pituitary–gonadal (HPG) axis. The evidence cited for an earlier onset of puberty involves the age of the first physical changes of puberty. In girls, the appearance of breast may simply be due to fatty tissue deposition, particularly in overweight children; alternatively, breast tissue may be a consequence of non-HPG-stimulated estrogen production. In males, genital staging is poorly defined and therefore subjective and prone to significance within and between observer disagreements. Inexperienced observers, unacquainted with the normal variation in prepubertal genital size and appearance, may erroneously assign G2 based on size alone. This is a possible explanation of recent studies showing a high percentage of 9-year-old boys in G2 in recent surveys in contrast to findings in the last 1970s. Data remain insufficient because of problems with sample size and selection, race, socioeconomic status (SES), assessment, and statistical methods to conclude that there is a significant continuation of the secular trend toward an earlier pubertal onset in boys or girls.

Key words

Secular change Puberty Menarche Tanner stages 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Lee PA. Secular changes in the age of onset of puberty. Topical Endocrinology 2002;20:5–8.Google Scholar
  2. 2.
    Zacharias L, Wurtman RJ. Age at menarche. Genetic and environmental influences. N Engl J Med 1969;280:868–875.Google Scholar
  3. 3.
    Wyshak G, Frisch R. Evidence for a secular trend in age of menarche. N Engl J Med 1982;306(17):1033–1035.PubMedCrossRefGoogle Scholar
  4. 4.
    MacMahon B. Age at Menarche: United States. DHEW pub (HRA) 74-1615. Rockville, MD: National Center for Health Statistics, 1973.Google Scholar
  5. 5.
    Harlan WR, Grillo GP, Cornoni-Huntley J, Leaverton PE. Secondary sex characteristics of boys 12 to 17 years of age–the U.S. Health Examination Survey. J Pediatr 1979;95:293–297.PubMedCrossRefGoogle Scholar
  6. 6.
    Harlan WR, Harlan EA, Grillo GP. Secondary sex characteristics of girls 12 to 17 years of age: the U.S. Health Examination Survey. J Pediatr 1980;96:1074–1078.PubMedCrossRefGoogle Scholar
  7. 7.
    Freedman DS, Khan LK, Serdula MK, Srinivasan SR, Berenson GS. Secular trends in height in children during 2 decades: the Bogalusa Heart Study. Arch Pediatr Adolesc 2000;154:155–161.Google Scholar
  8. 8.
    Freedman DS, Kahn LK, Serdula MK, Dietz WH, Srinivasan SR, Berenson GS. Relation of age at menarche to race, time period, and anthropometric dimensions: the Bogalusa Heart Study. Pediatrics 2002;110(4):e43.PubMedCrossRefGoogle Scholar
  9. 9.
    Foster TA, Voors AW, Webber LS, Frerichs, Berenson GS. Anthropometric and maturation measurements of children, ages 5 to 14 years, in a biracial community–the Bogalusa Heart Study. Am J Clin Nutr 1997;30:582–591.Google Scholar
  10. 10.
    Anderson SE, Dallal GE, Must A. Relative weight and race influence average age at menarche: results from two nationally representative surveys of US girls studied 25 years apart. Pediatrics 2003;111:844–850.PubMedCrossRefGoogle Scholar
  11. 11.
    Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child 1969;44:291–303.PubMedCrossRefGoogle Scholar
  12. 12.
    Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in boys. Arch Dis Child 1970;45:13–23.PubMedCrossRefGoogle Scholar
  13. 13.
    Reiter EO, Lee PA. Have the onset and tempo of puberty changed? Arch Pediatr Adolesc Med 2001;155:988–989.PubMedGoogle Scholar
  14. 14.
    Lee PA, Kulin HE, Shumei G. Letter to the editor: age of puberty in girls and the diagnosis of precocious puberty. Pediatrics 2001;107:1493–1494.PubMedCrossRefGoogle Scholar
  15. 15.
    Reynolds EL, Wines JV. Individual differences in physical changes associated with adolescence in girls. Am J Dis Child 1948;75:329–350.PubMedGoogle Scholar
  16. 16.
    Nicolson AB, Hanley C. Indices of physiological maturity: derivation and interrelationships. Child Dev 1953;24:3–38.PubMedGoogle Scholar
  17. 17.
    Lee PA. Normal ages of pubertal events in American males and females. J Adolesc Health Care 1980;1:26–29.PubMedCrossRefGoogle Scholar
  18. 18.
    Reynolds EL, Wines JV. Physical changes associated with adolescence in boys. Am J Dis Child 1951;82(5):529–547.Google Scholar
  19. 19.
    Herman-Giddens ME, Slora EJ, Wasserman RC et al. Secondary sexual characteristics and menses in young girls seen in office practice: a study from the Pediatric Research in Office Settings Network. Pediatrics 1997;99:505–512.PubMedCrossRefGoogle Scholar
  20. 20.
    Britton JA, Wolff MS, Lapinski R et al. Characteristics of pubertal development in a multi-ethnic population of nine-year-old girls. Ann Epidemiol 2004;14:179–187.PubMedCrossRefGoogle Scholar
  21. 21.
    Sun S, Schubert CM, Chumlea WC et al. National estimates of the timing of sexual maturation and racial differences in US children. Pediatrics 2002;110:911–919.PubMedCrossRefGoogle Scholar
  22. 22.
    Chumlea WC, Schubert CM, Roche AF et al. Age at menarche and racial comparisons in U.S. girls. Pediatrics 2003;111:110–113.PubMedCrossRefGoogle Scholar
  23. 23.
    Sun SS, Schubert CM, Liang R et al. Is sexual maturity occurring earlier in U.S. children? Journal of Adolescent Health 2005;37:345–355.PubMedCrossRefGoogle Scholar
  24. 24.
    Herman-Giddens ME, Wang L, Koch G. Seconday sexual characteristics in boys. Arch Pediatr Adolesc Med 2001;155:1022–1028.PubMedGoogle Scholar
  25. 25.
    Biro FM, Lucky AW, Huster GA, Morrison JA. Pubertal staging in boys. J Pediatr 1995;127(1):100–102.PubMedCrossRefGoogle Scholar
  26. 26.
    Garnier D, Simondon KB, Benefice E. Longitudinal estimates of puberty timing in Senegalese adolescent girls. Am J Hum Biol 2005;17:718–730.PubMedCrossRefGoogle Scholar
  27. 27.
    Rimpela AH, Rimpela MK. Towards an equal distribution of health? Socioeconomic and regional differences of the secular trend of the age of menarche in Finland from 1979 to 1989. Acta Paediatr 1993;82:87–90.PubMedCrossRefGoogle Scholar
  28. 28.
    Parent A-S, Teilmann G, Juul A, Skakkebaek NE, Toppari J, Bourguignon JP. The timing of normal puberty and the age limits of sexual precocity: variations around the world, secular trends, and changes after migration. Endocr Rev 2003;24:668–693.PubMedCrossRefGoogle Scholar
  29. 29.
    Chaning-Pearce SM, Solomon L. Pubertal development in black and white Johannesburg girls. S Afr Med J 1987;71:22–24.PubMedGoogle Scholar
  30. 30.
    Helm P, Grolund L. A halt in the secular trend towards earlier menarche in Denmark. Acta Obstet Gynecol Scand 1998;77:198–200.PubMedCrossRefGoogle Scholar
  31. 31.
    Lindgren GW, Degerfors IL, Fredriksson A et al. Menarche 1990 in Stockholm schoolgirls. Acta Paediatr Scand 1991;80:953–955.PubMedCrossRefGoogle Scholar
  32. 32.
    Wu T, Mendola P, Buck GM. Ethnic differences in the presence of secondary sex characteristics and menarche in US girls: the third national health and nutrition examination survey, 1988–1994. Pediatrics 2002;110:752–757.PubMedCrossRefGoogle Scholar
  33. 33.
    Huen KF, Leung SS, Lau JT, Cheung AY, Leung NK, Chiu MC. Secular trend in the sexual maturation of southern Chinese girls. Acta Paediatr 1997;86:1121–1124.PubMedCrossRefGoogle Scholar
  34. 34.
    Nebesio TD, Pescovitz OH. Historical perspective: endocrine disruptors and the timing of puberty. Endocrinologist 2005;15:44–48.CrossRefGoogle Scholar
  35. 35.
    Jolliffe D. Extent of overweight in US children and adolescents from 1971 to 2000. Internatl J Obesity 2004;28:4–9.CrossRefGoogle Scholar
  36. 36.
    Karpati AM, Rubin CH, Kieszak SM, Marcus M, Troiano RP. Stature and pubertal stage assessment in American boys: the 1988–1994 Third National Health and Nutrition Examination Survey. J Adolesc Health 2002;30:205–212.PubMedCrossRefGoogle Scholar
  37. 37.
    Kulin HE, Bwibo N, Mutie D, Santner SJ. The effect of chronic childhood malnutrition on pubertal growth and development. Am J Clin Nutr 1982;36:527–536.PubMedGoogle Scholar
  38. 38.
    Biro FM, Lucky AW, Simbartl LA et al. Pubertal maturation in girls and the relationship to anthropometric changes: pathways through puberty. J Pediatr 2003;142:643–646.PubMedCrossRefGoogle Scholar

Copyright information

© Van Nostrand Reinhold 1990

Authors and Affiliations

  • Peter A. Lee
  • Christopher P. Houk

There are no affiliations available

Personalised recommendations