Delayed Puberty

Puberty often begins between the ages of 9 and 14 in young men.  Puberty hasn’t begun by age 14 can be emotionally troublesome for young men as their peers become “men” and they remain “boys.”  Delayed puberty (puberty after age 14) is directly linked to delayed release of gonadotropins from the pituitary.  This delay in gonadotropins leads to a subsequent decrease in testosterone from the testicles. 


During the teen years, decreases in testosterone production can actually prevent or reduce the impact of puberty.  We call this delayed puberty.  These young men experience the following after age 14:

  • Little to no body hair growth

  • Lack or very little increase in genital growth

  • Decreased muscle mass

  • Lack of voice deepening

  • Lack of ejaculation (most notably no wet dreams)


As we discussed in the puberty section, the first physical signs of puberty occur in the genital region – with the beginning of pubic hair growth (darkening and/or courser hair growing), slight growth in the size of the penis, and the thinning and darkening of the scrotum.  Because of this, no outward signs of puberty may be noticeable to the parents if their sons have become private about nudity.  Other signs of puberty that are clearly obvious--such as change in voice, growth spurt, muscle mass, armpit and facial hair--all occur later on in puberty.  So a young man that begins puberty at age 13 (which is normal) may not have signs visible to others for a few more years since most early changes involve the genitals.  This is one reason why parents of teenage boys should have conversations with their boys about puberty, especially if they are concerned about delayed puberty.  However; if there have been no signs of puberty by age 14, it is best to see a healthcare provider.  In fact; everyone should have a physical examination by a healthcare provider at least every year, especially during childhood and adolescence.  During these physical examinations a healthcare provider can assess the growth of the genitals to ensure that puberty is tracking normally.


Treatment for young men who have not started going through puberty in any way often begins at age 14 or 15.  In some cases, these young men are simply late bloomers and will go through puberty by age 15 or 16.  However, in other cases treatment may be administered.  There are different reasons for delayed puberty.  For some it is genetic.  If one or both of their parents went through puberty late and developed normally, these young men may simply be following their genetics and treatment may be withheld for a time.  Yet for others, the delay in puberty can be an issue with the testicles or the pituitary gland – either little to no testosterone is being produced or the pituitary gland is not releasing gonadotropins to cause the testes to produce testosterone.  Treatment typically consists of giving the young man short-term testosterone replacement to give puberty a “jump start.”  Once testosterone is administered to a young man, physical signs of puberty will soon follow.