The 5 Stages of Puberty

Puberty is a series of hormonal and physical changes that prepare the reproductive system and allow the body to produce offspring. Most females begin puberty between the ages of eight and 13 years old, while most males begin puberty between the ages of nine and 14 years old. (1) 

During puberty, children will show various signs of development, including changes in body shape and hair growth. Keep reading below to learn more about the signs and stages of puberty. 

What are the 5 stages of puberty?

The Tanner stages are often used to describe the body changes children undergo during puberty. The Tanner stages are based on predictable signs of puberty and are used to track the development of children throughout puberty. According to Tanner staging, there are five stages of puberty most males and females experience over the course of several years. (4)

Stage 1

Tanner stage one describes the early stages of puberty before there are any physical signs. (4) Puberty begins when certain hormone signals increase the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). LH and FSH are needed to stimulate the reproductive glands (i.e., ovaries, testes) to produce sex hormones (i.e., estrogen, testosterone). These sex hormones then begin to shape the reproductive development of males and females. (2)

Stage 2

Tanner stage two is characterized by the first physical signs of puberty. For females, breasts develop “buds” and begin to swell just beneath the nipple. This is triggered by increased levels of estrogen, the dominant female sex homone. (4)(13)

For males, the dominant sex hormone is testosterone. This hormone is released by the testes (testicles) and increases their size and development. (7) Both males and females may begin to see thin underarm or pubic hair development and their hands and feet will start to grow more rapidly. (4)(8)(13)

Stages 3 and 4 

Throughout Tanner stages three and four, a child’s body begins to change significantly. These stages of puberty may last several years. During this time, pubic and underarm hair continue to grow thicker and longer. (4) For females, body shape changes include increases in height and the growth and rounding of breasts, hips, and thighs. (8) The larynx (voicebox) also changes shape during this time, maturing female voices. (13)

Females may also get their first menstrual period within these stages. (16) Each month, the lining of the female uterus (womb) thickens, and an egg is released by the ovaries. If pregnancy does not occur, the lining will be shed as blood, and the egg (though microscopic) will be released through the vagina, known as menstruation. (8)(16)(17)

For males, during these stages of puberty, a significant growth spurt occurs. Height increases at a fast rate and the voice changes pitch. (13) The larynx gets larger and vocal cords grow longer, which may cause male voices to squeak or crack until matured into a deeper voice. (7) Male testicles continue maturing and the penis also begins to grow. Other components of male genitalia (e.g., prostate) also start to grow. These characteristics contribute to fertility of males by producing sperm cells, male reproductive cells that combine with female eggs to produce a fetus. (13)(14)

Stage 5

During the final stage of puberty, most reproductive changes are complete and males and females are considered sexually mature. Females have gotten their first menstrual period, and males are capable of producing and releasing sperm. Male and female bodies may continue to mature in size and shape, but most teenagers will be close to their adult height by the final stage of puberty. Males may also continue to develop hair in new places, such as the chest or face. (9)(13)

Signs of puberty

The growth and development that occurs during puberty takes place over several years. With changing hormone levels, there are many emotional and physical changes that happen throughout puberty. The chart below summarizes common physical changes that males and females may experience during puberty. (17)

In addition to changes in a child’s appearance, there are also many mental and emotional signs of puberty. Aging adolescents may begin to find a greater sense of self and seek more independence. Hormonal changes may alter appetite, energy levels, mood, and sleep patterns. (6)(17) Adolescents going through puberty may also begin to develop sexual interests and romantic relationships. (7)

Puberty concerns

Although puberty is a completely normal part of a child’s development, there are some potential concerns and complications of puberty to keep in mind. 

Precocious puberty

Precocious (early) puberty occurs when Tanner stage two begins earlier than usual—before the age of eight in females and nine in males. (4) Precocious puberty is most common in females and typically is not related to serious health complications. However, going through early puberty can make a child’s peak growth spurt earlier than normal. This may cause them to stop growing before they reach their maximum height potential. (5)

If you have any concerns about precocious puberty, connect with your family doctor or primary care provider to learn more about the condition. Practitioners may run a variety of tests, such as blood tests or X-rays, to access a child’s growth and maturation. (5) Depending on the root cause of precocious puberty, your healthcare practitioner may try to intervene and slow the progression of puberty. (12)

Delayed puberty

If children haven’t reached Tanner stage two of puberty by age 13 for females and age 14 for males, puberty is considered delayed. Many children will continue to go through an otherwise normal puberty at a later age. (11)

Some children may be experiencing delayed puberty due to an underlying medical condition, often hypogonadism. (11) In cases of hypogonadism, gonads (sex glands) that produce the sex hormones necessary for puberty don’t produce enough or any sex hormones. Hypogonadism is often caused by an underlying condition, such as:

• Autoimmune conditions (i.e., type 1 diabetes)
• Genetic disorders (i.e., Turner syndrome) 
• Infection
• Trauma (10)

Consult with your healthcare provider if you have any concerns about delayed puberty. Similar to precocious puberty, practitioners may run a variety of tests to access a child’s growth and maturation. Depending on the cause of delayed puberty, practitioners may suggest increasing sex horomone levels by using hormone therapy/medications. (12)

Emotional well-being

Children and teens may experience a variety of emotions throughout their transition into sexual maturity. Acne and other skin changes, body image changes, and voice breaking or cracking may be difficult to cope with for some adolescents. Individuals going through puberty early or delayed may be even more self-conscious about these changes as they are developing differently than their peers. It’s important to keep these changes in mind and offer support to adolescents going through the stages of puberty. (6)(17)

The bottom line

Puberty is a normal transition during a child’s development. During puberty, adolescents change mentally and physically and gain the ability to reproduce. There are many signs children may be going through puberty, including body changes and mood changes. These changes may be overwhelming for some children, so it’s important to be supportive throughout the stages of puberty. If you have any concerns about puberty, reach out to your integrative healthcare provider to learn more about what to expect during this time.