In the past GP’s have been very quick to dismiss boys of 15-16 who have not started puberty as “late developers” and just to wait and see what happens. This can in fact lead to serious social or psychological disadvantages if the person still does not enter puberty when virtually his entire peer group has completed puberty.

An article published in 2005 in the British Medical Journal (BMJ) stated that if a boy has shown early stages of puberty by 15 (a testicle size of 4ml) then everything can be considered “normal”. However this might not be true. Dr Richard Quinton from University of Newcastle is a consultant endocrinologist and a leading specialist in Kallmann syndrome and HH.

Dr Quinton suggests this is incorrect and that any boy who has not shown any stage of puberty by the age of 15 should be referred to an endocrinologist.

It might just be that a boy is late developing, but an endocrinologist would be able to assess this at an early stage. Waiting a few more years before referring could waste valuable time and increase the boys feeling of being left behind his social and peer group.

The standard test for testicular development is the Prader orchidometer, where the testes are compared to a series of beads of different volumes to assess their size. The standard expected volumes are:

Pre-puberty 1 to 3ml
Early puberty 4ml
Mid puberty 8 to 10ml
Adult 15 to 25ml

Click on this link to read the letter published in the British Medical Journal in 2005.

http://bmj.bmjjournals.com/cgi/content/full/330/7494/789