Pubertal disorders

​​​​​​Emergency

If any of the following are suspected, seek emergency medical advice or refer the patient to the emergency department (via ambulance if necessary)

When public outpatient services are not routinely provided

  • ​​​​Presence of fine downy and non-pigmented short hair (i.e. not considered secondary sexual pubic hair) in the supra pubic area or generalised hypertrichosis without other features of puberty​.

Criteria to access public outpatient services

CategoryCriteria
Category 1
Recommended to be seen within 30 calendar days.

  • Females aged < 5 years with early onset of breast development and concerns of true precocious puberty (rather than benign premature thelarche)
  • Males aged < 8 years with early onset of testicular enlargement (> 4 mL or > 2.5 cm) and/or penile enlargement ​
​Category 2
Recommended to be seen within 90 calendar days.
  • Delayed puberty indicated by any of the following features:
    • Males aged > 14 years with no testicular enlargement (> 4 mL or < 2.5 cm)
    • Females aged > 13 years with no breast development
    • Females aged > 15 years with no menses
  • Precocious puberty indicated by any of the following features:
    • Breast development in females aged 6-7 years
    • Pubic hair development in females aged < 7 years or males aged < 8 years

Category 3
Recommended to be seen within 365 calendar days.

  • ​All other referrals for pubertal concerns including syndromal causes of abnormal puberty (e.g. XO, XXY)

Information to include within a referral

Required

  • Reason for referral
  • Details of the presenting condition, including symptoms and their duration
  • Provisional diagnosis
  • Patient health summary (such as relevant medical history, relevant investigations, current medications and dosages, immunisations, allergies and/or adverse reactions), including specifically:
    • Age of onset of breast development (females) or pubic hair development (females or males)
    • Age of menarche (females)
    • Puberty state (absent or stalled)
    • History of pituitary or gonadal problems
    • Family history (including parent height and pubertal timing)
    • Examination findings, including Tanner staging of breast development or testicular volume
    • Serial measurements of height, weight and body mass index (over 6-12 months is preferred)
    • Bone age X-ray
    • Lutenising hormone (LH) and follicle-stimulating hormone (FSH)
    • Testosterone (if increase in testicular size or pubic hair)
    • Oestradiol (if breast development)
    • Early morning 17 hydroxyprogesterone (17-OHP) and dehydroepiandrosterone sulphate (DHEAS) (if increase in pubic hair)

If available

  • Thyroid stimulating hormone (TSH)
  • Free thyroxine (fT4)
  • Chromosome microarray

Important information for referring health professionals

If there is a change to a patient’s condition while waiting for their appointment, referring health professionals may further investigate and manage the situation, or send an updated referral to the outpatient service. Where there are significant concerns about a patient's condition, referring health professionals may check HealthPathways for urgent/same day advice or contact the relevant clinical team. 

Current as at: Monday 23 March 2026
Contact page owner: System Purchasing