Puberty: Stages, Timing, Hormones and Support
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer: What is puberty?
Puberty is the developmental period when a child’s body and brain-related systems go through hormonal and physical changes toward sexual maturity. It typically follows five Tanner stages, but the age, pace and visible changes differ from child to child. It begins when the hypothalamus starts producing GnRH, which signals the pituitary gland. [1]
Core idea | Plain-language meaning |
Development | The body matures and develops adult characteristics. |
Hormone trigger | The hypothalamus begins producing GnRH. |
Main hormone pathway | GnRH signals the pituitary gland; LH and FSH act on the gonads. |
Typical start | Ages 8–13 for children with ovaries and 9–14 for children with testes. |
Staging | Tanner staging describes secondary sex characteristics in five stages. |
Variation | Timing and sequence vary; the stages are a general guide. |
Support | Information, reassurance, privacy, boundaries and professional review can help. |
What the research says
Puberty is starting earlier in girls. A systematic review and meta-analysis of 30 studies (selected from 3,602 screened) found that the age at thelarche, the start of breast development, fell by about 0.24 years (almost 3 months) per decade between 1977 and 2013 (95% CI −0.44 to −0.04). The authors note that the traditional definition of precocious puberty may be outdated in some regions of the world (Eckert-Lind et al., JAMA Pediatr, 2020). [2]
Earlier maturation is linked to small increases in emotional and behavioral problems. A meta-analysis of 101 articles found that early pubertal timing was associated with more psychopathology in both males and females across all domains studied, with small effects (Cohen’s d about 0.20). Sex did not change the size of the effect. This is an average across many studies, not a prediction for any individual child (Ullsperger & Nikolas, Psychol Bull, 2017). [3]
What is puberty?
Puberty is a natural part of development in which a child’s body goes through physical and hormonal changes to reach sexual maturity. It also involves emotional and mental changes. [1]
Puberty is the body’s way of physically becoming an adult. Major organs and body systems mature, and the body becomes capable of sexual reproduction. The brain continues developing and maturing into the mid-to-late 20s. [1]
This article uses “children with ovaries” and “children with testes” to describe timing and hormone patterns by organ type. Body changes can differ for children taking puberty blockers or feminizing or masculinizing hormone therapy.
How does puberty start?
Puberty starts when the hypothalamus, a part of the brain, begins producing GnRH. GnRH travels to the pituitary gland and stimulates it to release LH and FSH. [1]
LH and FSH travel to the gonads, meaning the ovaries or testes. They trigger the gonads to release sex hormones, either estrogen-related hormones or testosterone. These messenger hormones cause the familiar signs of puberty to begin. [1]
Step | What happens |
1. Hypothalamus | Begins producing GnRH. |
2. Pituitary gland | Releases LH and FSH after GnRH stimulation. |
3. Gonads | Ovaries or testes respond to LH and FSH. |
4. Sex hormones | Estrogen-related hormones or testosterone help trigger puberty changes. |
When does puberty start and end?
The typical ages are broad ranges, not fixed deadlines. Puberty usually starts between ages 8 and 13 for children with ovaries and between ages 9 and 14 for children with testes. [1]
It typically lasts two to five years. It usually ends around ages 15 to 17 for children with ovaries and around ages 16 to 17 for children with testes, but individual timing varies. [1]
Developmental pattern | Typical timing |
Start for children with ovaries | Usually ages 8–13. |
Start for children with testes | Usually ages 9–14. |
Typical duration | Two to five years. |
Typical end for children with ovaries | Around ages 15–17, with variation. |
Typical end for children with testes | Around ages 16–17, with variation. |
Brain development | Continues into the mid-to-late 20s. |
What are Tanner stages?
Tanner staging, also called Sexual Maturity Rating (SMR), is a classification system healthcare providers use to document and track secondary sex characteristics during puberty. It has five stages. [1]
Tanner staging is a general guide rather than a strict rule. Each child develops at a different rate, and the timing of one physical change does not predict the exact timing of every other change.
There are separate staging patterns for breast and pubic-hair changes in children with ovaries and for genital and pubic-hair changes in children with testes. [1]
What puberty changes happen in children with ovaries?
Puberty in children with ovaries follows common patterns, including breast budding, pubic hair growth and the start of periods. Individual development varies.
Stage | Common changes |
1 | Prepubertal; the adrenal glands mature and the ovaries grow. |
2 | Breast budding, areola enlargement, sparse pubic hair, height increase, clitoris enlargement, uterine growth and possible body odor. |
3 | Continued breast development, armpit hair, more pubic hair, a growth spurt and oilier skin or acne. |
4 | Continued breast growth, a separate areola mound, numerous pubic hairs, continued growth, possible acne and the beginning of menstruation for many. |
5 | Final development; pubic hair may extend toward the thighs and height may continue to increase for some people. |
Menstruation often begins around age 12 in Stage 4, but some children start earlier or later. Periods usually begin about two years after breast budding or pubic-hair growth. If menstruation has not started three years after puberty began, make an appointment with the child’s healthcare provider. For a closer look at the first period, see our guide to menarche. [1]
What puberty changes happen in children with testes?
Puberty in children with testes follows common stages, and some boys have temporary breast development along the way. Individual development varies.
Stage | Common changes |
1 | Prepubertal; the adrenal glands mature. |
2 | Testicle and scrotum growth, sparse hair near the penis and underarms, height increase, body-composition changes and possible body odor. |
3 | Continued penis and testicle growth, possible nocturnal emissions, darker and coarser pubic hair, more sweating, voice changes and increased muscle mass. |
4 | Further genital growth, scrotal and testicular skin changes, adult-level body hair, a peak growth spurt, acne and continued voice changes. |
5 | Final physical development; facial hair may appear, and growth may continue into the early 20s for some. |
Temporary breast development occurs in about 50% of boys in Stage 3 and typically resolves by the end of puberty. If it causes physical or social concerns, discuss it with the child’s healthcare provider. [1]
What hormones are involved in puberty?
Several hormones coordinate puberty.
Hormone | Role in puberty |
GnRH | Starts the puberty hormone pathway. |
LH | Stimulates ovarian cells to produce estrogen-related hormones and testicular cells to produce testosterone. |
FSH | Stimulates estrogen production in the ovaries and helps cells in the testicular seminiferous tubules create sperm. |
Testosterone | The main sex hormone in boys; contributes to growth, body and pubic hair, genital and prostate enlargement and increased libido. |
Estrogen | The main sex hormone in girls; contributes to breasts, body-composition changes and menstruation with other hormones. |
Progesterone | Contributes to breast changes, menstruation and healthy pregnancy. |
Androgens | Adrenal-gland hormones that contribute mainly to pubic and underarm hair. |
To see how the master glands behind this pathway work, read our guides to the hypothalamus and the pituitary gland.
How does puberty affect emotions?
Puberty can bring emotional and social changes as well as physical changes. Sex-hormone surges and social pressures may contribute to moodiness, emotional outbursts and family conflict. [1]
A child may also experience confidence concerns or complex feelings related to identity and sexuality, including desire, confusion or fear. These experiences can be difficult to discuss, but reassurance and respectful listening can help.
Serious anxiety, depression, extreme mood swings or aggression merit professional attention. Psychotherapy and/or medication may help when serious emotional or behavioral problems arise. Learn more about anxiety disorders and clinical depression. [1]
What are early and delayed puberty?
The two main puberty-related concerns are precocious (early) puberty and delayed puberty. Possible contributors include nutritional deficiencies such as eating disorders, environmental exposure to hormones, tumors that affect hormone production, genetic conditions and cases with no known cause. [1]
Precocious puberty
Healthcare providers consider precocious puberty to be the onset of Tanner Stage 2 secondary sexual characteristics before age 8 in children with ovaries or before age 9 in children with testes, when later stages follow soon afterward. See our full guide to precocious puberty. [1]
Delayed puberty
Delayed puberty is described as no Tanner Stage 2 breast development by age 13 in children with ovaries or no Tanner Stage 2 genital development by age 14 in children with testes. See our guide to delayed puberty in children. [1]
Primary amenorrhea, meaning lack of a menstrual period, may be diagnosed if menstruation has not started within three years of Tanner Stage 2 or by age 15. [1]
These thresholds are reasons to discuss development with a healthcare professional, not tools for self-diagnosis.
When should a child see a healthcare professional?
Discuss puberty with a child’s healthcare professional when development appears much earlier or later than the typical ranges.
Professional input is also recommended for heavy acne that will not go away (see our acne guide), pain associated with growth spurts, signs of depression or anxiety, irregular periods beyond the first year of menstruation, or more than mild period pain and cramping. [1]
Additional timing prompts are signs of puberty before age 9 or no signs by age 14 in a child with testes, and signs before age 8 or no signs by age 13 in a child with ovaries.
How can caregivers support a child through puberty?
Caregivers can explain the bodily changes a child may experience and provide age-appropriate education about sexual reproduction, consent and safer sex. Reassurance can help when a child feels fear, confusion or other complex emotions. [1]
It also helps to model body acceptance and a healthy lifestyle, respect privacy and growing independence, and step in when there are safety issues or boundaries to set. [1]
Supportive action | Why it matters |
Explain expected changes | Reduces surprise and supports informed conversations. |
Discuss consent and safer sex | Provides age-appropriate safety education. |
Offer reassurance | Supports children through fear, confusion and complex emotions. |
Model body acceptance | Helps create a respectful environment for changing bodies. |
Respect privacy and independence | Acknowledges growing autonomy. |
Set safety boundaries | Helps respond when safety concerns arise. |
Conclusion: puberty is a varied developmental process
Puberty is a natural period of physical, hormonal, emotional and mental change. The hypothalamus, pituitary gland and gonads coordinate a hormone pathway that leads to sex-hormone production and secondary sex characteristics. [1]
Tanner staging offers a five-stage framework, but timing and progression differ widely. A child may develop earlier or later than peers and still fall within their own normal pattern. [1]
Information, reassurance, privacy, body acceptance and respectful conversations about consent and safety can make the process easier. When timing, physical symptoms or emotional changes raise concern, a child’s healthcare professional can evaluate development and discuss next steps. [1]
Use this guide to prepare questions for a pediatric healthcare professional. Puberty education should support, not replace, individualized care and listening to the child. [1]
Frequently Asked Questions
What is puberty?
Puberty is the natural developmental period when the body goes through physical and hormonal changes toward sexual maturity. It also includes emotional and mental changes.
How does puberty start?
The hypothalamus begins producing GnRH. GnRH signals the pituitary gland to release LH and FSH, which act on the ovaries or testes and lead to sex-hormone production.
How many stages of puberty are there?
There are typically five Tanner stages. Tanner staging is a general guide used to document secondary sex characteristics, not a strict rule.
When does puberty usually start?
Typically between ages 8 and 13 for children with ovaries and between ages 9 and 14 for children with testes.
How long does puberty last?
Puberty typically lasts two to five years, but the pace varies.
When does puberty end?
It typically ends around ages 15 to 17 for children with ovaries and ages 16 to 17 for children with testes, with individual variation.
What changes can happen during puberty?
Changes can include growth, body hair, breast or genital development, acne, body odor, voice changes, menstruation, nocturnal emissions, body-composition changes and emotional development.
What hormones control puberty?
GnRH, LH, FSH, estrogen-related hormones, testosterone, progesterone and adrenal androgens all play roles in puberty.
What is Tanner staging?
It is a five-stage system, also called Sexual Maturity Rating, that healthcare providers use to document and track secondary sex characteristics.
Is Tanner staging a strict timetable?
No. There is a wide range of normal timing, and every child develops at their own rate.
What is precocious puberty?
It is the onset of Tanner Stage 2 secondary sexual characteristics before age 8 in children with ovaries or before age 9 in children with testes, when later stages follow soon afterward.
What is delayed puberty?
It is described as no Tanner Stage 2 breast development by age 13 in children with ovaries or no Tanner Stage 2 genital development by age 14 in children with testes.
When should a child’s development be checked?
Discuss much earlier or later development, heavy acne that does not resolve, growth-related pain, serious emotional symptoms, persistent irregular periods or more than mild period pain with a healthcare professional.
Is temporary breast development during puberty common in boys?
It occurs in about 50% of boys in Stage 3 and typically resolves by the end of puberty. Physical or social concerns should be discussed with a healthcare professional.
How can caregivers support a child through puberty?
Explain expected changes, discuss reproduction, consent and safer sex, offer reassurance, model body acceptance, respect privacy and independence and set appropriate safety boundaries.
Does the brain finish developing during puberty?
No. The brain continues to develop and mature into the mid-to-late 20s.
Can puberty vary for children receiving hormone therapy or puberty blockers?
Yes. Children taking puberty blockers or feminizing or masculinizing hormone therapy may experience different bodily changes.
Related reading
Precocious Puberty: Complete Guide to Signs, Causes, and Treatment
Delayed Puberty in Children: Causes, Signs, and Treatment Guide
Understanding Menarche: A Guide to the First Menstrual Cycle
Pituitary Gland: Anatomy, Hormones, Function and Related Conditions
Understanding the Hypothalamus: The Brain’s Homeostasis Center
Acne: Complete Guide to Symptoms, Causes, Diagnosis, and Treatment
Anxiety Disorders: Symptoms, Types, Causes, Treatment & Complete Guide
References
Cleveland Clinic. Puberty: Tanner Stages for Boys and Girls. Cleveland Clinic. Updated August 26, 2024. https://my.clevelandclinic.org/health/body/puberty
Eckert-Lind C, Busch AS, Petersen JH, et al. Worldwide Secular Trends in Age at Pubertal Onset Assessed by Breast Development Among Girls: A Systematic Review and Meta-analysis. JAMA Pediatr. 2020;174(4):e195881. PMID 32040143. https://doi.org/10.1001/jamapediatrics.2019.5881
Ullsperger JM, Nikolas MA. A meta-analytic review of the association between pubertal timing and psychopathology in adolescence: Are there sex differences in risk? Psychol Bull. 2017;143(9):903-938. PMID 28530427. https://doi.org/10.1037/bul0000106
Disclaimer
This article is for general educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare professional with any questions about a medical condition or treatment.
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