American Medical Association Family Medical Guide - American Medical Association [222]
The goal of treatment for precocious puberty is to stop and possibly reverse the premature sexual development; the treatment varies depending on the cause. For example, if precocious puberty has resulted from an adrenal gland tumor, removal of the tumor will correct the condition. In most cases, a doctor prescribes a hormone (given by injection or nasal spray) that suppresses the body’s production of sex hormones (estrogen in girls; testosterone in boys). Once the hormone treatment is stopped, the body’s own hormone function gradually returns and the process of puberty continues normally.
Female hormones stimulate an increase in fat all over the body, but mostly on the hips, thighs, and buttocks. Girls have a normally higher proportion of fat to muscle and bone than boys do. Also, a girl’s pelvis widens during puberty.
Physical and Sexual Development in Boys
In boys, puberty begins at about age 12 or 13 (and continues until 17 or 18). Puberty can begin as early as 9½ years of age, and continue until 21 years of age in boys who start puberty late. A boy’s testicles and scrotum (the pouch of skin and tissue that holds the testicles) usually start to enlarge by age 11 or 12 and stop by age 16 or 17. One testicle may appear to be larger or hang lower than the other; this is normal. As the testicles grow, the skin of the scrotum darkens.
The penis lengthens before it grows broader at about age 12 or 13; growth stops at about 15 or 16. The ability to ejaculate semen (a fluid produced by the male reproductive organs that contains sperm) begins about a year after the penis starts to grow. At about the time that a boy’s penis starts to lengthen and widen, he usually starts having more frequent erections. It is normal to have erections for no apparent reason, although erections usually occur with sexual excitement or physical stimulation. Spontaneous erections generally go away after a few minutes and are not noticeable to anyone else. Some boys (but not all) have erections and ejaculate during their sleep when they are dreaming (nocturnal emissions, or wet dreams), which is a normal part of sexual development. Many boys worry about the size (or shape) of their penis. If changes in the testicles or penis are not noticeable in a boy by age 15, he should see his pediatrician.
Pubic hair is visible by age 11 or 12, but underarm hair may not appear until 13 or even 15. As in girls, the development of hair on the body varies from person to person and depends on heredity. Although pubic and underarm hair usually stop growing noticeably by about age 16 (depending on when growth started), hair on the chest and abdomen usually continues growing into adulthood. Sweating and underarm odor, along with the development of sweat glands in the groin, usually are first noticeable between ages 13 and 15.
In boys and young men, the larynx enlarges, making the Adam’s apple more prominent, and the vocal cords become longer and thicker, causing the voice to deepen at about age 14. During this time a boy’s voice may fluctuate between high and low, cracking or breaking (changing pitch) unexpectedly. The deepening may occur gradually or rapidly. If a boy still has a childlike voice at age 16, he should see a doctor. A boy usually starts growing a beard at about the time his voice changes. Beards grow slowly at first and get heavier with age.
The male hormone testosterone makes muscles grow larger in most boys, especially the muscles in the shoulders and upper chest. Testosterone also causes the bones to lengthen, giving most boys a heavier bone structure and longer arms and legs than girls.
Health Concerns During Adolescence
Adolescence is a good time for teens to begin taking responsibility