Recent secular trends in pubertal timing: implications for evaluation and diagnosis of precocious puberty
Abstract
The decline in age at puberty in the general population has been paralleled by an increase in the number of girls referred for evaluation of precocious puberty (PP). In 1999, The Lawson Wilkins Pediatric Endocrine Society recommended a lowering of the age limit for evaluation of PP in girls. However, the limited evidence on which these recommendations were based led many experts to question these new suggestions. The emergence of new European pubertal timing data evaluated by robust clinical as well as biochemical markers has broadened our insight on how to interpret the recent pubertal changes. The recent pubertal trends have resulted in a concomitant lowering of the lower limit of normality of the pubertal onset. However, evidence suggests that age at the gonadotropin and sex steroid surges have not changed. Thus, it looks as if an increasing proportion of contemporary early pubertal girls may experience isolated gonadotropin-independent thelarche rather than central PP, which may not be discernible on pubertal examination alone. Thus, the population-based limits of normality should not be directly translated into revision of age limits for evaluation of PP due to the risk of misdiagnosing rapid progressive PP as well as intracranial and other underlying pathology.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In countries across the globe, the age of puberty has continued to decline.
“In countries across the globe, the age of puberty has continued to decline”
From Becoming a sexual being: The “elephant in the room” of adolescent brain development (2017) · cites this paper as Sørensen et al., 2012
The decrease in age of onset of breast development has not been clearly associated with early increases in the sex hormones associated with puberty, including gonadotropins and estrogen.
“Interestingly, the decrease in age of onset of breast development has not been clearly associated with early increases in the sex hormones associated with puberty, including gonadotropins and estrogen”
From Becoming a sexual being: The “elephant in the room” of adolescent brain development (2017) · cites this paper as Sørensen et al., 2012
Declines in the early physical sign of puberty for boys-primarily testicular growth-have been paralleled by secular shifts in hormones associated with puberty.
“In contrast, declines in the early physical sign of puberty for boys—primarily testicular growth— have been paralleled by secular shifts in hormones associated with puberty”
From Becoming a sexual being: The “elephant in the room” of adolescent brain development (2017) · cites this paper as Sørensen et al., 2012
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Variations in pattern of pubertal changes in girls
Marshall, W. A., & Tanner, J. M. (1969) · Archives of Disease in Childhood · doi:10.1136/adc.44.235.291 · Cited by 5,963 · see citing works
Variations in the pattern of pubertal changes in boys
Marshall, W. A., & Tanner, J. M. (1970) · Archives of Disease in Childhood · doi:10.1136/adc.45.239.13 · Cited by 5,147 · see citing works
Parent, A.-S., Teilmann, G., Juul, A., Skakkebaek, N. E., Toppari, J., & Bourguignon, J.-P. (2003) · Endocrine Reviews · doi:10.1210/er.2002-0019 · Cited by 1,762 · see citing works
Self-citationHerman-Giddens, M. E., Slora, E. J., Wasserman, R. C., Bourdony, C. J., Bhapkar, M. V., Koch, G. G., & Hasemeier, C. M. (1997) · PEDIATRICS · doi:10.1542/peds.99.4.505 · Cited by 1,709 · see citing works
Consensus Statement on the Use of Gonadotropin-Releasing Hormone Analogs in Children
Carel, J., Eugster, E. A., Rogol, A. D., Ghizzoni, L., Palmert, M. R., & on behalf of the members of the ESPE-LWPES GnRH Analogs Consensus Conference Group (2009) · PEDIATRICS · doi:10.1542/peds.2008-1783 · Cited by 816 · see citing works
Earlier Onset of Puberty in Girls: Relation to Increased Body Mass Index and Race
Kaplowitz, P. B., Slora, E. J., Wasserman, R. C., Pedlow, S. E., & Herman‐Giddens, M. E. (2001) · PEDIATRICS · doi:10.1542/peds.108.2.347 · Cited by 750 · see citing works
Link Between Body Fat and the Timing of Puberty
Kaplowitz, P. B. (2008) · Pediatrics · doi:10.1542/peds.2007-1813f · Cited by 710 · see citing works
Age at menarche and racial comparisons in US girls
Chumlea, W. C., Schubert, C. M., Roche, A. F., Kulin, H. E., Lee, P. A., Himes, J. H., & Sun, S. S. (2003) · PEDIATRICS · doi:10.1542/peds.111.1.110 · Cited by 685 · see citing works
Wang, Y. (2002) · PEDIATRICS · doi:10.1542/peds.110.5.903 · Cited by 663 · see citing works
Examination of US puberty-timing data from 1940 to 1994 for secular trends: panel findings
Euling, S. Y., Herman-Giddens, M. E., Lee, P. A., Selevan, S. G., Juul, A., SØrensen, T. I. A., Dunkel, L., Himes, J. H., Teilmann, G., & Swan, S. H. (2008) · PEDIATRICS · doi:10.1542/peds.2007-1813d · Cited by 662 · see citing works
Self-citationRecent decline in age at breast development: The Copenhagen Puberty Study
Aksglaede, L., Sørensen, K., Petersen, J. H., Skakkebæk, N. E., & Juul, A. (2009) · Pediatrics · doi:10.1542/peds.2008-2491 · Cited by 626 · see citing works
Self-citationNational Estimates of the Timing of Sexual Maturation and Racial Differences Among US Children
Sun, S. S., Schubert, C. M., Chumlea, W. C., Roche, A. F., Kulin, H. E., Lee, P. A., Himes, J. H., & Ryan, A. S. (2002) · PEDIATRICS · doi:10.1542/peds.110.5.911 · Cited by 545 · see citing works
Thirty new loci for age at menarche identified by a meta-analysis of genome-wide association studies
The GIANT Consortium, Elks, C. E., Perry, J. R. B., Sulem, P., Chasman, D. I., Franceschini, N., He, C., Lunetta, K. L., Visser, J. A., Byrne, E. M., et al. (2010) · Nature Genetics · doi:10.1038/ng.714 · Cited by 504 · see citing works
Public health implications of altered puberty timing
Golub, M. S., Collman, G. W., Foster, P. M. D., Kimmel, C. A., Rajpert-De Meyts, E., Reiter, E. O., Sharpe, R. M., Skakkebaek, N. E., & Toppari, J. (2008) · PEDIATRICS · doi:10.1542/peds.2007-1813g · Cited by 497 · see citing works
Anderson, S. E., Dallal, G. E., & Must, A. (2003) · PEDIATRICS · doi:10.1542/peds.111.4.844 · Cited by 485 · see citing works
Kaplowitz, P. B., & Oberfield, S. E. (1999) · PEDIATRICS · doi:10.1542/peds.104.4.936 · Cited by 479 · see citing works
Evidence for a secular trend in age of menarche
Wyshak, G., & Frisch, R. E. (1982) · New England Journal of Medicine · doi:10.1056/nejm198204293061707 · Cited by 448 · see citing works
Testicular volume during adolescence. Cross-sectional and longitudinal studies.
ZACHMANN, M., Prader, A., Kind, H. P., Häfliger, H., & Budliger, H. (1974) · PubMed · Cited by 444 · see citing works
Recent changes in pubertal timing in healthy danish boys: associations with body mass index
Sørensen, K., Aksglaede, L., Petersen, J. H., & Juul, A. (2010) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-1478 · Cited by 393 · see citing works
Hagen, C. P., Aksglaede, L., Sørensen, K., Main, K. M., Boas, M., Cleemann, L., Holm, K., Gravholt, C. H., Andersson, A.-M., Pedersen, A. T., et al. (2010) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2010-0930 · Cited by 383 · see citing works
Pubertal assessment method and baseline characteristics in a mixed longitudinal study of girls
Biro, F. M., Galvez, M. P., Greenspan, L. C., Succop, P. A., Vangeepuram, N., Pinney, S. M., Teitelbaum, S., Windham, G. C., Kushi, L. H., & Wolff, M. S. (2010) · Pediatrics · doi:10.1542/peds.2009-3079 · Cited by 348 · see citing works
Environmental Factors and Puberty Timing: Expert Panel Research Needs
Louis, G. M. B., Gray, L. E., Marcus, M., Ojeda, S. R., Pescovitz, O. H., Witchel, S. F., Sippell, W. G., Abbott, D. H., Soto, A. M., Tyl, R. W., et al. (2008) · PEDIATRICS · doi:10.1542/peds.1813e · Cited by 334 · see citing works
Percent Body Fat at Age 5 Predicts Earlier Pubertal Development Among Girls at Age 9
Davison, K. K., Susman, E. J., & Birch, L. L. (2003) · PEDIATRICS · doi:10.1542/peds.111.4.815 · Cited by 317 · see citing works
Pubertal development in The Netherlands 1965–1997
Mul, D., Fredriks, A. M., van Buuren, S., Oostdijk, W., Verloove-Vanhorick, S. P., & Wit, J. M. (2001) · Pediatric Research · doi:10.1203/00006450-200110000-00010 · Cited by 313 · see citing works
Common genetic influences on BMI and age at menarche.
Kaprio, J. A., Rimpelä, A., Winter, T., Viken, R. J., Rimpelä, M., & Rose, R. J. (1995) · PubMed · Cited by 310 · see citing works
Pubertal development in Danish children: comparison of recent European and US data
JUUL, A., TEILMANN, G., SCHEIKE, T., HERTEL, N. T., HOLM, K., LAURSEN, E. M., MAIN, K. M., & SKAKKEBÆK, N. E. (2006) · International Journal of Andrology · doi:10.1111/j.1365-2605.2005.00556.x · Cited by 300 · see citing works
Self-citationOng, K. K., Ahmed, M. L., & Dunger, D. B. (2006) · Molecular and Cellular Endocrinology · doi:10.1016/j.mce.2006.04.018 · Cited by 298 · see citing works
Aksglæde, L., Sørensen, K., Boas, M., Mouritsen, A., Hagen, C. P., Jensen, R. B., Petersen, J. H., Linneberg, A. R., Andersson, A., Main, K. M., et al. (2010) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2010-1207 · Cited by 279 · see citing works
Self-citationThe timing of puberty: is it changing? Does it matter?
Walvoord, E. C. (2010) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2010.05.018 · Cited by 277 · see citing works
HERMAN‐GIDDENS, M. E. (2006) · International Journal of Andrology · doi:10.1111/j.1365-2605.2005.00575.x · Cited by 226 · see citing works
Role of Environmental Factors in the Timing of Puberty
Euling, S. Y., Selevan, S. G., Pescovitz, O. H., & Skakkebæk, N. E. (2008) · PEDIATRICS · doi:10.1542/peds.2007-1813c · Cited by 222 · see citing works
Biro, F. M., Lucky, A. W., Huster, G. A., & Morrison, J. A. (1995) · The Journal of Pediatrics · doi:10.1016/s0022-3476(95)70265-2 · Cited by 208 · see citing works
Secondary sex characteristics of girls 12 to 17 years of age: The U.S. Health examination survey
Daniel, W. A., Harlan, W. R., Harland, E. A., & Grillo, G. P. (1980) · The Journal of Pediatrics · doi:10.1016/s0022-3476(80)80647-0 · Cited by 203 · see citing works
Trend towards Earlier Menarche in London, Oslo, Copenhagen, the Netherlands and Hungary
Tanner, J. M. (1973) · Nature · doi:10.1038/243095a0 · Cited by 203 · see citing works
Stockman, J. A. (2007) · Yearbook of Pediatrics · doi:10.1016/s0084-3954(08)70076-9 · Cited by 175 · see citing works
Foster, T., Voors, A. W., Webber, L., Frerichs, R. R., & Berenson, G. (1977) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/30.4.582 · Cited by 169 · see citing works
Chellakooty, M., Schmidt, I. M., Haavisto, A.-M., Boisen, K. A., Damgaard, I. N., Kai, C. M., Petersen, J. H., Juul, A., Skakkebæk, N. E., & Main, K. M. (2003) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2002-021468 · Cited by 162 · see citing works
Self-citationEtiology and Age Incidence of Precocious Puberty in Girls: A Multicentric Study
Cisternino, M., Arrigo, T., Pasquino, A. M., et al. (2000) · Journal of Pediatric Endocrinology and Metabolism · doi:10.1515/jpem.2000.13.s1.695 · Cited by 160 · see citing works
Albertsson-Wikland, K. G., Rosberg, S., Lannering, B., Dunkel, L., Selstam, G., & Norjavaara, E. (1997) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.82.2.3778 · Cited by 158 · see citing works
Palmert, M. R., Hayden, D. L., Mansfield, M. J., Crigler, J. F., Crowley, W. F., Chandler, D. W., & Boepple, P. A. (2001) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.86.9.7863 · Cited by 153 · see citing works
Diagnostic Work-Up of 449 Consecutive Girls Who Were Referred to be Evaluated for Precocious Puberty
Mogensen, S. S., Aksglæde, L., Mouritsen, A., Sørensen, K., Main, K. M., Gideon, P., & Juul, A. (2011) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2010-2745 · Cited by 142 · see citing works
Self-citationAre Pubertal Changes in Girls Before Age 8 Benign?
Midyett, L. K., Moore, W. V., & Jacobson, J. D. (2003) · PEDIATRICS · doi:10.1542/peds.111.1.47 · Cited by 137 · see citing works
Karpati, A. M., Rubin, C., Kieszak, S. M., Marcus, M., & Troiano, R. P. (2002) · Journal of Adolescent Health · doi:10.1016/s1054-139x(01)00320-2 · Cited by 135 · see citing works
Timing of maturation and predictors of menarche in girls enrolled in a contemporary British cohort
Rubin, C., Maisonet, M., Kieszak, S. M., Monteilh, C. P., Holmes, A. K., Flanders, D. W., Heron, J., Golding, J., McGeehin, M., & Marcus, M. (2009) · Paediatric and Perinatal Epidemiology · doi:10.1111/j.1365-3016.2009.01055.x · Cited by 132 · see citing works
Chalumeau, M., Hadjiathanasiou†, C. G., Ng, S. M., Cassio, A., Mul, D., Cisternino, M., Partsch, C., Theodoridis, C., Didi, M., CACCIARI, E., et al. (2003) · The Journal of Pediatrics · doi:10.1067/s0022-3476(03)00328-7 · Cited by 126 · see citing works
Current Age of Onset of Puberty
Rosenfield, R. L., Bachrach, L. K., Chernausek, S. D., Gertner, J. M., Gottschalk, M. E., Hardin, D. S., Pescovitz, O. H., & Saenger, P. H. (2000) · PEDIATRICS · doi:10.1542/peds.106.3.622 · Cited by 125 · see citing works
Hagen, C. P., Main, K. M., Kjaergaard, S., & Juul, A. (2010) · Human Reproduction · doi:10.1093/humrep/deq291 · Cited by 114 · see citing works
Self-citationMogensen, S. S., Aksglæde, L., Mouritsen, A., Sørensen, K., Main, K. M., Gideon, P., & Juul, A. (2012) · PLoS ONE · doi:10.1371/journal.pone.0029829 · Cited by 107 · see citing works
Self-citationAssociation between overweight and early sexual maturation in Portuguese boys and girls
Ribeiro, J. C., Santos, M. P., Duarte, J. A., & Mota, J. A. P. S. (2006) · Annals of Human Biology · doi:10.1080/00207390500434135 · Cited by 106 · see citing works
Cranial MRI scans are indicated in all girls with central precocious puberty * COMMENTARY
Ng, S. M. (2003) · Archives of Disease in Childhood · doi:10.1136/adc.88.5.414 · Cited by 94 · see citing works
Cross‐Sectional and Longitudinal Studies
Machin, D., & Campbell, M. J. (2005) · doi:10.1002/0470012994.ch5 · Cited by 90 · see citing works
Sørensen, K., Aksglæde, L., Munch‐Andersen, T., Aachmann‐Andersen, N. J., Petersen, J. H., Hilsted, L. M., Helge, J. W., & Juul, A. (2009) · Diabetes Care · doi:10.2337/dc08-1618 · Cited by 90 · see citing works
Self-citationRegulation and Disorders of Pubertal Timing
Nathan, B. M., & Palmert, M. R. (2005) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2005.04.015 · Cited by 75 · see citing works
Sørensen, K., Mouritsen, A., Mogensen, S. S., Aksglæde, L., & Juul, A. (2010) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2010-0731 · Cited by 64 · see citing works
Self-citationPubertal Development of Turkish Children
Semiz, S., Kurt, F., Kurt, D. T., Zencir, M., & Sevinç, Ö. (2008) · Journal of Pediatric Endocrinology and Metabolism · doi:10.1515/jpem.2008.21.10.951 · Cited by 63 · see citing works
Slora, E. J., Bocian, A. B., Herman‐Giddens, M. E., Harris, D. L., Pedlow, S. E., Dowshen, S. A., & Wasserman, R. C. (2009) · Journal of Pediatric Endocrinology and Metabolism · doi:10.1515/jpem.2009.22.4.291 · Cited by 42 · see citing works
Timing of Pubertal Onset in Girls: Evidence for Non-Gaussian Distribution
Papadimitriou, A., Pantsiotou, S., Douros, K., Papadimitriou, D. T., Nicolaidou, P., & Fretzayas, A. (2008) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-0661 · Cited by 38 · see citing works
Herman-Giddens, M. E., Wang, L., & Koch, G. (2001) · Archives of Pediatrics & Adolescent Medicine · doi:10.1001/archpedi.155.9.1022 · Cited by 2 · see citing works
Flagged first, then by citations
Research works printed but not linked: 4
- Karpati AM, Rubin CH, Kieszak SM, Marcus M, Troiano RP: Stature and pubertal stage assessment in American boys: the 1988-1994 Third National Health and Nutrition Exam- ination Survey. J Adolesc Health 2002; 30: 205-212.
- Sun SS, Schubert CM, Liang R, Roche AF, Kulin HE, Lee PA, Himes JH, Chumlea WC: Is sexual maturity occurring earlier among U.S. children? J Adolesc Health 2005; 37: 345- 355.
- Viner R: Splitting hairs. Arch Dis Child 2002; 86: 8-10.
- Sorensen K, Nielsen J, Busch P, Hamborg- Petersen B, Hansen E, Lassen LB, Nielsen K, Poulsen JP, Rossen K, Schaap SK, Taudorf K, Thelle T, Vestermark S, Vrang C: Measure- ment of testicular volume with Prader's or- chiometer in 1,389 boys 5-15 1/2 years old. Ugeskr Laeger 1979; 141: 915-918.
Cited by
Sorted by citations
Annual Research Review: Secular trends in child and adolescent mental health
Collishaw, S. (2015) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12372 · Cited by 788 · see citing works
Treatment and Outcomes of Precocious Puberty: An Update
Fuqua, J. S. (2013) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2013-1024 · Cited by 260 · see citing works
Keyes, K. M., & Platt, J. M. (2024) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13864 · Cited by 253 · see citing works
Becoming a sexual being: The “elephant in the room” of adolescent brain development
Suleiman, A. B., Galván, A., Harden, K. P., & Dahl, R. E. (2017) · Developmental Cognitive Neuroscience · doi:10.1016/j.dcn.2016.09.004 · Cited by 89 · see citing works
Dassa, Y., Crosnier, H., Chevignard, M., Viaud, M., Personnier, C., Flechtner, I., Meyer, P., Puget, S., Boddaert, N., Breton, S., et al. (2019) · European Journal of Endocrinology · doi:10.1530/eje-19-0034 · Cited by 34 · see citing works
Making Memories: Why Time Matters
Kelley, P., Evans, M. D. R., & Kelley, J. (2018) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2018.00400 · Cited by 10 · see citing works
- Authors
- Sørensen, K., Mouritsen, A., Aksglaede, L., Hagen, C. P., Mogensen, S. S., & Juul, A.
- Affiliations
- University of Copenhagen (DK)
- Venue
- Hormone Research in Paediatrics
- Publisher
- S. Karger AG
- Published
- 2012
- Volume
- 77
- Issue
- 3
- Pages
- 137-145
- ISSN
- 1663-2818 (ISSN-L)
- 1663-2826
- OpenAlex
- W2069575278
- Cited by
- 386
- References
- 58
- Citations by year
- 2026: 20 · 2025: 34 · 2024: 25 · 2023: 33 · 2022: 28 · 2021: 31 · 2020: 34 · 2019: 31 · 2018: 22 · 2017: 21 · 2016: 24 · 2015: 29 · 2014: 29 · 2013: 21 · 2012: 2
- FWCI
- 3.52
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Hormone Research in Paediatrics (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Sexual Differentiation and Disorders
- Health Sciences › Health Professions › General Health Professions › Adolescent Sexual and Reproductive Health
- Keywords
- pubertal timing, secular trends, precocious puberty, puberty onset, thelarche, gonadotropin surge, central precocious puberty, diagnostic criteria, misdiagnosis
- MeSH terms
- Breast, Child, Europe, Female, Gonadotropins, Humans, Male, Menarche, Nutrition Surveys, Obesity, Puberty, Puberty, Precocious, Testis, United States, White People
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
