1. Take the Quiz on Puberty
2. Parenting Principles Slideshow Pictures
3. Parenting and Healthy Eating Slideshow Pictures

Medical Author:

John Mersch, MD, FAAP

John Mersch, MD, FAAP

Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.

View Full Profile

Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

View Full Profile

Secondary sex changes

For any child experiencing puberty, the most impressive evidence of the profound hormonal changes that are occurring center around the reproductive organs. This evolution commonly requires approximately five years from onset to completion. A series of predictable physical changes was noted and studied by several groups. In 1970, Dr. W.A. Marshall and Dr. J.M. Tanner published a landmark paper standardizing this sequence, and the series of changes have subsequently been known as the Tanner stages. These sequential stages of sexual maturity are listed below.

Tanner stages have been developed as a way to classify the time, course, and progress of changes that occur during puberty. They are based upon attainment of the so-called secondary sex characteristics, which include genital development in males, breast development in females, and pubic hair development in both genders.

Males

• Tanner I: preadolescent
• Tanner II: testicular enlargement and thinning of scrotal skin
• Tanner III: penile enlargement and continued increase in testicular size
• Tanner IV: further testicular/penile enlargement and appearance of pubic hair<
• Tanner V: adult testicular/penile size and pubic hair distribution

Females

• Tanner I: preadolescent breast
• Tanner II: breast tissue development with onset of areolar enlargement sparse longitudinal labial pubic hair
• Tanner III: increase in breast tissue volume and areolar enlargement coarser and curlier pubic hair
• Tanner IV: adult breast shape and elevation of the nipple thickening and broader distribution of pubic hair
• Tanner V: mature adult breast shape and contour adult pubic hair character and distribution

The onset of puberty in males should take place between 9-14 years of age; females should experience the initial pubertal changes between 8-13 years of age. Precocious puberty is defined as the onset of the complete changes of puberty prior to these ages. Delayed onset of puberty implies lack of pubertal onset by the above timetable. There are several medical conditions (both physiologically normal and abnormal) that may give rise to problems with only adrenarche, pubarche, or thelarche.

Listed below is a table relating the physical changes and their age of onset as described by Marshall and Tanner. There exists a standard deviation of approximately one year. It is important to note that while some adolescents have a methodical step-by-step march through this period of their life, others seem to follow a much more erratic timetable of maturation.

Must Read Articles Related to Puberty

Acne Acne is a red skin rash caused by several factors, including hormones and bacteria. Treatment involves washing skin with a mild cleanser once or twice daily, ap...learn more >>

Menstrual Pain Menstrual cramps are either classified as primary dysmenorrhea (painful menstruation) in which there is no anatomical cause for the pain. Secondary dysmenorrhea...learn more >>

Nutrition and Diet Nutrition and diet is needed for health. Read dietary guidelines, dietary reference intakes, food guide pyramid, calories, carbohydrates, protein, fats, vitamin...learn more >>

See the Entire Puberty Topic Guide »