Delayed Puberty: Concerns and Insights for Young Adults

Pubertal Growth and Development

Hello Doctor,
1.
I am currently 23 years old, born in the Year of the Pig.
I have some concerns regarding my growth and development during puberty.
My height is approximately 168 cm and my weight is 70 kg.
To describe myself from head to toe: I have a baby face and my skin is quite good.
I have never had facial hair and my Adam's apple is very, very small.
My voice is often mistaken for that of a female.
My nipples have not hardened or darkened, and I have only a few short armpit hairs that seem to have taken a long time to grow.
I have pubic hair, which I remember starting to grow in the last couple of years, but it feels sparse.
My penis is small, and I have difficulty retracting the foreskin; when I pull it back about 0.5 cm, it feels tight.
However, when I shower, it seems to swell a bit, and at that time, I can retract the foreskin about 1 cm, which is 0.5 cm more than usual.
I have heard that having an erection in the morning indicates development, but I seem to rarely experience this (maybe 2 to 5 times a month).
I am unsure if this is a problem.
However, I do get erections when viewing adult images.
Lastly, I do have some leg hair.
2.
By the way, I am about to undergo a military physical examination, and I am concerned about being considered abnormal.
3.
Additionally, I wonder if the examination will require me to retract the foreskin to check for any abnormalities on the glans.
In my usual state, I can only retract it a little bit.
Also, I have experienced nocturnal emissions but have not engaged in sexual intercourse.
Thank you!

Xiong Xiong, 20~29 year old female. Ask Date: 2005/01/30

Dr. Lin Wenxian reply Pediatrics

Dr.
Lin Wen-Hsien, the Chief of Pediatrics at Tainan Hospital under the Department of Health, Executive Yuan, responded to your inquiry:
You mentioned several concerns, one regarding secondary sexual characteristics, including facial hair, Adam's apple, voice changes, armpit hair, leg hair, and pubic hair.
Another concern is about the foreskin.
The phenomena you described can actually be normal; however, I recommend that you visit the hospital's endocrinology or urology department for an examination.
Many subjective symptoms (personal feelings) may not necessarily indicate a problem, but a doctor's evaluation is essential to confirm whether there is an issue that needs to be addressed, which can help alleviate any unnecessary anxiety.

As for the military physical examination, as long as these subjective symptoms are addressed by a physician, you should be able to face it with confidence.
Everyone has some differences from others, just like some people are taller or heavier, and doctors are accustomed to seeing a variety of cases.

Tainan Hospital wishes you good health and all the best!

Reply Date: 2005/01/30

More Info

Hello! Thank you for reaching out with your concerns regarding delayed puberty and related issues. It's important to understand that puberty can vary significantly from person to person, and there are many factors that can influence its timing and progression. Let's break down your concerns and provide some insights.

Understanding Delayed Puberty
1. Physical Development: From your description, it seems that you are experiencing signs of delayed puberty. Typically, puberty begins between ages 9 and 14 for boys, and it can last several years. The changes you mentioned, such as minimal facial hair, a lack of deepening voice, and limited growth of body hair, suggest that your body may still be in the earlier stages of puberty.

2. Hormonal Factors: The development of secondary sexual characteristics, such as facial hair and voice changes, is primarily driven by testosterone. If you are not experiencing these changes, it might be worth consulting an endocrinologist or a healthcare provider specializing in hormonal issues. They can evaluate your hormone levels and determine if there is an underlying condition affecting your development.

3. Psychological Impact: It's not uncommon for individuals experiencing delayed puberty to feel self-conscious or anxious about their development, especially in social situations. This can lead to feelings of inadequacy or being different from peers. It's crucial to remember that everyone develops at their own pace, and many factors, including genetics and health, play a role.

Concerns About Military Service
Regarding your upcoming military service physical examination, it's understandable to feel anxious. The military typically conducts a thorough health assessment, but they are trained to handle various situations sensitively. If you have concerns about being perceived as different, it may help to discuss these feelings with a trusted friend or family member beforehand.

Medical Examination and Privacy
During the physical examination, medical professionals are required to maintain confidentiality and professionalism. If there are concerns about your genital development, they may ask you to expose the area for examination. However, you have the right to ask questions and express any discomfort you may have. It's important to communicate openly with the healthcare provider about your concerns regarding your body and any difficulties you experience, such as the tightness of the foreskin.

Sexual Function and Erections
It's also normal for young men to experience variations in erectile function, especially during puberty. The fact that you can achieve an erection in response to sexual stimuli, such as pornography, indicates that your body is capable of sexual arousal. The frequency of spontaneous erections can vary widely among individuals, and it's not uncommon for some to experience them less frequently, especially during times of stress or anxiety.

Recommendations
1. Consult a Healthcare Provider: If you haven't already, consider scheduling an appointment with a healthcare provider who specializes in adolescent medicine or endocrinology. They can provide a comprehensive evaluation and discuss any necessary tests to assess your hormone levels and overall health.

2. Mental Health Support: If feelings of anxiety or self-consciousness persist, consider speaking with a mental health professional. They can help you navigate these feelings and provide coping strategies.

3. Educate Yourself: Understanding the normal range of puberty can help alleviate some anxiety. Resources from reputable health organizations can provide valuable information about what to expect during this developmental stage.

4. Open Communication: If you have concerns about the military examination, consider discussing them with a recruiter or a trusted individual who can provide guidance and support.

In conclusion, while it’s natural to have concerns about delayed puberty and its implications, remember that you are not alone in this experience. Many young men go through similar challenges, and there are professionals available to help you navigate this phase of life. Don’t hesitate to seek the support you need. Best of luck with your upcoming examination and your journey toward understanding your development!

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