How to Know When You're a Teenager (for Boys). Boys’ genitals: what to look for Features of the development of the genital organs in boys

Boys and puberty... parents have a period ahead of them through which they must successfully pass. What you need to know about puberty as parents and, in particular, your son.

As we grow older, and especially during puberty, many changes occur in the human body, as this is the very moment when it begins to develop and change.

Girls' breasts enlarge and menstruation begins. Boys' voices break, mustaches and body hair begin to grow.

Most boys begin puberty between the ages of 9 and 14 years. But remember that puberty begins exactly when the boy’s body is ready for it, and, as we know, each child develops at his own pace.

Here are a few questions boys have about puberty.

Boys and puberty. What you need to know about this period

Why are girls taller?

You may have noticed that some girls you know are taller than boys.

But you've probably also noticed that among the adults you know, most men are taller than women. What's going on?

As a rule, puberty in girls occurs between the ages of 8 and 13 years. They develop faster than boys and, therefore, surpass them in height.

As for boys, for most of them such changes begin only between the ages of 9 and 14 years.

This is why girls are often taller than boys during puberty.

It is important to note that each person's genetics also plays a role in their height.

So if your parents are tall, you will probably be tall too.

If your parents are short, you may be short. However, not necessarily.

Remember that not all adult men are tall. Many representatives of the stronger sex, who are considered “low”, manage to make successful careers in cinema, military affairs and even in sports.

There are no magic exercises or pills that will make you grow.

But if you are active and your diet consists of nutritious foods, it will help your body grow as healthy as it should.

Boys and puberty. When do muscles appear?

During puberty, some boys may develop concerns about their body by looking at what some of their friends look like.

For example, many boys are concerned about their muscles. You may have already noticed that some boys develop chest muscles called pecs.

Some boys may have broad shoulders and deltoids. Others may be weaker and frail.

Remember that puberty is different for everyone, so don't worry if your muscles are developing a little slower.

You may want to start exercising to gain muscle mass faster.

However, it is important to know that if you have not yet reached puberty, such exercises will help you keep your muscles toned, but will not build new muscles. They can also harm your growth.

Eating nutritious foods and playing sports like cycling, swimming, etc. will help you become a strong child.

Eventually you will hit puberty and then you can start working on your muscles.

If you want to lift weights as exercise, discuss this with your parents and a specialist in advance.

Develop a qualified sports program or work with a trainer who will supervise your training process.
This will help you become stronger and avoid injury.
Use lighter weights. Your trainer will be able to recommend the right weight for you.
Lifting heavy weights can cause injury.
Do exercises with repetitions. It is better to lift a smaller weight, but several times, than to try to lift a large weight 1-2 times.
Rest. Take a break, give your body time to recover and rest.

Boys and puberty. Do I think about girls too much or too little?

There is a girl who lives next door to you and you see her hanging out with her friends every day after school.

You feel good and your palms sweat when she greets you or looks at you.

When you fall asleep, you think only about her. Every day for several weeks now you can’t stop thinking about her.

You may ask yourself, “Why do I feel this way?” Maybe you are experiencing passion.

Or maybe, on the contrary, your friend tells you about one girl whom he considers the most beautiful.

He keeps saying that he likes her. You're thinking, "Why don't I feel or talk like that about some girl, should I?"

During puberty, some boys are very friendly with girls, while others may be nervous when meeting them.

Thinking about the person you like is a completely normal process during puberty.

Talk to your parents, grandparents, uncles about this topic, and they will give you good advice.

So why do you feel this way? Hormones in your body become more active.

As a result, you begin to experience more feelings. These feelings can make you scared or confused.

This is natural because you are going through a new phase of your life.

Talking to a friend or an older person like your brother or sister can help you gain some insight.

Sometimes your elders have more experience than you, so they can be the right people to ask for advice.

Boys and puberty - why do we get hair on our bodies?

They appear during puberty. Some boys begin to notice facial hair growing around the chin, on the cheeks and above the upper lip.

Hair also begins to grow on the chest, arms, armpits and even pubic area.

Don't worry, because hair is just one of the many ways your body tells you that you are becoming a man.

Some hormones that trigger the process of new hair growth are produced by the adrenal glands.

Other hormones are produced by the pituitary gland, a pisiform gland located at the base of the brain.

These pituitary hormones travel through the bloodstream and cause the testicles to grow and begin producing another hormone called testosterone.

Boys and Puberty – Body Odor

You probably know what sweating is and what you need to do to avoid body odor.

Our body feels good at a temperature of 37°C. If it decreases, your body doesn’t like it and you start to sweat.

Sweat comes out of your skin and then evaporates (meaning it turns from liquid to vapor) into the air, which makes you feel cold.

Sometimes sweat or moisture can have an unpleasant odor and can therefore ruin your body odor.

During puberty, your hormones are constantly working, which explains the fact that you sweat a lot and sometimes smell bad.

What to do about an unpleasant odor? Sweat is almost entirely water, with small amounts of other chemicals such as ammonia, urea, salts and sugar.

Unpleasant odors can be eliminated primarily by maintaining proper hygiene. You can also use deodorant.

Boys and puberty. About erection

An erection is the process of filling the penis with blood and hardening it.

The penis increases in size and moves away from the body. Boys begin to experience erections more often when they reach puberty. And that's completely normal.

An erection can occur at any time. You may have several erections a day or none at all.

It all depends on your age, puberty, activity level and your sleep patterns.

An erection can occur even during sleep. Sometimes you may wake up and notice that your bedding or bed is wet.

You might be concerned that you've started wetting your bed like you did as a child, but you could simply be experiencing a nocturnal emission or "wet nap."

Wet sleeping is when seminal fluid (the fluid containing sperm) is released from the penis while you sleep.

Sperm is released through the urethra, the same channel through which urine is eliminated from the body. This process is called ejaculation.

Wet dreams occur when a boy's body begins to produce more testosterone.

This is a sign that the boy is growing and his body is preparing for the day when he, as a man, decides to become a father.

As usual, at a certain period of puberty, and even in adulthood, almost all boys have such dreams.

However, if you have ever experienced pain or problems with your penis or testicles, it is important that your parents or family member make an appointment with your doctor for an examination.

Is your son already 11 years old? The girls in his class most likely already sometimes begin to wear cosmetics, quickly grow in height, and in general no longer look like little girls, but like full-fledged girls. Boys, most likely, are still boys, playing “war games”, and so far they look at girls only from the point of view. What is the most convenient way to pull the pigtail? It’s okay, soon our little boys will enter puberty (usually for boys it begins one and a half to two years later than for girls).

Physical aspect and quantitative measurements

In boys, puberty usually begins at the age of 11-12, sometimes, however, it can be delayed up to 14-15 years.

The muscles and skeletal system noticeably increase, the voice breaks, the figure changes. The muscles of the shoulder girdle develop. The genitals also become enlarged. At seven years of age, the length of the testicles on average reaches 2.7 cm, and the length of the penis in a calm state is 3-3.5 cm; by the beginning of puberty, these figures increase slightly: 2.8-3 cm for the testicles and 3.8 cm for the penis .

During puberty, the dynamics of growth of the genital organs is much higher, because there is an intensive production of male sex hormones. At the age of 13, these important indicators will be 3.6-3.7 for the testicles and 6.3 cm for the penis, by 15 - 4 cm and 6.7 cm, respectively. Of course, these are average readings, and a step to the right or left does not count as an escape (unless, of course, it is a giant step).

Puberty is also marked by the appearance of hair, primarily on the pubic area. By the age of 14-15, hair appears under the arms and - hurray! - youthful fuzz on the upper lip and chin.

Simultaneously with the appearance of hair, the voice breaks and, unfortunately, your child’s face often becomes covered with acne. Some people have more acne, some lucky people have less or none at all. If acne bothers you a lot, you can contact a specialist. And, of course, monitor the healthy lifestyle of your growing “baby”: sports, proper nutrition, keeping the skin clean - all this can significantly reduce the number of these nasty acne. Although, of course, by the age of 16-17 they will disappear on their own.

Comment on the article "Puberty of boys: anxieties and problems"

In America, where everyone is obsessed with sexual harassment, they have gone so far that in the state of Colorado, a six-year-old boy was expelled from school and charged with sexual harassment for kissing the hand of his classmate!

14.12.2013 12:07:58,

Total 1 message .

At what age does a penis grow?

The penis in boys begins to grow from about ten years of age, but maybe only from fourteen. At the same time, secondary sexual characteristics gradually appear: they grow under the armpits, the first hairs appear on the chin. At the same time, the testes enlarge, the voice breaks, the outlines of the face and body change, becoming more and more masculine, and so on.

During the entire period of maturation and growth of such an important male organ, a teenager, and then a young man, is worried about one problem: how much does the penis grow, how long will it last? By the way, such curiosity can be caused not only by the fear of being the owner of a small penis, but and fears of seemingly excessive amounts of male “dignity.”

The thing is that most often the increase in this organ occurs in spurts: either its length or volume increases. This is precisely what frightens young representatives of the stronger sex.

How long does it take for the penis to develop?

It is immediately necessary to make a reservation that the completion of the complete formation of a man’s external sexual characteristics is absolutely individual. Doctors give examples of the completion and cessation of genital growth in young people aged seventeen and even twenty-five.

But you need to know that the size of the mentioned organ does not depend on how old the penis grows. The time of his growth is always directly related to the rate of development of the entire male body. It’s just that those who ended this period at a younger age may have completed theirs earlier due to the fact that at one time it was much more intense.

What determines the development of male genitalia?

Several factors influence how and up to how many years a penis grows. A significant role in them is played by the genetic characteristics and heredity of each of the representatives of the stronger sex.

Hormonal levels are very important, namely the level of testosterone in the blood of a developing man. It often directly determines the time during which maturation will occur and the genitals will acquire their final size.

By the way, insufficiency of these sizes is a clear sign of endocrine disorders associated with low production of the male sex hormone. As a rule, this phenomenon is accompanied by the absence of many secondary sexual characteristics. Such a pathology requires mandatory contact with endocrinologists and a thorough examination to prescribe adequate treatment.

Chronic diseases that a teenager already has and the quality of his diet also play an important role in the formation of the penis.

Of course, all the above factors cannot be the final answer to the questions: how long does it take for a penis to grow, and what size will it be in the end? But any young man, having analyzed his state of health and hereditary characteristics, will be able to understand for himself how great the extent of his male prowess will be in the future.

A little anatomy: what exactly influences periodic changes in penis size

The dimensions of the named object of pride also change within one day. This depends on the anatomical features of its structure.

Thus, in a calm state, the size of the penis is directly related to the filling with blood of the so-called cavernous bodies, which are part of the tissues of the male genital organ.

They are spongy substances penetrated by many small blood vessels and cavities. They react sensitively to the action of substances present in the blood, as well as to the ambient temperature.

When it decreases, the vessels of the penis narrow, which, in turn, causes a decrease in the amount of incoming blood and, accordingly, a decrease in the size of the penis. The same reaction can be caused by the release of adrenaline into the blood as a result of stress. But when the temperature rises, the opposite reaction occurs.

The structural features are also associated with a noticeable difference in the size of the penis at rest or in a state of erection.

How does the angle of view change?

Impassive statistics report that at least 45% of men want to enlarge their penis. What's this? Half of the male population has a small penis? It turns out no, most representatives of the stronger sex have very respectable genital parameters - average or above average. But one should not lose sight of such a feature of the male character as the desire to be a leader in everything, including in the size of the penis.

This is probably why the opinion that “the larger the organ, the better” has spread so widely. And this, in turn, makes the young man worry: is everything okay with him?

And the nuance of size perception, in particular, lies in the fact that a man sees his genitals at an angle, which makes them appear shorter. But when examining someone else’s organ, there is no such effect, so the stronger sex often thinks that his penis is smaller than that of his neighbor in the bathhouse.

Taking into account the fact that any man, throughout his active life, constantly compares his “dignity” with what he sees, he may at some point begin to feel deprived of nature. And having found out how long a penis grows, you worry: will it really not get any bigger?

Alas, everything depends mainly on genetic factors: they are the ones responsible for how long it takes for a young man to go through puberty, and what exactly a mature man will be proud of.

Which ones can be considered normal?

When we say how long the penis grows, we also mean its size. To what size should it increase during the growth period for a strong man to feel confident?

It is believed that the normal size of a formed penis in an erect state should lie in the range from 10 to 18 centimeters. And in a calm state, its length is from 7 to 10.5 cm. Thus, the average length of “male pride” in excitement is approximately 14-15 centimeters, and the thickness ranges from 3 to 4.5 cm.

But you need to remember that these indicators are very conditional! They cannot be the final verdict on what size can be considered normal.

Penis sizes that are outside the norm

What is absolutely clear to urologists and endocrinologists is that if the penis of a mature man in an erect state does not exceed 10 cm in length, then it is considered small. And a size of up to 6 cm is even called “micropenis” in medicine.

By the way, there is information about the owner of a “dignity” living in the UK with a length of 34.5 and a volume of 25 cm. However, in this case, strong doubts arise about the possibility of using this “giant” for its intended purpose.

What to do to make your penis grow?

Huge money is made from the natural and persistent desire of men to have greater “dignity”. Doctors and people living in the medical space come up with “magic” ointments, creams, tablets and other drugs that can make the penis impressive and therefore, from a man’s point of view, capable of satisfying any lady. Traditional medicine, in turn, also does not stand aside, offering hundreds of absolutely useless recipes.

People with money spend huge amounts of money on “miraculous” massages performed by young maidens all day long, which, according to the advice of ancient Eastern medicine, help increase the size of the penis.

But, alas, all this does not bring results!

Effective ways to enlarge the penis

So far, there are only two real ways to increase the size of the penis - this is, firstly, surgery and, secondly, stretching the organ using an expander. In the latter case, the increase occurs due to the activation of cell division in the cavernous body of the penis.

By using an expander, you don’t have to worry about how long your penis grows, since this tool will help you enlarge it at any age. The expander changes the length of the penis, adding at least three centimeters to it, and sometimes more, its thickness, and also corrects curvatures and strengthens erection

An option for penis enlargement through surgery is the implantation of an implant. This operation is indicated for penis sizes no more than 12 cm in length when erect. But we must remember that any surgical intervention is, first of all, a risk. Therefore, before you decide on it, you should weigh all the pros and cons, and think about how important the result is.

Does penis size matter?

To summarize the above, we can assume that, of course, the owner of a completely normal 13 cm can be calm and confident. After all, regardless of the age to which a member grows, its average statistical parameters can satisfy the majority of women. And any complaints about the size of manhood are just the aesthetic whims of each of the fair sex.

Yes, contemplating or touching something impressive is very pleasant, but ladies should not forget that the average size is within the range of 8 to 13 cm. So for a woman to fully enjoy a man, all she needs is the ability to use the tool that nature has endowed him with.

Almost every woman dreams of giving birth to a healthy son, a future protector and a reliable support in the family. The boy is growing and over time there are more and more questions about his health. Most often, mothers are concerned about a physiological issue - the normal size of the penis in children and adolescents.

It is laid in the womb. At birth, its length is approximately 2 cm. There are cases when, during development, the head can grow to the side or down. Even newborn babies may have an erect organ, this indicates that the child wants to urinate; there is no need to sound the alarm.

Penis growth since birth and average standard increase:

Age	Length	Increase
0-5 months	3.9+0.4cm	+1.9cm
6-12 months	4.3+0.8cm	+2.3cm
1-2 years	4.7+0.9cm	+2.6cm
2-3	5.1+0.9cm	+2.9cm
3-4	5.5+0.9cm	+3.3cm
4-5 years	5.7+0.9cm	+3.5cm
5-6	6.0+0.9cm	+3.8cm
6-7	6.1+0.9cm	+3.9cm
7-8	6.2+1cm	+3.7cm
8-9	6.3+1cm	+3.8cm
9-10	6.3+1cm	+3.8cm
10-11	6.4+1cm	+3.7cm

Period of change in height

At the age of 11, the boy has an important moment. He begins to notice that his body is changing - hair is growing in the armpit and on the pubis, light fuzz is forming on the face, the scrotum and penis are enlarged. The hormone testosterone is responsible for the proper functioning of the body.

If there is not enough of this hormone in the body, the boy will look like a girl. You can find out about testosterone levels by taking tests. There is no need to worry too early about your teenager not growing a beard. Maturation is different for each child.

Standard parameters for changing penis size in teenagers

The table provides information on how the size of an intimate organ changes in a teenager.

Age	Resting size	Erection size	Thickness
12 years	5-6 cm	10-11 cm	7.6 cm
13	6-7 cm	12-13 cm	9.9 cm
14	7-8 cm	13-14 cm	10.5 cm
15	8-8.5 cm	15-15.5 cm	11 cm
16	8-9.5 cm	16-17 cm	11.5 cm

Signs of maturation

Puberty begins at approximately 10-11 years of age. In some cases it may happen later. Acne and pimples appear on the young man's face. Hair appears on the face, pubic area, armpits and sometimes on the chest.

In the morning, a teenager may see white spots or an erect penis on his underwear. This is a normal phenomenon that parents should tell him about. Such discharges are called wet dreams, when there is a small release of seminal fluid without a characteristic odor.

If it is, you should visit a urologist as soon as possible.

You cannot neglect your doctor; lack of treatment can lead to serious consequences, such as kidney disease and genitourinary system, urethra and prostate disease.

Stages of development

The development of the penis occurs in five stages:

Stage 1 begins from the moment the child is born and ends at puberty. This is the time when a boy becomes a teenager. Until this moment, the value remains virtually unchanged; puberty has not yet occurred;
Stage 2 - during this period the testicles begin to descend into the scrotum, and the phallus begins to grow;
Stage 3 - at thirteen, the boy notices that pubic hair appears. The penis grows by 1.5 or 2 cm per year. Morning enlargement is normal at this age;
Stage 4 – the sexual organ grows not only in length, but also in width, by about 0.5 cm per year;
Stage 5 lasts from 17 and ends at 23. From this moment on, the reproductive system is fully formed, the teenage penis is fully formed, its growth has stopped, and the young man can become a father after unprotected sex.

During each of these periods, it is worth monitoring the teenager’s weight and nutrition. With any deviation, the growth of the entire body slows down and will have a detrimental effect on health in the future. Once a year you need to visit a urologist and surgeon.

Features of the reproductive apparatus

According to statistics, the average organ size at 17-18 years old is 17 cm when erect. The length depends on heredity. There must be trust between parents and child so that dad or mom can explain to their son about intimate upbringing and sexually transmitted diseases. A teenager should not wear underwear that is too tight; this can be the main reason for improper development of the genitals.

What influences the development process

Ultrasound during pregnancy superficially determines the presence of a penis in a boy. After birth, specialists in the maternity hospital examine the newborn baby for pathologies. In a healthy baby, the testicles are in the scrotum, and the foreskin covers the head of the penis. This is called physiological phimosis. The size of the penis in children usually does not exceed 3 cm.

If a mother notices that the baby is crying when urinating, she should consult a doctor. By 3-4 the head gradually opens on its own; if this does not happen, then you need to consult a surgeon who can prescribe an operation. If phimosis is not treated in time, it can further affect the intimate life of a young man. During sex, he may tear the foreskin.

What factors can affect a boy's health?

genetic predisposition;
bad ecology;
injuries or severe bruises of the genitals;
endocrine system disease;
bad habits that minors try too early - cigarettes, alcohol, drugs;
overweight.

Experts' opinion

During adolescence, boys develop a special interest in the genitals. The young man should know that the foreskin cannot be spread too wide; the integrity of the frenulum can be damaged by tearing it. Hygiene must not be neglected; the white discharge around the head is thoroughly washed to prevent bacteria from multiplying.

Parents should be wary of the boy's early maturation, for example at 8-9 years old. You need to see a doctor and get tested. Do not think that the size of a penis at 13 years old should correspond to the size of an adult man. The penis will grow only a few centimeters per year.

Conclusion

The boy’s health from birth until he comes of age depends on the parents and their knowledge, which they must tell the young man. Hygiene, proper clothing, upbringing and knowledge about any deviations in the development of the penis should be laid down by mom or dad. This is necessary so that in the future their son can become a full-fledged healthy man and have children.

If a boy is embarrassed to talk with his mother about intimate life and penis size, he should talk about these topics with his father.

Parents must take the issue seriously: you cannot laugh or joke about sizes.

A teenager may develop a complex, which will negatively affect the young man’s sex life and psyche in the future. A young man needs to watch his diet; excess weight can have a detrimental effect on men's health.

Conversations held with their son will allow parents to be calm about their son’s future. If mom or dad doesn’t know the answers to some questions, you need to read about it in reference books or contact a specialist.

Endocrinology

Anastasia Pleshcheva: Hello, the program “Hormones at Gunpoint”. And today we continue the series of programs “Pediatric Endocrinologist” and will analyze the sexual development of boys. My guest is Anna Viktorovna Bolmasova, 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 influence 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 the 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 that you are talking about?

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

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

Anna Bolmasova: Between the ages of three and six months there is a period of mini-puberty. This is when the level of LH, FSH and testosterone levels increase to approximately the same levels as 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 an erection; some mothers are scared by this, but this is an absolutely normal phenomenon. Usually, by the age of one year, mini-puberty passes and the period of childhood begins, when the hypothalamus produces less LH and FSH, and there is no stimulation of the testicles. After childhood, from about nine years of age, LH and FSH rise, their concentration increases, testicular stimulation occurs, 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 that 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, and the amount of hair increase. Also, the boy’s growth rate is accelerating, the body’s architecture is changing: the size of his shoulders is increasing, 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. Changes in the timbre of the voice and figure are 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 begins pubertal 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 12 and 13 years of age; compared to girls, it is a little later. For girls it is 11-12 years old. Often in 9th grade it turns out that the girls have all grown up and matured, while the boys are still children. This is how nature works, it is a physiological thing.

If we take the literature over the last 100 years, 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 timing of the onset of sexual development.

Anastasia Pleshcheva: Let's discuss delayed puberty.

Anna Bolmasova: If after 14 years of age a boy does not develop secondary sexual characteristics, then he has delayed puberty.

It can be divided into transient delay of puberty, primary and secondary. Transient is the most common; it is an institutional delay in the growth of puberty. During the period of sexual development in a boy, in addition to changes in appearance, growth rates accelerate. If puberty is delayed, then growth rates are delayed. For example, all the boys around him have already made a growth spurt, 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 cases are related to the fact that there is some kind of constitutional, family history in this regard.

Anastasia Pleshcheva: Is it possible to somehow understand how tall a child should grow?

Anna Bolmasova: There is a calculation formula for the final growth of a 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 to subtract 12.5 cm rather than add. This is not an absolute number, a range of plus or minus 5 cm is taken, the child must fall within this range. If we assume a final height of, for example, 180 cm, and it is at the lower limit of the norm, this makes us think that something has gone wrong.

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

Anna Bolmasova: Usually, in children who have a constitutional delay in pubertal growth, one of the parents had a late puberty. It doesn’t have to be dad, if we are talking about 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 in severe chronic diseases, malabsorption syndrome, malabsorption, and cancer. And also with inadequate nutrition or inadequate energy expenditure, athletes may suffer from this during intense physical exertion.

Anastasia Pleshcheva: How correct is it 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 load is harmful, no matter what the achievements are. But there must be some kind of line other than the desire for success.

Anastasia Pleshcheva: When we say that we want to raise our child to be an athlete, we must think about the fact that we may lose the child’s health. I encourage everyone to play sports, but it must be properly dosed exercise under the supervision of doctors.

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

Anastasia Pleshcheva: During your practice, is obesity common now?

Anna Bolmasova: Often.

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

Anna Bolmasova: Nothing has changed, everything remains the same, it’s a short process. If you look at a person from the point of view of the biological species, there has never been such a large amount of carbohydrates available, there has never been such low physical activity.

Anastasia Pleshcheva: Are there schools for obesity in your center?

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

Anastasia Pleshcheva: Schools are needed, what do you think?

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 children goals for the month, how much to lose, how to change their views. For the most part, this work is not so much with children as with parents.

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

Anna Bolmasova: Psychologists have to be involved quite often, because sometimes parents come with completely casuistic options, when, for example, a mother, father, or grandmother is obese, and they come with a three-year-old child and ask: “What should we do? Where did it come from?

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

Anna Bolmasova: It seems to me that propaganda should be at the pediatrician level, when the child is just born, so that, given the outer world, which is so rich in carbohydrates, they know how to protect themselves.

Anastasia Pleshcheva: What about malnutrition?

Anna Bolmasova: Children can be underweight, but usually this is not the result of not being fed, it is the result of something wrong with their intestines. Personally, I see two or three children a month, this is not very common, but such children do exist.

Anastasia Pleshcheva: Why does he have intestinal problems?

Anna Bolmasova: This may be a predisposition, a past infection, or other intestinal diseases that have a genetic predisposition.

But the infection lasts for a certain period of time, the child had an intestinal infection, lost weight, and he may also be underweight. But in normal conditions, with adequate therapy, he will gradually gain this weight. If we are talking about malabsorption or Crohn's disease, such things must be treated. Therefore, with an intestinal infection, a child may be 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 the primary. This is a pathology of the gonads, pathology of the testicles or the gonads themselves. Congenital forms can be in the form of Klinefelter syndrome, eunuchoid proportions. These are long, thin boys who do not have a male body structure, he has rather narrow shoulders, he is elongated, he has testicular pathology. Quite a characteristic clinical picture.

Also, the most common congenital forms are gonadal dysgenesis, the relationship between the anlage of the gonad itself and the testicle, some forms of adrenal cortex dysfunction, and a protein start defect. This is a fairly rare form of hypogonadism, in which almost all steroid synthesis is blocked. In a common 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 a pathology of the pituitary gland, a pathology of the central nervous system.

It can be congenital or acquired. Congenital, when the anlage of this area is already defective. This may be Kalman syndrome - secondary hypogonadism, combination with impaired sense of smell, anosmia. These children do not distinguish smells. Or they do not differentiate to the extent that we would like. Their PH is not sufficiently developed. This may be hypopituitarism, deficiency of tropic hormones. Such 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 intrauterine development, then everything is formed perfectly. If testosterone levels are low, we may have bilateral cryptorchidism and the penis may be small in size.

This can be determined at birth; during mini-puberty, you can look at LH, FSH, testosterone and pay attention to it. But there are also some rare forms, such as Prader-Willi syndrome. This is a syndrome with obesity, with muscle hypotonia, 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 traumatic brain injuries with hemorrhages that could damage the hypothalamic-pituitary region. This can lead to hypopituitarism and secondary delayed 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 missing. 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 the fact that they enter puberty late. Therefore, some children undergo short courses of testosterone therapy, after which they can start puberty. Children with secondary hypogonadism are treated with hCG and FSH.

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

Anna Bolmasova: Puberty 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 premature puberty in boys is most often associated with neoplasms or organic damage to 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 hypothalamic hamartomas - these are benign formations of hypothalamic tissue. They come in different sizes, on average about a centimeter. In rare cases, they may cause 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 premature sexual development follows the same laws as normal puberty, but at an earlier date. Accordingly, children grow rapidly, growth zones close, and their final height is small, this is dwarfism. Plus a big psychological problem, because his testosterone level is high, he is a small man. He may even behave aggressively and be uncontrollable.

Peripheral forms are quite rare; it may be testotoxicosis. This is a mutation of the LH receptor gene in testicular tissue. That is, stimulation of the testicle occurs in a constant mode, uncontrolled by the level of LH that exists in the blood of this child. It produces testosterone itself and doesn’t 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 and testicles increase in size, hair growth, and acne.

Anastasia Pleshcheva: Is it possible to do something about this?

Anna Bolmasova: Unfortunately no. There are now attempts at therapy with inhibitors, testosterone blockers, but so far not very successful. HCG provokes tumors that produce chronic human gonadotropin. This 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. Sexual development also begins.

A false form of premature development is hormonally active tumors of the ovaries and adrenal glands. With untreated congenital dysfunction of the adrenal cortex, puberty may begin. Therapy is carried out accordingly. If we talk about treatment, then central forms of premature sexual development are treated in the same way as in girls, with drugs analogues of LHRH, which block the release of LH, FSH, and sexual development is inhibited, the growth rate gradually slows down.

This is usually a drug that is given by injection, 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 gradually disappear. But if changes in the architectonics of the body have already occurred, it will not go away, but will be blocked. At an age close to normal sexual development, the drug is discontinued. Sexual development starts again on its own. It will start up after cancellation; it has already been proven that within about a year in boys it starts up 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 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 progressed according to class age, his growth zones are already practically 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 closed the growth zones are.

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

Anastasia Pleshcheva: How to treat peripheral forms?

Anna Bolmasova: This is usually surgical treatment. The Endocrinology Research Center now conducts such therapy, some oncology centers, I refer everyone to the Oncological Center.

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

Anastasia Pleshcheva: What does “complicated” mean? Do you organize consultations?

Anna Bolmasova: Yes, the question of canceling therapy is individual for each person, but there are some criteria. Depending on what his bone age is, what his growth rate is, what his growth forecasts are. Because here it is important not to overdo it, not to reduce 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 issue of discontinuing therapy is always decided individually with each patient. There is no such thing that everyone is canceled at the age of 10 and is not treated. Even the international consensus emphasizes that discontinuation of therapy is individual.

Anastasia Pleshcheva: What indicates to us that we urgently need to go to an endocrinologist?

Anna Bolmasova: If a boy develops pubic or scrotal hair at an early age, before the age of 9, the size of the penis approximately doubles. The growth of the penis and hair runs parallel to each other, so this is where mom will pay attention. This is the growth of hair shafts that were not there before.

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

Anastasia Pleshcheva: Thank you very much, Anna, the topic is really, very difficult. Thank you for voicing these most obvious points now, because I hope this will also help a lot of moms and dads. Thank you very much and see you again.

Anna Bolmasova: Thank you, goodbye.