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Adolescent Medicine

  Adolescent Growth and Development

Physiology of Pubescence

Physical Development

The first sign of pubescence in males in usually testicular enlargement (normal age of onset is 11.5 years with a range of 9-14 years)

The first sign of pubescence in females is usually breast bud formation (normal age of onset has a range of 8-14 years)

  Secondary Sexual Characteristics

Males - testicular growth, pubarche, penile growth, peak height velocity

Females - breast budding, pubarche, peak height velocity, menarche

Menarche usually occurs around 2 years after thelarche (usually SMR 4)

The height of girls will rarely increase more than two inches after menarche

Tanner Staging of Breasts

Stage 1 - no palpable glands

Stage 2 - breast bud develops directly below areola

Stage 3 - gland is larger than areola

Stage 4 - "mound on mound" configuration with glands in areolar region elevated separately from the other glands

Stage 5 - mature breast with flat areola


Gynecomastia occurs very commonly in pubertal males.

Pubertal gynecomastia can be asymmetric and not indicate pathology.

Gynecomastia can cause a change in dressing habits and physical activity.

Usually resolves in 1 to 2 years, and it rarely needs plastic surgery for correction.

Stages of Pubic Hair DevelopmentIcon

Stage 1 - no hair

Stage 2 - few straight hairs around base of penis or on labia majoris

Stage 3 - dense hair in circumscribed limits

Stage 4 - dense, curly hair in mons pubis area out to thighs

Stage 5 - hair extending laterally onto thighs or upwards toward umbilicus

Stages of Testicular DevelopmentIcon

Stage 1 - prepubescent, child-like, < 4 mL volume

Stage 2 - enlargement, usually first sign of pubescence, 4 to 6 mL volume

Stage 3 - proliferation of seminiferous tubules, 8 to 10 mL volume

Stage 4 - 10 to 15 mL volume

Stage 5 - 15 to 25 mL volume

IconPsychosocial DevelopmentIcon

Characteristics of Adolescent Psychosocial Development

Psychosocial StagesIcon

Rapid body changes affect self esteem.

Evaluation of family dynamics requires one to look for sources of stress and also predominant modes of coping with stress.

Family influence influences early modeling health behaviors, such as smoking, drinking, conflict resolution and violence.

IconCharacteristics of Early AdolescenceIcon

11-13 through 14-15 years of age

Preoccupation with body changes in search for identity

Minor parental conflicts and rebellion common

Peers are usually same sex and age, peer acceptance paramount

Concrete cognition

Beginning to seek independence

Limited dating

Limited ability to imagine the consequences of risky behavior

Limited ability to link cause and effect in regard to health behavior (eg, smoking, reckless driving, overeating)

Attachment to non-parental adults is common

Characteristics of Middle AdolescenceIcon