The diagnosis of idiopathic delayed puberty is as much a matter of convention as the definition of idiopathic precocious puberty. Most clinicians seem to agree that the onset of puberty two or three years after the median age justifies concern and the label “delayed puberty.” Many boys aged fifteen or sixteen who are not yet in puberty are unhappy, and many of them seek professional help. Just by statistical definition, there must be the same percentage of girls with delayed puberty, but relatively fewer of them seek medical attention, because they do not seem to suffer as much as boys do. Although there are many physical conditions that may cause delayed onset of puberty, the most common is idiopathic or constitutional. Again it is not quite clear whether the hormonal pattern of constitutionally delayed puberty is identical with normal puberty, except for timing, or whether there are also some characteristic endocrine differences.

The delayed adolescent boy has many disadvantages. Compared with his peers, he falls behind in size and strength, and faces teasing and sometimes physical harassment by peers. If he is not able to keep up with his peers in some way, he may withdraw, which usually implies missing out on all the typical experiences of one’s age group and having less of an opportunity of acquiring the teenage skills of same-sex socializing and heterosexual contact and bonding. These transient developmental deficiencies may have long-term effects. Several longitudinal studies in which late maturers were compared to early (not precocious) or normal maturers, like the classical California Adolescent Growth Study, found not only the described disadvantages of late pubertal development during adolescence but also relative delays in their career status and “organizational leadership” as well as in marriage and number of children in adulthood. Unfortunately, information on the sexual behavior of these subjects was not published. Clinical studies of severe forms of delayed puberty show both psychological and psychosexual delay to be present, though it is difficult to disentangle the influence of pubertal delay per se from other contributing factors, especially the short stature resulting from the delayed growth spurt.


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