How should the genitals develop in boys. Pediatric endocrinologist. Sexual development of boys. What are the consequences of early puberty

The puberty of a man is identified with his fertility, that is, the ability to conceive. In fact, this is a combination of the development of primary and secondary male characteristics, indicating the transformation of a boy into an adult man. The puberty of a boy takes place in several stages. The peculiarity of the manifestation of sexual characteristics on each of them lies in the tendency to increase.

Male sexual development begins in the womb. At the 16th week of pregnancy, the formation of the reproductive organs - the penis, scrotum and testicles - ends. With the physiological development of the fetus a few weeks before birth, the testicles descend into the scrotum.

The second stage of sexual development is called childhood. There is a physiological growth of the skeleton, muscles, organs. The boy has rounded "childish" facial features, sloping body shapes. The period lasts 9–11 years from the moment of birth.

If the boy's endocrine system is working normally, puberty begins at the age of 11-12. Due to the individual characteristics of the child's body, hereditary predisposition, environment, the terms vary within 1-2 years. The manifestation of the first signs at the age of 10-13 is considered the norm.

There are 3 stages of puberty:

• The initial stage (pubertal period, puberty) is the preparatory stage of the body. External signs are the accelerated growth of the boy: the pituitary gland produces somatotropin and follitropin, which stimulate the growth of the skeleton. The production of gonadoliberin, a pituitary hormone that activates the work of the sex glands and the synthesis of sex hormones, begins. The influence of gonadoliberin is manifested by the growth of the genital organs. The average age of onset of puberty in boys is 11–12 years.
• Active puberty begins in a boy at the age of 13-14 and lasts 2-3 years. Gonadoliberin, previously produced only at night, is now produced by the pituitary gland around the clock, stimulating the production of testosterone. Due to its increased concentration in the blood, an intensive growth of the genital organs is observed, secondary sexual characteristics appear, the boy has the first ejaculation.
• The final stage of puberty covers the age from 16-17 to 18-19 years. The boy's body adapts to the production of sex hormones. The reproductive system is ready for procreation. The figure of a young man is finally formed, growth stops.

The acquisition of puberty affects the physiological and psychological aspects of the development of a teenager. During this period, it is important to control the boy's health, as well as his sexual education.

signs

During puberty, guys have an active development of primary sexual characteristics - the growth of the testicles and penis. From birth to the onset of puberty, the size of the testicles changes imperceptibly. Active growth of the genital organs is observed in boys from 11 years of age with an increase in the concentration of androgens in the blood. The appearance of the scrotum changes: the smoothness of the skin is lost, pigmentation and coarse hairs appear. The enlargement of the penis in a boy follows the enlargement of the testicles.

The first erections appear in future men at the age of 12-13 years with a feeling of sexual desire. At the age of 14, the seminal vesicles begin to produce sperm. There is an enlargement of the prostate gland and secretion by it. A clear sign of a boy's puberty is nocturnal emission, which means the young man is ready to conceive a child.

Secondary sexual characteristics appear in a boy with an increase and depend on the activity of the gonads:

• Hair growth. One of the first manifestations of puberty is the appearance of hair at the base of the penis with subsequent spread to the pubis. There is hair growth in the center of the abdomen, in the inguinal folds, armpits. The first hair on the boy's face is noticeable at 14-15 years old. The fluff is located above the upper lip, near the ears. The next place for hair growth is the inner thighs, chest. At the end of puberty, facial hair growth forms a mustache. Following them, the appearance of dense hair on the cheeks is noticed.

• Active growth. The first acceleration of growth is observed at the very beginning of maturation - 11-12 years. Under the influence of androgens and somatotropin, the boy grows by 10 cm. After the jump, growth is slowed down. The boy adds 7–8 cm in the active phase of maturation and another 4–5 cm at its end. At the age of 18–22 years, an increased content of estrogens in the blood causes ossification of the growth zones of long bones - growth stops.

• Physique change. The reason for the growth of the shoulder girdle and the stretching of the pelvic bones in a boy is an increased concentration of testosterone. There is a disproportionate increase in the limbs - first, the hands and feet increase, after which growth in height begins. For this reason, the boy may experience psychological discomfort, but the body quickly becomes proportional. In the active phase of sexual development, boys are thin. Muscle mass is gained closer to 17–19 years, when the hormonal storm passes.

• Voice change. A hormonal surge leads to an increase in the larynx due to the growth of the thyroid cartilage in the boy. As a result, the stretched vocal cords produce sounds of different tonality, which is popularly called "voice mutation". By the age of 17, the thyroid cartilage increases to the maximum, forming the "Adam's apple", and the strengthened ligaments emit stable sounds, called the male timbre.

• At the end of puberty, the boy's facial features change. This happens due to the growth of the jaws. Childish roundness gives way to masculine angularity.
• Hormonal surges in the boy's body cause an increase in the intensity of sweating, the acquisition of a characteristic odor later, and an increase in the activity of the sebaceous glands of the skin. As a result, 14–15-year-old teenagers develop acne and blackheads.

Elevated concentrations in the blood of female sex hormones - estrogen - provoke pitting in the boy's chest, as well as an increase in nipples. Symptoms of gynecomastia disappear on their own after a few months.

Deviations

If a boy under 9 years of age develops primary and secondary male sexual characteristics, we can talk about early puberty.

The reasons for the early onset of puberty are:

• Pathological development of the genital organs.
• Brain injury.
• genetic predisposition.
• Malfunctions of the thyroid gland.
• The appearance of tumors in the brain.
• Obesity.
• Infectious diseases in history.

Men who become sexually mature early have a strong sexual constitution. The dangers of early maturation of the boy lie in the cessation of growth due to the ossification of areas of enlargement of large bones. The negative point is the effect of powerful doses of sex hormones on the boy's body, which is not yet ready for such a surge. As a result, hormonal disruptions occur, there are violations of the work of all body systems.

Prematurity.

Premature maturation of the boy is manifested by too early enlargement of the genital organs, as well as the acquisition of secondary male characteristics: early voice mutation, intensive growth, hair growth according to the male type of hair growth.

Treatment is prescribed by an endocrinologist. To eliminate symptoms, androgen synthesis inhibitors are prescribed. Therapy continues until the physiological onset of sexual development.

Late puberty

If at the age of 13 the boy does not have an increase in the genitals, the endocrinologist states a delay in the onset of puberty. The condition is not considered pathological if the boy shows signs of puberty before the age of 15, and further sexual development occurs without deviations. When a 15-year-old boy does not have the first signs of maturation, the specialist states late sexual development. It can be provoked by:

• Chromosomal abnormalities.
• Disorders of the endocrine system.
• hereditary factor.

Late puberty is fraught for a man with underdevelopment of the genital organs and even infertility. The problem is corrected by replacement therapy with sex hormones, as well as the elimination of the underlying disease.

Prematurity.

What Parents Should Know

The process of male puberty involves physiological changes that affect the emotional state of the boy. It is important for parents to control both aspects of growing up. A disproportionate physique, a change in one's own smell, involuntary ejaculation - all signs of sexual development have a physiological explanation that must be conveyed to the maturing young man in an accessible format.

A boy's puberty takes a time period of 5-6 years. This is the time of the rapid transformation of a young man into an adult man. On the way to the formation of the son's personality, understanding and support from parents are important. Knowledge of the basic aspects of male physiology, as well as the psychology of adolescents, will help in this.

pubertal growth spurt

At the beginning of puberty, a pubertal growth spurt occurs: under the influence of sex hormones, the child's body grows and develops rapidly, girls turn into girls before our eyes, boys become young men. The physical development of girls and boys occurs at slightly different rates. In girls, it occurs more rapidly and spasmodically. They go through all stages of development before boys. In boys, this process is less intense and ends later than in girls.

At this time, the length of the body per year can increase by 7-12 cm. Girls usually overtake their peers-boys in growth and development. For girls, the jump occurs on average at 10-11 years old, for boys - at 13 years old. After reaching the peak of the growth rate, its rapid slowdown and cessation are observed (for girls - after 16 years, for boys - after 18 years). The maximum growth rate of adolescents is observed in spring, and the maximum rate of weight gain is observed in autumn. The intensity and duration of this jump is different for each teenager. Boys “catch up” and sometimes outstrip girls in development, as a rule, only by the last grades of school, while a boy of 17-18 years old is still growing, and a girl of the same age has already stopped growing.

Before the start of the growth spurt, the body shape of boys and girls is the same. But with the onset of puberty, under the influence of sex hormones, male and female body types begin to form. In boys, the width of the shoulders will exceed the width of the pelvis, while in girls it will be the other way around. Boys grow larger than girls.

Sometimes teenagers worry that their growth is very high or, conversely, low. The approximate final height of a boy can be calculated using the formula: (father's height + mother's height + 12.5) / 2 (cm), and for girls: (father's height + mother's height - 12.5) / 2 (cm). The prognosis of the development of the length of the daughter's body is more reliable according to the height of the mother, and the son - according to the height of the father. The prognosis of the daughter's body length is more reliable than that of the son. Normally, the target height of the child may vary within: the average height of the parents is ± 8 cm.

Prospects for a further increase in body length can be determined by radiographs of the hands. Evaluate the so-called growth zones in the bones of the fingers and wrist. If they are open, then the child will still grow.

Age-related changes in the body

The shape of the body and the rate of maturation of the reproductive system are determined by sex hormones. At boys This is testosterone produced by the testicles. It causes genital development and physical changes in a teenager's body, including an increase in muscle mass and bone maturation. The physique acquires typical male features - a wide shoulder girdle and narrow hips, relief muscles of the chest and back, and a male shape of the buttocks. There may even be temporary swelling of the mammary glands and nipples, followed by pigmentation of the areola.

All dates mentioned below serve as guidelines and are quite subject to individual fluctuations. The development of secondary sexual characteristics in boys on average covers the period from 10.5 to 18 years. First of all, at the age of 10.5-12 years, the testicles increase, at the age of 12-13, penis growth begins, pubic hair appears at the same time, after which other signs of puberty appear sequentially: voice mutation (13-14 years), growth of the thyroid cartilage (14-15 years), acne, axillary hair growth and the appearance of a characteristic smell of sweat (14 years), the beginning of facial hair (14-16 years). Some young men begin to shave so that such “vegetation” appears faster. The growth of the external genitalia is usually completed by the age of 17-18, although it is possible to continue their growth up to 20-25 years.

Major sex hormones girls are estrogens produced by the ovaries. They ensure the maturation of the genital organs and the development of the mammary glands. Androgen hormones are partly involved in the puberty of girls. Under the influence of sex hormones, the shape of the body is rounded, the chest increases, the pelvis becomes wider than the shoulder girdle. The external manifestations of the sexual development of girls cover the period from 9 to 17 years. With the onset of puberty in girls, the pelvis expands, the hips and buttocks become noticeably rounded, the mammary glands increase (9-10 years), for the full development of which it takes about 4 years. From 10-11 years of age, pubic hair begins, reaching a maximum in 2.5-3 years. The hair growth of the axillary regions begins 1.5-2 years after the pubic one and ends by the age of 18.

The first menstruation occurs between 9 and 15 years, most often at 12-14 years. The age of menstruation is mainly determined by the state of health, heredity and living conditions. At first, periods may be irregular and have a different duration. Gradually, menstruation becomes regular, occurs on average every 28 days and lasts 3-5 days.

The first wet dreams (involuntary ejaculation at night and in the morning, often accompanied by erotic dreams) occur at the age of 14 and in most young men become regular by the age of 16.

On average, over the period of puberty from 10 to 17 years, the body weight of adolescents increases by 34 kg in boys and 25 kg in girls, height - by 35 cm and 25 cm, respectively. Behind all these external changes is the intense activity of all organs and systems of the body.

In adolescence, the formation of the skeleton, nervous, endocrine and cardiovascular systems continues. Hence the characteristic clumsiness and angularity of adolescents, sudden mood swings, frequent complaints of adolescents about general weakness or even about the heart. But this is completely normal, since not all body systems develop evenly and, for example, an increase in the mass of the heart muscle (myocardium) may lag behind the increase in the total body weight of a teenager.

Functional indicators and physical development. The quality of physical development should be assessed during the annual preventive medical examinations of schoolchildren. For this, there are special tables with the parameters of length and body weight at each age. In order to reliably speak about the nature and correctness of physical development, it is necessary to measure the length and weight of the body every year. At the same time, it is necessary to take into account not only body parameters, but also functional indicators - speed and strength, according to testing at physical education lessons. Body dimensions and functionality (speed, endurance) do not always coincide.

Anastasia Pleshcheva: Welcome to the program "Hormones at gunpoint". And today we continue the series of programs "Children's Endocrinologist" and will analyze the sexual development of boys. My guest is Bolmasova Anna Viktorovna, who is a pediatric endocrinologist, candidate of medical sciences at the Scientific Center for Obstetrics, Gynecology and Perinatology named after Academician Kulakov. Hello Anna.

Anna Bolmasova: Hello.

Anastasia Pleshcheva: What hormones affect the sexual development of boys?

Anna Bolmasova: There is a hierarchy in the work of the endocrine glands. The main regulator of the production of endocrine glands is the hypothalamus and pituitary gland. They produce two main hormones: LH and FSH. These hormones have a target organ - the boy's testicles. As a result of stimulation, the testicles produce testosterone and other androgens, and gradually these androgens affect the body as a whole, and the boy gradually turns into a man. An integral part of sexual development are endocrine glands such as adrenal glands, they also produce androgens. This whole process is genetically determined, and there are clear laws that can be violated in various diseases. Accordingly, boys may experience delayed puberty or premature puberty.

Anastasia Pleshcheva: How do boys differ from girls in the entire hierarchy you are talking about?

Anna Bolmasova: If in the entire hierarchy, then they have a fundamental difference in the target organ. In girls, the target organ is the ovary, in boys, the target organ is the testicles. The ovaries and testicles produce fundamentally different hormones and their effects are different.

Anastasia Pleshcheva: What are the periods of sexual development in boys?

Anna Bolmasova: Between three and six months of age, there is a period of mini-puberty. This is when the level of LH, FSH and testosterone rises to about the same numbers that are in puberty. The reasons for this phenomenon and the need for such an increase are still unknown, this issue is being discussed. During this period, boys may experience erections, some mothers are afraid of this, but this is absolutely normal. Usually, by the age of one year, mini-puberty passes and the period of childhood begins, when the hypothalamus produces less LH, FSH, and there is no stimulation of the testicles. After the period of childhood, from about the age of nine, LH and FSH rise, their concentration increases, testicles are stimulated, and puberty begins.

Anastasia Pleshcheva: What do the signs of puberty look like?

Anna Bolmasova: In boys, sexual development begins with an increase in the volume of the testicles. There is a Tanner scale, which shows five stages. The first stage is a child, the fifth stage is an adult man. The second, third, fourth, fifth stages are periods of puberty. That is, the size of the testicles, the length of the penis, the amount of hair increase. Also, the boy's growth rate is accelerating, there is a change in the architectonics of the body: the size of the shoulders increases, a typical androgenic figure.

Anastasia Pleshcheva: How to understand that a child has begun puberty?

Anna Bolmasova: This is the growth of pubic hair, pigmentation of the scrotum and enlargement of the penis. These are the very first signs. The acceleration of growth rates sometimes coincides with the onset of puberty, sometimes it is somewhat delayed in time. The change in the timbre of the voice and figure is more delayed in time than the enlargement of the testicles and the appearance of hair.

Anastasia Pleshcheva: What age does each period correspond to?

Anna Bolmasova: It is believed that the normal range in which a boy should enter puberty is from 9 to 14 years. If a child starts sexual development before the age of nine, it is considered premature, if he does not show signs of sexual development, then this is considered delayed puberty. On average, puberty in boys occurs between the ages of 12 and 13, compared with girls, this is a little later. Girls are 11-12 years old. Often in the 9th grade it turns out that the girls have all grown up, matured, and the boys are still children. This is how nature works, it is a physiological thing.

If we take the literature over the past 100 years, then there is a tendency to accelerate sexual development, but the norms that are given are based on the results of modern ideas about the normative terms for the onset of sexual development.

Anastasia Pleshcheva: Let's discuss the delay in puberty.

Anna Bolmasova: If after 14 years the boys do not have the appearance of secondary sexual characteristics, then he has a delay in puberty.

It can be divided into transient delay of puberty, primary and secondary. Transient occurs most often, it is an institutional growth retardation of puberty. During the period of sexual development, the boy, in addition to changes in appearance, is accelerating growth. If puberty is delayed, then there is a delay in growth rates. For example, all the boys in his environment have already given a growth leap, but he has not yet started puberty and remains small relative to these children.

Anastasia Pleshcheva: The first sign that we can pay attention to is the growth of the child.

Anna Bolmasova: This is growth: everyone has grown, but he has not grown. Most of the cases are related to the fact that there is some kind of constitutional, family history in this regard.

Anastasia Pleshcheva: Can you somehow understand how high a child should grow?

Anna Bolmasova: There is a calculation formula for the final growth of the child. It is calculated as follows: mom's height, plus dad's height, plus 12.5 cm, and all this is divided by 2. If we have a girl, then we need not add 12.5 cm, but subtract. This is not an absolute figure, a range of plus or minus 5 cm is taken, the child must fall into this range. If we assume the final height, for example, 180 cm, and it is at the lower limit of the norm, this makes us think that something went wrong.

Anastasia Pleshcheva: The institutional feature that we often pay attention to is growth, but what about the constitutional one?

Anna Bolmasova: Usually in children who have constitutional growth retardation of puberty, one of the parents had late puberty. Not necessarily dad, if it's a boy, it can be mom. Such a child enters puberty later, but there is a line when it is necessary to differentiate this from the pathological form.

In addition, the transient form can occur with severe chronic diseases, with malabsorption syndrome, malabsorption disorders, and with oncological diseases. And also with inadequate nutrition, or inadequate energy consumption, athletes can suffer from this during strong physical exertion.

Anastasia Pleshcheva: Is it right to send a child to professional sports at an early age?

Anna Bolmasova: I, as an adherent of physiological dosages of physical activity, believe that any anti-physiological exercise is harmful, no matter what the achievements. But there must be some line, in addition to striving for success.

Anastasia Pleshcheva: When we say that we want to raise our child as an athlete, we must think that we may lose the health of the child. I urge everyone to go in for sports, but these should be correctly dosed loads under the supervision of doctors.

Anna Bolmasova: Sexual development can be indirectly affected by overweight, extreme obesity. This is our problem, which delays puberty.

Anastasia Pleshcheva: Over the period of your practice, is obesity common now?

Anna Bolmasova: Often.

Anastasia Pleshcheva: Has something changed, has it become worse or better?

Anna Bolmasova: Nothing has changed, everything remains the same, this is a short process. When looking at a person from the point of view of the biological species, there has never been such a large amount of carbohydrates in such access, there has never been such a low physical activity.

Anastasia Pleshcheva: Do you have schools on obesity in your center?

Anna Bolmasova: There is no school as such. I am now conducting the necessary examinations, we work with patients individually.

Anastasia Pleshcheva: Do you think schools are needed?

Anna Bolmasova: I believe that with a large flow of obese children, schools are needed. It's easier for them in society. Conversations go well when you set goals for the children for a month, how much to lose, to change their views. For the most part, this work is not so much with children as with parents.

Anastasia Pleshcheva: Are you enough alone, or do you immediately connect psychologists?

Anna Bolmasova: Psychologists have to be connected quite often, because sometimes parents come with completely casuistic options, when, say, mom, dad, grandmother are obese, and they come with a three-year-old child and ask: “What should I do? Where did it come from?

Anastasia Pleshcheva: I believe that schools are needed, endocrinologists, nutritionists need to come to them and tell. We don't have any special propaganda.

Anna Bolmasova: It seems to me that propaganda should still be at the level of a pediatrician, when the child was just born, so that, given such a carbohydrate-rich outside world, they know how to protect themselves.

Anastasia Pleshcheva: And what about malnutrition?

Anna Bolmasova: Children are underweight, but usually this is not the result of not being fed, it is the result of something with the intestines. Personally, I have two or three children a month at my appointment, this is not very often, but there are such children.

Anastasia Pleshcheva: Why does he have problems with his intestines?

Anna Bolmasova: This may be a predisposition, and a previous infection, and other intestinal diseases that had a genetic predisposition.

But the infection has a certain period of time, the child has had an intestinal infection, lost weight, he may also be underweight. But in a normal state, with adequate therapy, he will gradually gain this weight. If we're talking about malabsorption or Crohn's disease, these things need to be treated. Therefore, with an intestinal infection, a child can walk thin for some time, but by the end of puberty, he will gain weight and catch up.

Anastasia Pleshcheva: We have a transient delay in puberty, what else?

Anna Bolmasova: Next is primary. This is the pathology of the gonads, the pathology of the testicles or the gonads themselves. Congenital forms may be in the form of Klinefelter's syndrome, eunuchoid proportions. These are long, thin boys who do not have a masculine body structure, he has rather narrow shoulders, he is elongated, he has testicular pathology. A fairly typical clinical picture.

Also, the most common of the congenital forms is gonadal dysgenesis, the ratio of the laying of the gonad itself, the testis, some forms of dysfunction of the adrenal cortex, a start protein defect. This is a fairly rare form of hypogonadism, in which almost all steroid synthesis is blocked. In a frequent variant, 21-hydroxylase deficiency has a precursor. The block occurs at the very initial stage of steroidogenesis. There are acquired forms of this infection, for example, mumps, mumps in childhood. But with adequate and timely vaccination, the child is protected.

Anastasia Pleshcheva: Let's move on to the next one.

Anna Bolmasova: Secondary hypogonadism is already a pathology of the pituitary gland, a pathology of the central nervous system.

It can be congenital and acquired. Congenital, when the bookmark of this area is already defective. This may be Kalman's syndrome - secondary hypogonadism, a combination with a violation of smell, anosmia. These children do not distinguish smells. Or they are not distinguished to the extent that one would like. They are not sufficiently developed LH. This may be hypopituitarism, a deficiency of tropic hormones. These children are characterized by bilateral cryptorchidism at birth. Due to the fact that there is no intrauterine stimulation of the testicle, testosterone is not produced, and the descent of the testicles into the scrotum and the growth of the penis depend on the level of testosterone. If it is normal during fetal development, then everything is formed perfectly. If the testosterone level is low, we may have bilateral cryptorchidism, the penis may be small.

This can be determined from birth, during the period of mini-puberty, you can look at LH, FSH, testosterone and pay attention to this. But there are some rare forms, such as Prader-Willi syndrome. This is a syndrome with obesity, with muscle hypotension, in the future it may be secondary hypogonadism.

There are also acquired forms, there are some neoplasms in the central nervous system, there were neuroinfections or severe craniocerebral injuries with hemorrhages that could damage the hypothalamic-pituitary region. This can lead to hypopituitarism, a secondary delay in puberty.

Anastasia Pleshcheva: How can we treat delayed puberty?

Anna Bolmasova: There is hormone replacement therapy, its principle is based on the fact that we give what is not enough. A very controversial issue regarding the treatment of constitutional growth retardation of puberty. Because we know that it is not always possible to differentiate this 100%, there may also be psychological trauma for these children, given that they enter puberty late. Therefore, some children are given short courses of testosterone therapy, after which they can start puberty. Children who have secondary hypogonadism are treated with hCG and FSH.

Anastasia Pleshcheva: Why can sexual development in boys come ahead of time?

Anna Bolmasova: Sexual development is considered premature if it occurs in boys before the age of nine. Precocious puberty in boys is much less common than in girls, but it is worth paying attention to. And it can also be fundamentally divided into groups: central, peripheral and false.

Central precocious sexual development in boys is most often associated with neoplasms or organic lesions of the central nervous system. If in girls we most often do not find any changes in this form according to MRI data, here most often there will be hamartomas of the hypothalamus - these are benign formations of the hypothalamic tissue. They come in different sizes, with an average of about a centimeter. In rare cases, they can have epileptic seizures, and attacks of violent laughter, when the child laughs for no reason, and the laughter is obsessive. But most often with hypothalamic hamartomas, we see only early premature sexual development.

In addition, there may be various tumors of the central nervous system, gliomas, trauma, surgery, radiation therapy, everything that can damage the hypothalamic-pituitary region can stimulate early sexual development.

Central precocious sexual development follows the same laws as normal puberty, but at an earlier date. Accordingly, children grow rapidly, growth zones close, and their final growth is small, this is dwarfism. Plus a big psychological problem, because his testosterone level is high, he is a small man. He can even behave aggressively, be uncontrollable.

Peripheral forms are quite rare, it can be testotoxicosis. This is a mutation of the LH receptor gene in testicular tissue. That is, the stimulation of the testicle occurs in a constant mode, uncontrolled by the level of LH, which exists in the blood of this child. It produces testosterone itself, does not listen to anyone. As a result, the child has the same clinical picture: he grows at a rapid pace, his voice becomes rougher, his penis, testicles, hair growth, and acne increase.

Anastasia Pleshcheva: Can something be done about it?

Anna Bolmasova: Unfortunately no. There are now attempts at therapy with inhibitors, testosterone blockers, but so far not very successful. HCG provoking tumors that produce chronic human gonadotropin. It is a hormone similar in structure to LH, which is produced by the pituitary gland. This tumor can be localized not only in the head, maybe in the liver, and it stimulates the testicles to produce testosterone. It also starts sexual development.

A false form of premature development is hormonally active tumors of the ovaries, adrenal glands. With untreated congenital dysfunction of the adrenal cortex, puberty may start. Accordingly, therapy is carried out. If we talk about treatment, then the central forms of precocious sexual development are treated in the same way as in girls, with drugs analogous to LHRH, which block the release of LH, FSH, and sexual development is inhibited, growth rates gradually slow down.

Usually this is a drug that is administered in the form of injections, they are administered either once a month or once every 3 months, there are different forms of drugs. And sexual development is gradual, its signs are gradually disappearing. But if there have already been changes in the architectonics of the body, it will no longer go away, but is blocked. At an age that is close to normal sexual development, the drug is canceled. Sexual development starts again on its own. It will start after the cancellation, it has already been proven that in about a year in boys it starts again.

Anastasia Pleshcheva: That is, if you get to a good pediatric endocrinologist in time, the boy will be no different from his peers, right?

Anna Bolmasova: It all depends on how much this sexual development has progressed before treatment. If a child has been in puberty for four years, he has been there for the last year, he has active sexual development, he has a progression in class age, the growth zones are already almost closed, and he is already practically a man. Even if we block sexual development for a long period, there are big questions in terms of final growth. It all depends on how close the growth zones are.

If we catch it in the early stages, we quickly block and the growth prognosis will be better.

Anastasia Pleshcheva: How to treat peripheral forms?

Anna Bolmasova: Usually this is a surgical treatment. The Endocrinological Research Center is now conducting such therapy, some oncological centers, I send everyone to the ONC.

With VDKN, replacement therapy is used. There is such a feature that in children with VDKN, in addition to an increased level of androgens as a result of a synthesis defect, central precocious sexual development can also be triggered, it is then treated with LHRH analogues. This is a more complicated story.

Anastasia Pleshcheva: What does “difficult” mean, do you arrange consultations?

Anna Bolmasova: Yes, the question of canceling therapy with each individual, but there are some criteria. Depending on what his bone age is, what growth rate, what growth forecasts. Because here it is important not to overdo it, not to slow down the growth rate so that it completely disappears. And do not cancel earlier, so that the growth zones close too quickly. Plus, there is also a psychological factor, how ready the child will be for puberty. Therefore, the question of canceling therapy is always decided individually with each patient. There is no such thing that everyone was canceled at the age of 10 and we do not treat. Even the international consensus emphasizes that the withdrawal of therapy is individual.

Anastasia Pleshcheva: And what indicates to us that we urgently need to go to the endocrinologist?

Anna Bolmasova: If a boy at an early age, up to 9 years old, has pubic hair or scrotum hair, the size of the penis has approximately doubled. The growth of the penis and hair goes parallel to each other, so here mom will pay attention. This is the growth of rod hair, which was not there before.

If we talk about delayed puberty at 14, then dad goes with the boy, looks at what he has in his panties. Is there growth of the penis, is there hair. If none of this is present, you need to see a doctor.

Anastasia Pleshcheva: Thank you very much, Anna, the topic is indeed very complex. Thank you for now voicing such the most obvious moments, because I hope this will help a lot of moms and dads a little too. Thank you very much and see you again.

Anna Bolmasova: Thank you, goodbye.

Any parent is excited about how his child develops, and in the case of boys, he is very worried about the question of the correspondence of the sexual development of the future man.

And such an attitude is correct, since correctly formed secondary sexual characteristics represent part of the boy's personality and will play a strong role in his future development as a person through life, due to the psychological aspect.

In contact with

In accordance with this, an adequate approach of the parent and unobtrusive control of changes will allow you to calm your feelings and provide the child with a normal future life in adulthood.

Puberty up to 10 years

In general, it occurs from the birth of a boy and up to 18-22 years (depending on the individual characteristics of the organism).

Conventionally, puberty and changes in the reproductive organs can be divided into four stages of direct maturation and one - so to speak "zero" stage, during which the size of the penis changes up to 10 (in some cases 13) years.

At the same time, the fourth stage - the final one, falls on the age after the completion of puberty - 17-22 years.

The zero stage begins from the moment the young man was born, it is infantile or childish, since there are no radical changes and active hormonal changes. At the same time, it is important to take into account a boy of 10 years old will not be strikingly different from the one with which he was born, since the increase in reaches a maximum of 3-4 cm. Otherwise, this period will be accompanied by the disappearance of the physiological narrowing of the foreskin, and there will be no secondary signs.

The first stage of puberty starts just from 10 (rarely 13) years when the corresponding glands are preparing for future functional activity. The boy's body at this time is only preparing for radical restructuring of the third and fourth stages and there are no bright visual changes in penis size at 10 years old.

The first main process of this period is the activation of the pituitary gland and an increase in the synthesis of those that are responsible for the future formation of primary sexual characteristics. The second is a gradual decrease in the amount of subcutaneous fatty tissue in the scrotum area, an increase in the size of the scrotum itself, the appearance of some pigmentation and small folds on it in large numbers.

Watch a video about the problems of puberty in boys:

When does growth start

It is a well-known fact that the most pronounced changes in the dimensions of manhood are observed in the second and third stages of the development of a young man - periods of activation and active work of the gonads, that is, the gonads.

In this regard, compliance interests young people and their parents most often and causes doubts and concerns.

These periods of development are expressed in enhanced synthesis, which are involved not only in the proper development of the organs of the reproductive system, but also in secondary sexual characteristics. Thus, the active growth of the penis, the enlargement of the scrotum and the testicles themselves, is accompanied by male pattern hair growth, as well as voice changes, the acquisition of coarser facial features and the active growth of the musculoskeletal system.

Length in boys at 10, 11 and 12 years old

Adolescence of a young man falls on the period from 10 to 15 years, and the same period coincides with the first three stages of puberty.

In the first stage (from 10 to 12), the penis length is 10 cm in an erect state - this is a variant of the norm, differences from which are usually fluctuations of 1 - 2 centimeters up or down. At the same time, in a passive state, it fluctuates from 4 to 5 cm.

But it should be taken into account that penis size by the age of 11 rarely reaches 10 cm at once. More often it is at the level of 7-8 cm when excited, and about 4-5 cm in a relaxed state (with fluctuations up or down per centimeter).

In the second stage, which occurs at the age of 12-14, the changes are more pronounced. Yes, normal penis size for 12 year old boy in a relaxed state, usually 5-6 cm. In an excited state, he 11, rarely 12 cm. , the parameters change dramatically only in erection - they reach 13 cm in length. By the age of 14, a boy's relaxed penis is about 7-8 cm, and an excited penis is 15 cm.

In the third stage, the changes begin to slow down again, especially in comparison with how penis size changes at 12-14. The third stage itself occupies an interval from 14 to. At the same time, the relaxed penis of the boy is within 8-11 cm, and the excited penis is 14.5-16 cm.

In no case should you panic or show by your behavior that the size of the boy is different from expected, so as not to injure his psyche. If the difference is only half a centimeter-centimeter - this is normal, if more - you need to unobtrusively and without unnecessary actions and words take him to the doctor for a consultation, motivating this with a regular examination.

How to measure correctly

In order not to be mistaken about the length of your penis it is important to measure correctly. performed while standing to make it comfortable for the boy. The relaxed phallus is deflected so that it is parallel to the floor, while it must not be compressed or stretched so as not to cause pain and injury. Then the length from the pubis to the tip of the head is measured with a ruler or a soft meter.

What determines the growth of the penis

Let's analyze the issue and its development. It is influenced by external and internal factors, which are equally important. Among the internal factors, the main one is hereditary information received by the boy from his father and previous generations of men in the family of his father and mother. Another equally important basis for proper development is hormonal balance, which in turn can be affected by external aspects.

Also, among the internal factors, metabolic processes are also important. So, if a young man's metabolism is disturbed, then obesity develops, which first inhibits the growth of the entire body, and then visually reduces the penis. Of course, when losing weight, the visual problem is solved, but the internal damage in the form of insufficient size remains.

External factors for proper penis growth include:

• Food. Insufficient levels of vitamins and a deficiency of micro and macro elements weaken the boy's body, interfere with the normal development of all organs and systems, and in particular, affect the size of the penis.
• Organ diseases and injuries. Their impact directly affects the development of the penis and may lead to surgical intervention in the future.
• Early bad habits. Smoking and alcohol at a young age have a negative impact on the development of the boy, and in particular on his reproductive system.

In which case should you think about the problem

When is it worth "ringing the bells" and really worrying?

There are several reasons that can deservedly cause parents and even a child to panic:

• A pronounced difference in parameters from the average statistical data, exceeding the limit of 2-3 cm. This indicates a slowdown in development or its stop, requiring urgent intervention and correction of the state of the body.
• The appearance of deformities of the phallus or other external changes that are combined with a slowdown or complete stop in the development of secondary sexual characteristics. may be a sign that the boy has a disease that requires medical intervention and the selection of appropriate therapy.

For more information on permissible errors in the development of the organ, see the video:

Regardless of what caught the attention of a parent or a boy, and what made him think about the correctness of sexual development, you can’t focus on one point, for example, you can’t stop at the issue of size at 12 years old. It is the constant and responsible control of the development and growth of not just the whole organism, but each of its systems and external organs that becomes the key to the future well-being of the young man.

All somatic changes in boys, referred to as puberty, begin at 10 and end at 18. However, in fact, the main part of this process for most adolescents takes 3-4 years. It is impossible to judge any single age norm for the timing of sexual development in boys, since each organism has its own moment of onset and its own duration of this period. External manifestations of sexual development, the timing of their appearance and signs of progression are approximately the following.

The beginning of a noticeable increase in the testicles can be considered the first sign of the onset of puberty. On average, this occurs at 11 1 / 2 -12 years, but the variants of the age norm of this indicator cover the period from 10 to 13 1 / 2 years. As puberty progresses, the rapid growth of the testicles is primarily due to the reproduction of the spermatogenic epithelium of the seminiferous tubules and, to a lesser extent, to an increase in the number and size of Leydig and Sertoli cells. The growth of the testicles basically ends by the age of 17-18, although their slight increase is still possible up to 20-25 years. There are various methods for clinical assessment of the condition of the testicles and their increase in the process of maturation. The Prader model orchidometer is a set of ellipsoidal models of the testicles with a gradual increase in their volume from 1 to 25 ml. This is the first set of standards of this type. Other models do not have a fundamental difference. We determine the size of the testicles using a testiculometer-orchidometer (Fig. 17) modeled by M. A. Zhukovsky, which consists of ellipsoids corresponding to the age norm, indicating age-related fluctuations in the volume of the testicles. The testiculometer is convenient for use in the clinic, during mass preventive examinations.

Under the changes in the external genitalia during puberty understand the increase in the penis, the appearance of folding of the scrotum and an increase in its volume, as well as pigmentation of the scrotum and penis.

The growth of the external genitalia begins either immediately after the enlargement of the testicles, or after 1 / 2 -1 1 / 2 years, on average from 12-12 1 / 2 years. The period of rapid growth of the external genitalia, as a rule, is shorter than the period of testicular enlargement and lasts 2 1/2 -3 years. By the age of 16, in most adolescents, the growth of the external genitalia ends.

In foreign literature, the Tanner classification is often used (from G 1 to G 5):

G 1 - penis and scrotum for children;

G 2 - increase in the scrotum, the beginning of its pigmentation; the penis has not yet begun to grow;?

G 3 - further increase in the scrotum and growth of the penis, mainly in length;

G 4 - significant pigmentation of the genital organs, a further increase in the scrotum, growth of the penis, mainly in thickness;

G 5 - the genitals in size and shape correspond to those of an adult male.

Pubic hair in the form of single guard hairs around the root of the penis appears, as a rule, simultaneously with the onset of growth of the external genitalia, although this symptom may appear somewhat earlier or later.

Pubic hair begins at the age of 12-13 and, gradually progressing, by the age of 16-18 reaches the severity characteristic of adult men. In most older adolescents and young adult males, hair from the pubic region extends along the white line of the abdomen to the navel. However, the absence of such a pronounced hair growth in young men is not considered a sign of androgen deficiency, but is considered as a constitutional variant of the norm.

In most boys, pubic hair begins 1/2 -1 1/2 years after the onset of testicular enlargement, but in about 2% of adolescents, initial pubic hair precedes pubertal testicular growth. Some authors consider this a variant of the norm, others - a manifestation of premature activation of adrenal function, which can disrupt physiological maturation.

Usually, Tanner's gradation of pubic hair is used (from P 1 to P 5 -P 6):

P 1 - pubic hair is absent;

P 2 - the growth of sparse, long, poorly pigmented hair, mainly at the base of the penis;

P 3 - hair growth extends beyond the pubic joint, the hair becomes darker, more curly;

P 4 - adult hair type, but occupies less space;

P 5 - hair growth corresponding to that of an adult male;

P 6 - the spread of hair along the midline of the abdomen up to the navel.

Hair growth of the axillary regions begins in adolescents most often by the middle of the puberty period (at 13-15 years old), although in some boys pubic and axillary hair appear simultaneously.

The growth of a mustache near a beard - an indicator of a certain puberty - falls at the end of the puberty period (15 years and older).

Regular wet dreams are a very important indicator of physiological puberty. They begin no earlier than 13 years, by the age of 14 1 / 2 -15 years, half of the teenagers have them, and by the age of 16 - in the majority.

A number of other signs of puberty in boys appear by the middle of puberty (at 14-15 years old) and, accordingly, means the maximum of its speed. This is a pubertal acceleration of linear growth, an increase in muscle mass, a change in the architectonics of the skeleton (the predominant development of the girdle of the upper limbs), a decrease in the timbre of the voice, physiological gynecomastia, acne vulgaris on the skin.

In table. 1 shows the average terms for the appearance of the most important signs of puberty in boys according to domestic and foreign authors, which reflects the modern acceleration of maturation in children.

According to Table. 1 you can get only an approximate idea of ​​the norm of sexual development of boys. For the clinical differentiation of the norm and pathology of puberty, the average age norm is not applicable. This is explained by the fact that individual puberty (both in terms of onset and duration) in adolescents can differ significantly from the average, but remain a physiological option. To draw up standards in medicine, including pediatrics, the sigma method is used (M ± σ, M ± 2σ, etc.) or the percentile method (frequency distribution of the parameter in percentiles). If the sexual development of boys is approached taking into account the variability of the norm at each calendar age, then normal indicators should fit into the interval from M - 2σ to M + 2σ or in the interval from the 3rd to the 97th percentile.

The Children's Clinic of the IEE&CHG of the USSR Academy of Medical Sciences (M. A. Zhukovsky, N. B. Lebedev), together with the Research Institute of Anthropology of Moscow State University (E. Z. Godina, V. S. Solovieva), based on a survey of a large population of schoolboys, developed standards for sexual development according to various features (Table 2). In addition, for the sake of clarity, for the three main androgen-dependent secondary sexual characteristics, percentile tables of the distribution of each indicator by age were compiled: for the volume of the testicles (Fig. 18), for the length of the penis (Fig. 19), for pubic hair (Fig. 20) .

1 (In parentheses are the extreme values ​​of the norm from the 3rd to the 97th percentile.)

Rice. 20. Percentile table of the stage of pubic hair growth (P 1 -P 6) depending on age or older there are no signs of puberty

Studies have shown that the testicles reach a volume of 4 cm 3 (which is considered the beginning of their pubertal development) on average by 11 years 10 1/2 months. The maximum rate of testicular growth is noted at the age of 13-14 1/2 years, which corresponds to the maximum rate of puberty. At the age of 17, the volume of the testicles in healthy adolescents is 17-29 cm 3 (for comparison, the volume of the testicles in young adult men ranges from 15-35 cm 3).

The first significant penis enlargement occurs at 12-13 years of age, or 1 year later than the onset of testicular enlargement. The maximum growth of the penis in length and thickness was registered at the same age - at 13-14 years. The growth of the penis takes basically 2 1/2 years. At 16-17 years old, the penis enlargement is insignificant, which indicates that its size approaches those of adult men.

The appearance of pubic hair (P 2 according to Tanner) was noted in a small proportion of boys (8%) at 11 years of age; in the future, with age, this indicator rapidly progresses - at 12 years and 7 months, hair growth at least P 2 is found in 50% of boys, at 15 years - in 99%. Pubic hair on average appears 1 year 2 months later than the first significant increase in testicles.

The first regular wet dreams (oygarhe) were recorded from the age of 1272, at the age of 14 years 3 months they were already in every second teenager, and by the age of 17 - in almost all (98.5%). All adolescents with testicles of 12 cm 3 or more should have regular wet dreams.

On fig. 21 shows percentile tables of body weight and body length for boys of different ages. These data should be taken into account when assessing the dynamics of sexual development.