Going through puberty

Puberty is an important time when you are growing as it is the time that you grow quickly and at the end of puberty several years after starting is when you stop growing. Doctors will therefore be watching for when you go into puberty. Sometimes in young people with CAH it can happen at the right age and sometimes it can happen a little too early so needs stopping for a short while.

Why can some young people have a problem going through puberty too early?

In CAH you produce too much of the adrenal hormones called androgens, the most famous of which is testosterone, testosterone is the main hormone of puberty but in puberty it comes from your testicles not your adrenal glands. If the adrenal gland is producing too much testosterone because you have just been diagnosed or your hydrocortisone medication is not keeping the levels low it can give you changes usually seen in puberty and also kick start your puberty early by waking up your pituitary gland increasing the gonadotrophins, Luteinizing hormone and follicle stimulating hormone, LH and FSH for short which drive your testicles to make testosterone.

Mostly your pituitary gland and testicles are healthy it is just the hormones from the adrenal gland that are wrong. One possible exception to this is if your androgen levels are really out of control you can get lumps in your testicles.

How will I know if I am going to have a problem with my puberty?

Boys go into puberty at different times so you may notice that other boys at school are developing even from the age of 9. The first sign in boys is testicles getting larger, the first thing you might notice is hairs around your penis and then your penis getting bigger and you growing taller quickly. If you develop any of these signs before the age of 9 that is too early.

The doctors and nurses will keep a check on how you are growing and if you are showing any signs of puberty. They will also check your androgen levels, androstenedione, 17OHP and testosterone. They will also do a Xray of your hand and wrist every now and then to check the age of your bones.

What if my puberty starts too early?

There are two reasons to stop puberty if it starts too early. The first is you won’t be developing at the same time as other boys at school which might make you feel a bit different and uncomfortable. The second reason is that towards the end of puberty you stop growing so if you start early the earlier you will stop growing and the shorter you will be when you are an adult.

To stop puberty the most important thing is to get those androgen levels down by getting the dose of hydrocortisone spot on. This may be something you have to help with by taking your medication as regularly as possible, and ask for help if you are struggling with this as it is really important. The doctors may also have to stop puberty by giving you an injection that puts the hormones (LH and FSH) from your pituitary gland back to sleep until the right time which is usually just before you are a teenager.

Questions you could ask your doctor or nurse

  • Do you think I will start puberty early?
  • How tall will I be when I am an adult?
  • Do I have lumps in my testicles?