Puberty is a natural phase of human development, and it increasingly seems to be a crucial factor in understanding the risk of adverse health outcomes later in life. Studies focusing on girls have shown a strong link between the timing of puberty and health risks.
Early onset of puberty is linked to a greater likelihood of diseases such as endometriosis, type 2 diabetes, heart disease, breast cancer, depression, eating disorders, uterine fibroids, osteoarthritis, and even increased all-cause mortality. The risk of these conditions tends to rise as the age at which puberty begins decreases. Conversely, delayed puberty is associated with conditions like celiac disease, asthma, and poor sleep, but it also offers protection against some illnesses. Both early and delayed puberty—occurring before age 8 and after age 13—are linked to early menopause, which carries its own health risks.
Research has further elucidated how the timing of puberty impacts disease development in women. Early puberty exposes the body to hormones like estrogen for longer periods, heightening the risk of conditions such as endometriosis and breast cancer. Additionally, puberty timing can serve as an early indicator for metabolic and cardiovascular issues like type 2 diabetes and heart disease due to shared genetic factors. There is also a social dimension to the mental health issues linked with early puberty: girls who mature early often feel isolated and bullied, leading to long-lasting effects.
This body of research is creating a comprehensive guide to women’s health that could potentially help women live longer and improve their quality of life. However, extracting similar insights for men requires more investment and innovative strategies. There is a significant gender gap in research, with far less known about male puberty. Between 1990 and 2016, there were approximately 1.67 times more research papers published on female puberty than male puberty, prompting calls for more balanced research. By better understanding how puberty timing affects disease risk in men, the potential exists to improve identification and prevention of chronic illnesses.
Anders Juul, a professor of pediatric endocrinology at the University of Copenhagen and head of the growth and reproduction department at Rigshospitalet, is a prominent advocate for this research. With over 30 years of experience studying puberty, Juul emphasizes, “Increased knowledge on factors regulating timing of male puberty may be the key to understanding long-term health in males.” For men, who statistically experience poorer health outcomes over their lifetimes, this research could be game-changing.
Closing the Gap
In 2023, over half of American male deaths were considered premature. At that time, the average life expectancy for men was 75.8 years, which was 6.5 years less than their counterparts in the longest-lived high-income countries. Heart disease, cancer, and diabetes were leading causes of these early deaths, all of which have been linked to puberty timing.
When these diseases do not result in death, they often reduce the quality of life, especially after age 65, placing a significant caregiving burden on mostly female relatives. This scenario affects millions of fathers, sons, and brothers whose lives are cut short or diminished, along with millions of mothers, daughters, and sisters who face the demanding, unpaid tasks of caregiving. Additionally, the five leading causes of male death in America cost society approximately $420.6 billion annually, including treatment expenses and lost income. Addressing men’s health issues benefits everyone, lending a strong argument for increasing research into male puberty.
A key reason for the greater focus on female puberty is the clear and identifiable signs like breast buds and menarche. According to Juul, the male equivalent, spermarche (first ejaculation), is harder to measure because boys may not even realize it has occurred. Even when aware, boys are often reluctant to discuss these changes, as society has not celebrated their transition into puberty as it has for girls.
Despite these obstacles, male puberty research can advance by applying insights gained from studies on females. Research on girls has highlighted key factors influencing the onset of puberty. Genetics control about 50% to 80% of the timing variation, with about two-thirds of genetic variants affecting puberty timing shared across genders. Other factors include ethnicity, nutrition, body fat, socioeconomic status, emotional well-being, and exposure to endocrine-disrupting chemicals.
Current male puberty research has found initial links between puberty timing and adverse health outcomes in boys. A 2015 study analyzing data from 500,000 participants in the UK Biobank associated early puberty in both genders with 48 negative outcomes, spanning cancer, cardiovascular, gynaecological, gastrointestinal, musculoskeletal, and neuro-cognitive categories. However, authors caution that more research is needed to fully understand these findings in males.
Additional studies have linked early puberty in boys to increased risks for heart attack, type 2 diabetes, obesity, depression, and ADHD. A 2024 study discovered a strong genetic link between men’s hair color and puberty timing: adolescents with red, dark brown, or black hair showed progressively higher chances of early puberty. Androgens, which regulate body pigmentation, may influence this association. While a connection between early female puberty and breast cancer is well-established, the link between early male puberty and prostate cancer remains unclear.
Late puberty in boys and men carries its own health risks, including anxiety, panic attacks, depression, asthma, eczema, and poorer overall health. Though fewer negative implications arise from later puberty, Elizabeth Shirtcliff, a scientist at Boston Children’s Hospital and Harvard Medical School, notes that it often leads to bullying, worsening self-esteem and mental health issues.
On a positive note, late puberty may extend men’s lifespans. One study found that each year puberty is delayed correlates with a nine-month increase in lifespan. Significant progress has been made in identifying genetic factors unique to male puberty timing, with 76 distinct genetic variants identified thus far.
Experts focused on improving boys’ health view these advances in male puberty research positively. Jennifer Pfeifer, co-director of the Center for Translational Neuroscience at the University of Oregon, believes that expanding knowledge on male puberty will better address boys’ needs.
What is Needed Next
In 2024, researchers at the University of Cambridge led an international team that conducted the largest genetic study on girls’ puberty age, analyzing DNA from 800,000 women across Europe, North America, China, Japan, and Korea. They identified over 1,000 variants linked to the timing of first menstruation; some directly affected puberty age, while others influenced weight gain. The comprehensive list of variants enabled the team to create genetic risk scores that could predict girls’ puberty timing.
Ken Ong, a Cambridge researcher and co-leader of the team that also identified the 76 genetic markers for male puberty, highlighted that the National Health Service in England is conducting a trial involving whole genome sequencing at birth for 100,000 babies. Combining these results with puberty risk scores could soon allow identification of girls at risk for early or late puberty, potentially enabling interventions to improve their long-term health. “This could be important for their health when they grow up,” Ong stated in a university news release.
Such possibilities have not yet been realized for boys due to limited genetic studies on male puberty. However, using puberty timing predictions to guide interventions for improving men’s long-term health is achievable, provided that more longitudinal clinical research is conducted. Some ongoing long-term studies include the Copenhagen Puberty Study, initiated by Juul in the 1990s. His research has already identified a phase known as minipuberty, demonstrated a decrease in average puberty onset age, and explored connections between puberty timing and mental health and behavioral issues.
Juul and his team now aim to better understand how environmental and lifestyle factors affect puberty timing and the associated health risks of atypical puberty onset.
Recent advancements could aid this work. A 2023 study successfully used testosterone and DHEA levels in children, along with observations of body hair growth, growth spurts, skin changes, facial hair development, and voice changes, to develop a precise puberty measurement. This underscores the value of comprehensive puberty metrics, especially for males—a stance long advocated by Shirtcliff. The same team also used this data to create an AI model that assessed a child’s “puberty age” and accurately identified their risk of developing mental health disorders during adolescence.
For men’s health experts like Lee Ponsky, director of University Hospitals Urology Institute and a urologic oncologist at UH Cleveland Medical Center, this research holds transformative potential. Ponsky, who has devoted his career to enhancing men’s health and quality of life, expressed enthusiasm: “I would be ecstatic for anything at all that allows us to [better] screen, diagnose, or provide interventions for men that are going to improve outcomes and save lives.” He hopes the scope of clinical research in this area will expand, allowing physicians to determine the feasibility of such an approach for supporting future patients.
Ultimately, non-invasive practices like lifestyle and behavioral interventions could significantly improve health outcomes from childhood onward. This might include dietary changes and nutrition education for children with a higher diabetes risk, as well as proactive mental health support for those at greater risk of anxiety and depression. There’s also potential for using medication to adjust puberty timing if such interventions prove effective. Nonetheless, as Juul emphasizes, “if we want to take preventive measures, we need to know more.”
STAT’s coverage of the health challenges facing men and boys is supported by Rise Together, a donor-advised fund sponsored and administered by National Philanthropic Trust and established by Richard Reeves, founding president of the American Institute for Boys and Men; and by the Boston Foundation. Our financial supporters are not involved in any decisions about our journalism.
