DS14 should I be asking for a 2nd opinion

[TAQuestion]

DS has what would be considered delayed puberty, he’s 14 and no major signs suggesting it kicking in. Went to our GP about it 2 weeks ago although he seemed to brush it off a bit despite my concern. Should I be pushing for a 2nd opinion? My son is getting worried especially at school in year 10 all his peers are clearly in full puberty swing.

You don't need a second opinion, just insist that your concerns are taken seriously.

We took our 15 yo DS to the GP about this recently. He was referred for blood tests and a hand x ray which is done to see if their bone growth age matches their chronological age. We saw a paediatrician at our GPs surgery to discuss the results, which were kind of inconclusive so then he was referred to an paediatric endocrinologist at the hospital.

I’d go back again too for bloods at the very least. How’s his height in relation to his peers. I found it easier to get in the system for slow growth rather than delayed puberty but ultimately ended up with the same tests. My DS had a 12-18 month delayed bone age.

He’s also 14 and in year 10 with puberty only just starting.

At 14 it's still within normal range. We had to wait until 16 with dd for a referral, in reality as she approached her birthday things started to develop and she started periods at 16 and 5 months ... late for now but not historically. The dr should be giving guidance on when it is appropriate to return for further advice but i wouldn't expect a hospital referral at 14 unless there's other indicators, it's simply some dc develop later

Kids develop at different stages, I wouldn't necessarily be concerned. When did he turn 14? My son is 14 some of his friends look a bit young, like him. Others look more like they are 17!!!!

At 14, no at 16. Yes.

The GP said it’s still too early for any investigation or intervention, however at 14 that feels rather late? How did it go with the paediatric endocrinologist?

Has he any sign of puberty at all? Any hair at all? Is he small? When did he turn 14?

if he recently turned 14, has a bit of hair and is small still then I don’t think they’d worry because it’s still within realms of normal.

I’ll enquire about bloods, honestly are GP isn’t the best and there has been conplaints from people I know in the past, he seems more concerned of getting you out of the practice more than anything. He says he’s one of the smallest boys in his form and that a lot of year 7s and &s are taller which makes him feel embarrassed, I’ve been having talks with him to try and make him feel better but it’s clear he’s getting a bit fed up, although it’s definitely possible he is just slow growth, I’ve read it can match parental growth rate and I didn’t get my period until about 13

He turned 14 last April so not close to 15 really, but yeah you are right it is a weird random time, going to parents evening my jaw drops when I see year 10s walking round with full on beards!

Don’t know how much to say but ultimately not much in the way of signs no, last April

Well I think if you go about height, or slow growth, the GP will log the measurements. Hopefully things will just start to happen but if not go back to the GP and if still no growth spurt they will refer you.

My DS has the misfortune to have a load of mates who have gone through puberty early and looked likes blokes next to him. It helped my DS to find out the reason- delayed bone age in his case- and to know he’ll keep growing after they have stopped. He was also reassured to know puberty had started from the blood test results although there were no physical signs at the time. Anyway 4 months later, he’s grown about 3cm, got some spots and about 2 hairs in one armpit. Progress!

Similar thing with my friends son. He was checked out and all ok but didn't actually go through puberty until he was in sixth form. However his mum went through puberty late too. Not sure if there's a connection.

I may go back and change my context to asking about his bone growth and getting some bloods done. Then if nothing comes from that let nature (hopefully) take its place. Glad to hear it worked out for your son, has his voice changed at all? I assumed that would be the first sign

My son seems to have started puberty early at age 11. His first sign was hair down below.

he’s 12 now and his voice is now breaking, he has some spots and about 2 hairs under each armpit.

Not sure if that’s the same order for all boys though.

how tall is your son?

How tall is he?

Does sound a bit early of a start but I’m no expert and sounds like he’s getting on well. He’s hovering around 5ft 2

My eldest was 14 when he started needing deodorant. The hair began at 15. He had a growth spurt at 16. He's now 5ft10.

I was a late developer (periods started at 15) and so was his father. So we weren't unduly worried. But if you are concerned do see another GP.

The testicles starting to get bigger is the most important sign for early puberty in boys and can precede the more obvious physical findings by a bit. If that has started, relatively unlikely there will turn out to be anything too nasty going on. Often this is not something boys tell their parents let alone want them to check, but he may have realised if there has been growth there.

If things seem delayed, likely your GP would refer to your local paediatricians who will have a guideline about who needs to be seen and if any extra investigations needed. They may recommend certain tests while on the waiting list, or see them first. The purpose of the tests is largely "hormonally, has puberty started yet? Does that match up with the physical features? Is there reason to worry about a medical underlying cause?".

If it hasn't started yet, likely response would've to watch and wait if there are no worrying signs - most delayed puberty in boys is "constitutional" ie genetic and it's rare to give medical treatment just to start the process "on time".

If your son is being seen by doctors, the most helpful thing you can do is prime him before the consultant that they will need to fully examine him, including testicles. Also if you have some height measurements as accelerated growth is a useful clue.

@TAQuestion she said his bone age was 18 months behind his chronological age but that was not a problem and it means he has more growing to do. Also, much to his embarrassment, she checked his testicles and they are the "right' size.

We are seeing her again in 6 months.

It was important to me to get him checked out as I have a terminal illness and didn't want this to be overlooked with everything that is going on with me. Were I not in that position I think I'd still be pushing for blood tests and an x ray so at least you have a baseline.

@TwigTheWonderKid that’s all good! Hope everything works out for you all, hopefully it’s just delayed and nothing more. Not comfortable saying here but in terms of testicle development that has been a concern in a way, so if I am to go back I think I’d push for a full examination as well as bloods

The NHS website definitely says that investigations should be done if puberty hasn't kicked in by 14, so if he is nearly 15 then it is time.

https://www.nhs.uk/conditions/early-or-delayed-puberty/#:~:text=But%20it's%20perfectly%20normal%20for,not%20started%20by%20around%2014.

Oddly I can't find any reference at all to delayed male puberty in the nice guidlines, which is the document the GPs follow. There is a section for delayed female puberty but nothing about boys that I can see.

Here is a document explaining what the GP should be doing.

https://www.nn.nhs.scot/speg/wp-content/uploads/sites/36/2024/03/NSD610-016.19-SPEG-Precocious-Delayed-Puberty.pdf

Thank you!

okey dokey.

All it says is that if testicular volume is less then 4ml and there is no accelerated height growth, or the child is short compared to the family, then he should be referred to secondary care at 14.

I have no idea how to measure "testicular volume" but I would guess that it should be pretty obvious if things are under way, growth-wise.

I wonder if the GP's reluctance may be related to long delays in secondary care?