Delayed puberty is a common condition characterized by a lack of sexual maturation by two or more years than the population average. Hormonal imbalances and other illnesses can cause the condition, but sometimes doctors fail to identify the underlying cause. Without an underlying cause, the condition is usually self-limiting. Several studies have been done to identify the long-term consequences of delayed puberty on several health outcomes.
The most common negative effects of late puberty in the 20s are compromised height and bone mineral density. It has also been shown that late puberty in boys and girls can negatively affect adult psychosocial functioning and educational achievement. Other studies have also indicated that people with a history of late puberty in their 20s are at a greater risk of coming down with metabolic and cardiovascular disorders.
Potential Causes of Delayed Puberty
In most cases, late puberty in boys and girls is a normal variation. Sometimes, it can also run in families, known as the constitutional delay of puberty. Depending on the cause of the delayed puberty, individuals who experience it may or may not eventually proceed normally. Several disorders can lead to delayed puberty in boys and girls. These include diabetes mellitus, inflammatory bowel disease, cystic fibrosis, and kidney disease.
In some cases, children receiving chemotherapy might also end up with delayed puberty. The condition is also seen in cases of autoimmune disorders like Addison disease. All these different causes might lead to complications and abnormalities later in life. Read on to find out about the consequences of delayed puberty.
Bone Mineral Density and Fracture Risk as Consequences of Late Puberty
Puberty plays a huge role in bone mineral density. Most of the bone mass in an adult is acquired during puberty. Skeletal growth usually comes to an end around the mid-20s, and this is where peak bone mass is attained. BMD is an important marker for the occurrence of osteoporosis later in life. Many studies have been done to understand how late puberty in the 20s can affect peak bone mass.
Delayed Puberty and BMD in Men
Studies that have been done using dual X-ray absorptiometry show that males with a history of delayed puberty showed significantly lower bone mass density than those without. Other studies also show that individuals with delayed puberty have lower volumetric BMD. This was assessed using peripheral quantitative computed tomography.
Delayed Puberty and BMD in Women
Several conditions can cause delayed onset of puberty in females. These include conditions like hypothalamic amenorrhea. This is a condition that is characterized by reduced bone density. This means that apart from the direct effects of late puberty in girls, there might also be a reduced bone density due to the underlying cause of the condition.
In studies with women who had no notable underlying cause of delayed puberty, it was observed that individuals with delayed puberty had lower BMD in the femoral neck and tibia. This is one of the most prominent consequences of late puberty in women. This condition is observed in younger women, but it can also extend into adulthood. Other studies demonstrated that delayed onset of puberty could also increase the risk of osteoporosis both during the premenopausal and postmenopausal years.
The effects of delayed puberty on bone mass density in females are largely attributed to inadequate estrogen exposure. It is thought that greater exposure to estrogen may have a protective effect on bone mass density. However, other unknown factors can influence bone mass density other than estrogen exposure since lower BMD has also been observed as early as nine years of age in females who went on to have a delayed onset of puberty.
Stunted Growth as Part of Consequences of Late Puberty
Puberty is a period characterized by rapid skeletal growth. This period is also known as the pubertal growth spurt. For individuals with delayed puberty, this rapid growth is delayed as well. This means some of these individuals may be typically shorter than their peers with the normal onset of puberty.
Some studies have also shown that most individuals with delayed puberty also showed a slower growth rate even before puberty. This slow growth velocity might or may not be corrected when puberty eventually starts. Some studies show that some individuals will eventually experience a pubertal growth spurt, allowing them to catch up and reach their full height potential. However, some of them do not and will remain significantly shorter than their peers.
Psychosocial Outcomes of Late Puberty
Apart from being a period of serious physical development, puberty is also a time characterized by many psychosocial changes. Studies that have been done on the effect of delayed puberty on psychosocial aspects have indicated that this condition negatively impacts self-esteem, psychopathology, and behavior.
Self-Esteem and Delayed Puberty
Many studies have been done to analyze the effect of delayed puberty on self-esteem. These studies indicated that both males and females who reach puberty later than their peers show marked negative beliefs and attitudes toward themselves. In addition, some of these studies suggest that it might be short stature that is responsible for this negative self-image.
Some studies also show that race further plays a part in how late puberty in girls and boys affects self-image. For instance, a study showed that later pubertal development had more of an effect on Hispanic and Black males than Asian males. Similar results were observed with Hispanic girls. In addition, studies show that lower body-image scores were more observed in Hispanic girls than Black or Asian girls.
Psychopathology and Behavior in Delayed Puberty
Although there is not much evidence suggesting that late puberty in girls is associated with negative psychological effects in women, it has been shown to affect men more. Delayed puberty has been associated with depression, disruptive behavior disorder, and substance abuse in young males. It has also been shown that it might also cause depression and anxiety in later adulthood. Men who experienced late puberty also showed a higher rate of internalizing symptoms of depression or anxiety. This leads to higher incidences of substance abuse in the same group of people.
Other studies looked into whether or not late puberty affects educational achievement. It was shown that individuals with delayed puberty displayed worse academic performance during childhood. Similar studies also showed that in young adults, performance either improved or remained the same.
Metabolic and Cardiovascular Outcomes
While most studies linking puberty to metabolic and cardiovascular disease were concentrated on early puberty, it has now been shown that delayed onset of puberty has negative effects as well. In addition, there has been an association between late puberty in boys and girls and coronary heart disease. It was shown that both early and late puberty in girls and boys increased the risk of coronary heart disease.
Delayed puberty can cause a variety of issues later on in life. If your child is showing symptoms of delayed puberty and you need additional information, get in touch with us and feel free to book a consultation with our Pediatric Care Specialist Dr. Ana M. Hernandez-Puga. We have many years of experience dealing with such conditions, and we will provide you with the answers and help you need. Also, feel free to subscribe to our mailing list so we can notify you about similar articles that we post.
