Puberty is considered delayed if there is no breast development in girls by age or no testicular enlargement in boys by age 14 .

Caused by the early activation of the hypothalamic-pituitary-gonadal (HPG) axis . While often idiopathic in girls, it is frequently associated with central nervous system abnormalities in boys.

Bone age radiography, serum gonadotropin (LH, FSH) levels, and pelvic ultrasounds are critical for classification. Delayed Puberty: Stalled Maturation