A question of male maturation: boys to men too soon?

Some findings indicate the age boys reach puberty is decreasing -- a concept that raises questions about causes, responses and health implications.

By Victoria Stagg Elliott, amednews staff. Oct. 8, 2001.

Boys may be starting to turn into men younger than ever, according to a study published in the September Archives of Pediatrics & Adolescent Medicine.

Researchers say this finding raises concern about the causes and the unknown health consequences over the long term.

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"It's probably not healthy since earlier studies have shown that the sooner a boy starts puberty, the higher his risk is of developing testicular cancer, just as early-maturing girls are at greater risk of developing breast cancer," said Marcia Herman-Giddens, MPH, DrPH, lead author of the paper.

"Then there are the implications for sex education and preparing children for the psychosocial challenges of puberty, as well as the consequences of earlier sexual activity," she added.

Dr. Herman-Giddens, adjunct professor of maternal and child health at the School of Public Health at the University of North Carolina, Chapel Hill, has also published studies finding earlier puberty in girls. In the most recent article, she and other researchers followed boys' maturation by charting pubic hair and genital development in more than 2,000 research subjects. They found that these physical signs of maturation were occurring at earlier ages than noted in previous studies.

Physicians who treat children say, however, that they are not seeing large numbers of boys maturing earlier.

"That's not what exists in the real clinical world," said Edward O. Reiter, MD, chair of the department of pediatrics at Baystate Medical Center Children's Hospital in Springfield, Mass., who wrote the accompanying editorial in the Archives. "I don't think puberty is beginning earlier."

Critics also say that the paper was flawed because it relied on subjective indicators rather than more objective measures such as sex hormone levels.

Raising related questions

The study also did not find that puberty ended earlier, which experts say is more important.

"The really crucial thing is that the pediatrician be aware of the rate of progression of what's going on," said Dr. Reiter. "That's going to separate the pathology from variations of human normalcy."

Endocrinologists are concerned that the results of the research give out the wrong messages that early puberty is normal, especially for boys. Early puberty in girls is rarely a sign of a more serious problem, but for boys it usually is.

"It may turn out that they have a little early puberty, and it's irrelevant, or it's the beginning of something that's a problem," said Dr. Reiter. "Pediatricians need to watch these kids at the early edge of normalcy or abnormal. And if it's a boy, you need to jump on it because there's a 50% chance there's an organic cause of concern."

Experts did, however, praise the study for offering up more questions about male maturation than it answered because the area is one long neglected by science. "It's important that it's being discussed," said Dr. Reiter.

But just beyond the debate on whether boys really are maturing earlier is a great deal of concern and speculation about the causes. Dr. Herman-Giddens suggested in her paper that environmental toxins or obesity may play a role. Experts caution that environmental studies will be extremely difficult to do, and results from animal exposure should not be generalized to humans.

As for obesity, the question is what comes first? Are those who mature earlier heavier because they hit puberty early, or is it the other way around?

"What's driving early puberty, if it's happening?" asked Frank Biro, MD, professor of clinical pediatrics in the division of adolescent medicine at Children's Hospital Medical Center of Cincinnati. "I don't know."

Experts say that what is needed is much more research. To that end, the American Academy of Pediatrics' research group is looking to start a project in this area.

"I believe changes in when puberty starts in boys and girls is an important public health issue in this country," said Dr. Herman-Giddens. "It's good that these findings get attention because they stimulate research into the health implications, which we really do need to know about."

ADDITIONAL INFORMATION:

Weblink

Article, "Secondary sexual characteristics in boys, estimates from the National Health and Nutrition Examination Survey III, 1988-1994," Archives of Pediatrics and Adolescent Medicine, September (vol. 155, issue 9)
(http://archpedi.ama-assn.org/issues/current/abs/poa00333.html)

Editorial, "Have the onset and tempo of puberty changed?" Archives of Pediatrics and Adolescent Medicine, September (vol. 155, issue 9)
(http://archpedi.ama-assn.org/issues/current/ffull/ped10011.html)

PROS network (Pediatric Research in Office Settings), American Academy of Pediatrics
(http://www.aap.org/pros/abtpros.htm)