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Delayed puberty is defined as the absence of physical signs of sexual maturity by age 13 in girls (no breast development) or age 14 in boys (no testicular enlargement). It affects secondary sexual characteristics including pubic hair, breast growth, testicular development, voice changes, and height spurt. The condition is more common in boys and often runs in families.

The most frequent cause is constitutional delay—a normal variation where puberty starts later but eventually progresses normally, often inherited from parents. Other causes include chronic illnesses (diabetes, cystic fibrosis, kidney disease, celiac disease), malnutrition or eating disorders, excessive exercise, chromosomal abnormalities (Turner syndrome in girls, Klinefelter syndrome in boys), and problems with the pituitary gland, hypothalamus, thyroid, or gonads.

Symptoms include no breast growth by age 12 in girls, no periods by age 15, no testicular enlargement by age 14 in boys, and no pubic hair by age 15. Diagnosis involves blood tests for hormone levels, hand X-rays for bone age, and sometimes MRI or CT scans.

Treatment addresses underlying causes or uses short-term hormone therapy (testosterone or estrogen) to trigger puberty when psychological distress occurs. Most adolescents develop normally eventually, but emotional support helps manage stress and embarrassment.