A well-balanced diet and regular physical activity will support growth and healthy development.

However, puberty and subsequent growth can be delayed for a variety of reasons. Constitutional delay, or “being a late bloomer,” describes a pattern of later development that runs in families and is nothing to worry about. These teenagers will fully develop, just later than their peers.

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Children with long-term conditions, such as diabetes, cystic fibrosis, or kidney disease, may also experience delayed puberty. This may be less likely if the condition is well-controlled, with limited complications.

Conditions affecting the pituitary or thyroid glands, which produce the hormones the body needs to grow and develop, can also delay puberty. Likewise, some genetic conditions can interfere with the process.

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Intensive training and restrictive eating may delay the onset of puberty in young female athletes. In contrast, obesity is associated with an earlier start to puberty. These variations may be due to changes in hormone levels associated with activity levels and body composition.

Nutrition

Nutrition is important, and someone who is malnourished can develop later than their peers. Severe malnutrition as a child can contribute to growth delays, which can have ongoing effects if not corrected. Malnutrition can cause children to be underweight, low in height, or both.

Worldwide, the WHO reports that in 2020, 149 million children under the age of 5 were too short for their age, and 45 million were too thin for their height. These conditions can cause delayed puberty, as well as other developmental complications.

Puberty and gender-affirming care

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Some transgender, nonbinary, or intersex people may decide to take puberty blockers. These are medications that prevent the physical changes associated with puberty.

Gender-affirming hormone therapy may also be used by a person who is transgender, nonbinary, or intersex to help their body align with their gender identity. Options include estrogen therapy and T therapy (testosterone therapy).

According to the American Academy of Pediatrics, gender-affirming care includes supports other than medical care. This can include mental health resources, and social services for transgender, nonbinary, and intersex people and families.

Young people and their families can discuss gender-affirming care with their doctor or pediatrician.

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