Public Health Implications of Altered Puberty Timing

Abstract

Changes in puberty timing have implications for the treatment of individual children, for the risk of later adult disease, and for chemical testing and risk assessment for the population. Children with early puberty are at a risk for accelerated skeletal maturation and short adult height, early sexual debut, potential sexual abuse, and psychosocial difficulties. Altered puberty timing is also of concern for the development of reproductive tract cancers later in life. For example, an early age of menarche is a risk factor for breast cancer. A low age at male puberty is associated with an increased risk for testicular cancer according to several, but not all, epidemiologic studies. Girls and, possibly, boys who exhibit premature adrenarche are at a higher risk for developing features of metabolic syndrome, including obesity, type 2 diabetes, and cardiovascular disease later in adulthood. Altered timing of puberty also has implications for behavioral disorders. For example, an early maturation is associated with a greater incidence of conduct and behavior disorders during adolescence. Finally, altered puberty timing is considered an adverse effect in reproductive toxicity risk assessment for chemicals. Recent US legislation has mandated improved chemical testing approaches for protecting children's health and screening for endocrinedisrupting agents, which has led to changes in the US Environmental Protection Agency's risk assessment and toxicity testing guidelines to include puberty-related assessments and to the validation of pubertal male and female rat assays for endocrine screening.

Secondary Sexual Characteristics in Boys: Data From the Pediatric Research in Office Settings Network

“…36,37 Psychological, emotional, and behavioral affects of earlier sexual maturity may be pivotal, given the current phenomena of social and emotional delay in achieving adulthood. 4,33 Longitudinal tracking is needed to clarify any impact of overweight/obesity on boys' sexual development.…”

Age at menarche is associated with prediabetes and diabetes in women (aged 32–81 years) from the general population: the KORA F4 Study

“…There is evidence that younger age at menarche might lead to certain chronic diseases [8][9][10]12]. Whether this secular trend in puberty timing is really associated with adverse health implications still needs to be assessed [27].…”

Risky, early, controversial. Puberty in medical discourses

“…As mentioned above, there is considerable diversity in the speed of pubertal changes (Grumbach and Styne, 2003;Kaplowitz and Oberfield, 1999;Palmert et al, 1999;Palmert and Boepple, 2001;Bruni et al, 2001). Disturbances of the hypothalamus or higher neurologic centers can result into an abnormal release of GnRH, the growth hormone: whereas gonadotropin-independent sexual precocity can arise from a variety of anatomic or functional lesions.…”

“…In their review, Golub et al (2008) make out a difference between internalizing disorders (depression and eating disorders) and externalizing disorders (substances abuse and conduct disorders). What are the clinical and psychological sources that allow to identify these clusters of disorders?…”