Puberty occurring at an unusually early age
Sara was only seven when her mother noticed something unusual – her daughter had started developing breasts and even had her first period.
This caught the family by surprise. Isn't puberty supposed to start later?
Worried, they came to see me.
Sara's story is one many parents might find unfamiliar but is important to understand.
When children start puberty too early – before age eight in girls and before age nine in boys – it's called precocious puberty.
What happens during puberty?
Puberty is a time of big changes.
The brain tells the body to start producing hormones that help children grow taller, develop breasts or testicles, grow body hair, and eventually become capable of reproduction.
The main hormone messenger in this process is a chemical in the brain called gonadotropin-releasing hormone (GnRH).
It signals the pituitary gland (a small gland at the base of the brain) to release two key hormones: luteinising hormone (LH) and follicle-stimulating hormone (FSH).
These in turn stimulate the ovaries in girls and the testes in boys to produce estrogen and testosterone, the hormones responsible for the visible changes of puberty.
Normally, girls start puberty between eight and 13 years, while boys begin between nine and 14 years.
But when this process begins too soon, children face unique physical and emotional challenges. When precocious puberty strikes, boys might feel pressured to behave in a more mature way than they're ready for. — Pixabay
Signs to watch for
How do you know if your child may be entering puberty early?
Here are some common signs:
In girls:
> Breast development before the age of eight
> Menstrual bleeding before the age of 10
> Rapid growth or 'growth spurts'
> Pubic or underarm hair
> Acne or oily skin
> Body odour similar to that of a teenager.
In boys:
> Enlargement of the testicles or penis before age nine
> Deepening of the voice
> Muscle growth
> Facial, underarm, or pubic hair
> Acne and body odour.
In both boys and girls, a noticeable increase in height over a short period may be one of the first signs parents pick up on.
Sometimes these signs can be subtle at first. If you're unsure, speak to your child's doctor.
Why does early puberty happen?
In most girls, early puberty is due to the brain starting the hormone process too early.
This is called central precocious puberty (CPP), and in many cases, there is no identifiable cause – it just happens.
However, if the onset is very young before six years or in boys, it is likely to be caused by a medical issue, such as a problem in the brain, a tumour, or another hormonal disorder.
Less commonly, precocious puberty can be peripheral – meaning the hormone changes start outside the brain.
This could be due to problems with the adrenal glands, ovaries, or testes, and is not triggered by the usual brain hormones.
Other known factors that may play a role in triggering early puberty include:
> Brain abnormalities or tumours, especially in very young children
> Previous radiation or trauma to the brain
> Congenital conditions, such as hypothalamic hamartoma
> Obesity, which is increasingly recognised as a contributing factor
> Family history of early puberty
> Environmental exposures to hormone-disrupting chemicals.
What are endocrine disruptors?
Parents should be aware of endocrine-disrupting chemicals (EDCs).
These are substances that can interfere with the body's hormone systems.
Some are found in plastics especially bisphenol A (BPA), cosmetics, fragrances, pesticides and even some foods e,g, plant-based estrogen known as phytoestrogen.
For example, certain essential oils like lavender and tea tree oil have been linked – though not conclusively – to hormone effects in children.
Creams or supplements bought over the counter or online may also contain undisclosed hormones.
While the science and evidence is still evolving, it's best to reduce unnecessary exposure to products that may contain hormones or hormone-like compounds, especially in young children.
How is early puberty evaluated?
If your child is showing early signs of puberty, the next step is to consult a paediatric endocrinologist – a doctor who specialises in hormone issues in children.
Here's what you can expect during an evaluation:
> A detailed medical and family history, including growth patterns, timing of puberty in parents and any medications or exposures
> A physical examination to assess the stage of puberty and growth rate
> Blood tests to measure hormone levels (LH, FSH, estrogen or testosterone, and other related hormones)
> Bone age X-ray of the left hand and wrist to see how much a child's bones have matured
> Pelvic ultrasound in some girls to assess the uterus and ovaries, or testicular ultrasound in boys if needed
> Pituitary MRI in certain cases (especially in boys or girls under six years, or those with rapid progression) to look for brain abnormalities.
What problems can early puberty cause?
One major concern with precocious puberty is shorter adult height.
Children grow quickly at first, but their bones also mature faster. This can lead to the growth plates closing earlier than usual, limiting final height.
There are also emotional and psychological challenges.
Children who develop earlier than peers may feel different, embarrassed or self-conscious.
Girls may struggle with body image or unwanted attention.
Boys might feel pressured to behave in a more mature way than they're ready for.
These feelings can affect self-esteem, social development and even school performance.
Can early puberty be treated?
Yes! The good news is that precocious puberty can be managed effectively.
The main treatment for central precocious puberty is with GnRH analogues – medications that 'switch off' the puberty hormones by blocking the signals from the brain.
These medications are usually given as intramuscular injections, typically once a month or every three to six months, depending on the preparation used.
These medications are generally safe and well-tolerated, and once they are stopped (usually around the normal age of puberty), the body resumes puberty naturally.
Side effects such as sterile abscess at the injection sites are reported but uncommonly.
Treatment helps preserve height potential and gives children more time to grow physically and emotionally before entering adolescence.
Any underlying causes or contributing factors must also be addressed.
A paediatric endocrinologist considers treatment based on:
> The child's age
> How fast the puberty is progressing
> Bone age and predicted adult height
> The child's emotional readiness and how they're coping.
Sara's journey
Sara began treatment soon after her diagnosis.
Her hormone levels were consistent with early puberty, and her bone age showed advanced maturity compared to her actual age.
With three-monthly injections and regular follow-up, her puberty progression slowed, and her growth pattern stabilised.
More importantly, she had the time to adjust emotionally and her confidence returned.
With the support of her family, Sara started feeling like a kid again.
So, if you suspect your child might be going through puberty too early, trust your instincts.
Seek medical advice early – because early diagnosis can make a big difference in your child's growth, emotional health and long-term well-being.
Remember:
> Not all early signs mean your child has precocious puberty or needs treatment, but it's worth getting checked
> Treatment is available and effective
> Support from parents and clear information can help your child feel safe and understood.
And finally, be mindful of the products your child is exposed to – avoid unnecessary fragrances, creams, oils or supplements that may contain hormone-like substances.
With awareness, early action, and the right care, children with precocious puberty can go on to thrive – just like Sara.
Dr Jeanne Wong Sze Lyn is a consultant paediatrician and paediatric endocrinologist. For more information, email starhealth@thestar.com.my. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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The Star
3 days ago
- The Star
Puberty occurring at an unusually early age
Sara was only seven when her mother noticed something unusual – her daughter had started developing breasts and even had her first period. This caught the family by surprise. Isn't puberty supposed to start later? Worried, they came to see me. Sara's story is one many parents might find unfamiliar but is important to understand. When children start puberty too early – before age eight in girls and before age nine in boys – it's called precocious puberty. What happens during puberty? Puberty is a time of big changes. The brain tells the body to start producing hormones that help children grow taller, develop breasts or testicles, grow body hair, and eventually become capable of reproduction. The main hormone messenger in this process is a chemical in the brain called gonadotropin-releasing hormone (GnRH). It signals the pituitary gland (a small gland at the base of the brain) to release two key hormones: luteinising hormone (LH) and follicle-stimulating hormone (FSH). These in turn stimulate the ovaries in girls and the testes in boys to produce estrogen and testosterone, the hormones responsible for the visible changes of puberty. Normally, girls start puberty between eight and 13 years, while boys begin between nine and 14 years. But when this process begins too soon, children face unique physical and emotional challenges. When precocious puberty strikes, boys might feel pressured to behave in a more mature way than they're ready for. — Pixabay Signs to watch for How do you know if your child may be entering puberty early? Here are some common signs: In girls: > Breast development before the age of eight > Menstrual bleeding before the age of 10 > Rapid growth or 'growth spurts' > Pubic or underarm hair > Acne or oily skin > Body odour similar to that of a teenager. In boys: > Enlargement of the testicles or penis before age nine > Deepening of the voice > Muscle growth > Facial, underarm, or pubic hair > Acne and body odour. In both boys and girls, a noticeable increase in height over a short period may be one of the first signs parents pick up on. Sometimes these signs can be subtle at first. If you're unsure, speak to your child's doctor. Why does early puberty happen? In most girls, early puberty is due to the brain starting the hormone process too early. This is called central precocious puberty (CPP), and in many cases, there is no identifiable cause – it just happens. However, if the onset is very young before six years or in boys, it is likely to be caused by a medical issue, such as a problem in the brain, a tumour, or another hormonal disorder. Less commonly, precocious puberty can be peripheral – meaning the hormone changes start outside the brain. This could be due to problems with the adrenal glands, ovaries, or testes, and is not triggered by the usual brain hormones. Other known factors that may play a role in triggering early puberty include: > Brain abnormalities or tumours, especially in very young children > Previous radiation or trauma to the brain > Congenital conditions, such as hypothalamic hamartoma > Obesity, which is increasingly recognised as a contributing factor > Family history of early puberty > Environmental exposures to hormone-disrupting chemicals. What are endocrine disruptors? Parents should be aware of endocrine-disrupting chemicals (EDCs). These are substances that can interfere with the body's hormone systems. Some are found in plastics especially bisphenol A (BPA), cosmetics, fragrances, pesticides and even some foods e,g, plant-based estrogen known as phytoestrogen. For example, certain essential oils like lavender and tea tree oil have been linked – though not conclusively – to hormone effects in children. Creams or supplements bought over the counter or online may also contain undisclosed hormones. While the science and evidence is still evolving, it's best to reduce unnecessary exposure to products that may contain hormones or hormone-like compounds, especially in young children. How is early puberty evaluated? If your child is showing early signs of puberty, the next step is to consult a paediatric endocrinologist – a doctor who specialises in hormone issues in children. Here's what you can expect during an evaluation: > A detailed medical and family history, including growth patterns, timing of puberty in parents and any medications or exposures > A physical examination to assess the stage of puberty and growth rate > Blood tests to measure hormone levels (LH, FSH, estrogen or testosterone, and other related hormones) > Bone age X-ray of the left hand and wrist to see how much a child's bones have matured > Pelvic ultrasound in some girls to assess the uterus and ovaries, or testicular ultrasound in boys if needed > Pituitary MRI in certain cases (especially in boys or girls under six years, or those with rapid progression) to look for brain abnormalities. What problems can early puberty cause? One major concern with precocious puberty is shorter adult height. Children grow quickly at first, but their bones also mature faster. This can lead to the growth plates closing earlier than usual, limiting final height. There are also emotional and psychological challenges. Children who develop earlier than peers may feel different, embarrassed or self-conscious. Girls may struggle with body image or unwanted attention. Boys might feel pressured to behave in a more mature way than they're ready for. These feelings can affect self-esteem, social development and even school performance. Can early puberty be treated? Yes! The good news is that precocious puberty can be managed effectively. The main treatment for central precocious puberty is with GnRH analogues – medications that 'switch off' the puberty hormones by blocking the signals from the brain. These medications are usually given as intramuscular injections, typically once a month or every three to six months, depending on the preparation used. These medications are generally safe and well-tolerated, and once they are stopped (usually around the normal age of puberty), the body resumes puberty naturally. Side effects such as sterile abscess at the injection sites are reported but uncommonly. Treatment helps preserve height potential and gives children more time to grow physically and emotionally before entering adolescence. Any underlying causes or contributing factors must also be addressed. A paediatric endocrinologist considers treatment based on: > The child's age > How fast the puberty is progressing > Bone age and predicted adult height > The child's emotional readiness and how they're coping. Sara's journey Sara began treatment soon after her diagnosis. Her hormone levels were consistent with early puberty, and her bone age showed advanced maturity compared to her actual age. With three-monthly injections and regular follow-up, her puberty progression slowed, and her growth pattern stabilised. More importantly, she had the time to adjust emotionally and her confidence returned. With the support of her family, Sara started feeling like a kid again. So, if you suspect your child might be going through puberty too early, trust your instincts. Seek medical advice early – because early diagnosis can make a big difference in your child's growth, emotional health and long-term well-being. Remember: > Not all early signs mean your child has precocious puberty or needs treatment, but it's worth getting checked > Treatment is available and effective > Support from parents and clear information can help your child feel safe and understood. And finally, be mindful of the products your child is exposed to – avoid unnecessary fragrances, creams, oils or supplements that may contain hormone-like substances. With awareness, early action, and the right care, children with precocious puberty can go on to thrive – just like Sara. Dr Jeanne Wong Sze Lyn is a consultant paediatrician and paediatric endocrinologist. For more information, email starhealth@ The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
The Star
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- The Star
What is umami? Explaining the mysterious 'fifth taste'
You know that burst of flavour you experience when you take a bite of certain savoury foods such as meat, fish, mushrooms or miso? That sensation of 'whoa, that is just delicious'? In all likelihood, you are tasting umami. Umami, which translates to 'delicious savoury taste', was identified as a distinct flavour in 1908 by Japanese chemist Kikunae Ikeda. It's now recognised as the fifth taste, joining sweet, salty, bitter and sour. The concept of this fifth taste has been embraced in the East for a long time, before it had an official name. But it's still a relatively new idea to many home cooks in the West. If you've ever wondered why sprinkling Parmesan on your pasta made it just so much more satisfying, why the exterior of a roasted pork shoulder has so much flavour, why miso soup tastes so luxurious, why bacon is so freaking delicious, why an anchovy-based Caesar salad dressing makes you want to wriggle with joy, why caramelised onions have so much depth – the answer is umami. You can get rich umami flavours by cooking down your tomatoes. Umami flavour comes from glutamate, a common amino acid or protein building block found in many foods. The most familiar is monosodium glutamate, or MSG. In the United States, it was once believed that MSG wasn't good for you, but it's now generally recognised as a safe addition to food. Many Asian chefs have worked to reintroduce MSG into daily cooking. Foods rich with umami flavour include: Aged cheeses: Blue cheese, gouda and cheddar are some of the most umami-packed cheeses due to the breakdown of proteins that takes places during the ageing process. Parmesan cheese is widely recognised as an 'umami bomb'. Tomato products: The more cooked down, the more concentrated the umami – think tomato paste, sun-dried tomatoes and ketchup. Mushrooms: In particular, shiitake, oyster and portobello mushrooms. Also, make use of dried mushrooms. Mushrooms, especially shiitake mushrooms, are packed with umami flavours. — Photos: Pixabay Meat and meat broths: Roasted and grilled meats are examples of umami richness. A roasted chicken, pan-seared steak. Cured meats like prosciutto and bacon are also umami powerhouses. So are ramen, udon soup and other foods made with rich savoury broths. Fish and seafood: Especially varieties like sea urchin, shrimp and scallops. You will also find high levels of umami flavour in fish and fish broths, especially little oily fish like sardines and anchovies. Bonito flakes: These tissue-thin, fluffy shards of cooked and dry-smoked tuna are used as the base of dashi, a seasoning blend at the base of much Japanese cooking. Dashi also usually includes shiitake mushrooms and kombu (seaweed). Soy sauce or shoyu: One of the pillars of umami flavour in Asian cooking. Fermentation breaks down the proteins in the soybeans and wheat used to make soy sauce into amino acids, glutamic acid in particular. Tamari is a gluten-free version of this condiment. Fish sauce: This is another source of umami, used often in South-East Asian cooking. The basic ingredients are anchovies and salt. The salt pulls out the liquid from the fish and creates a dark, potent amber sauce. This is one of the reasons that Thai, Vietnamese and Filipino food, to name a few, taste so distinctively and pungently savoury. Sea urchin may be an acquired taste but its umami-ness is unmistakable. — Pexels Vegetarians and vegans might think that elusive fifth taste is hard to achieve without meat or other animal products, but there is much good news! The following are some options for vegans. Seaweed: Another big source of umami (and not coincidentally the other main ingredient in dashi). Yeast enhancers and spreads: Umami is the leading flavour note of Marmite and nutritional yeast. Miso paste: Made from fermented soybeans, miso paste is high in umami. It doesn't matter whether you are using white miso, brown rice miso, red miso or yellow miso. Now that you know what you're tasting, you'll be looking for ways to incorporate more of this fifth dates into your cooking. It's truly as easy as knowing what ingredients to reach for! – By KATIE WORKMAN/AP
The Star
01-05-2025
- The Star
We all go through it, but what is adolescence really?
The Netflix mini-series Adolescence is very interesting. So many emotions go through the young kids at that age. What age would be considered adolescence? Thirteen or 14 years of age? Actually, the World Health Organization (WHO) defines adolescence to be anyone from the ages of 10 to 19. A young person is defined as anyone from the ages of 10 to 24. Adolescence is considered a period of transition between childhood and adulthood. It is a particularly important period because there are many changes in the child's body and brains. Adolescents can go through many physical, social, psychological, cognitive and intellectual issues. It is also considered a time when they develop their own ethics and morals, as well as identities – some better than others. Adolescents also start to become more independent from their parents. Some adolescents and parents find this period very trying! What physical changes do adolescents go through? I barely remember those years in my own teenage years, except that I grew very tall suddenly. Adolescents go through puberty. If you are an adult now, you may remember going through it yourself. During puberty, the hypothalamus in your brain releases a hormone called gonadotropin-releasing hormone (GnRH) in pulses. GnRH then stimulates your pituitary gland, which is connected to your hypothalamus, to release the luteinising hormone (LH) and follicle-stimulating hormone (FSH). LH and FSH act on different organs depending on whether you are male or female. In girls, LH and FSH stimulate the ovaries to produce oestrogen, the female sex hormone. This causes your breasts to develop, widens your hips and starts the menstruation cycle. For girls, breasts and pubic hair develop first. Two years or so later, they will begin to menstruate for the first time. In boys, LH and FSH act on the testicles to produce testosterone, the male sex hormone. This results in the development of facial hair, deepens their voices and increases their muscle mass. Their penises grow and they begin to experience ejaculation. Why did I get my growth spurt then? Your growth spurt is caused by the growth hormone, which is also produced by the pituitary gland as part of the pubertal process. Other hormones are then stimulated by the growth hormone, such as Insulin-like growth factor-1 (IGF-1) and adrenal hormones like androgens, which lead to the growth of pubic and underarm hair, body odour and acne. In girls, progesterone is also produced to regulate the menstrual cycle and prepare the uterus for pregnancy. Once oestrogen and progesterone are produced, and menses commence, the adolescent girl can get pregnant. In puberty, you will grow rapidly in height and weight. I remember being smaller than my sister at puberty. We were both very close to each other's ages. Girls experience growth spurts at a younger age compared to boys. Girls have growth spurts between the ages of 10 to 14, while boys have it at ages 14 to 17. It is common to go to a class of girls and boys when they are 10 to 14 years old, and see the girls taller and bigger than the boys! Another issue is that some adolescents become bigger than others in the same class, and this may lead to bullying. Does the adolescent's brain develop during this time too? Yes, even the brain goes through a development spurt. Adolescents can now deal with more complex and sophisticated thoughts, including abstract possibilities involving the future, reasoning, creativity, problem-solving and decision-making. This is because the nerve cells, known as neurons, grow rapidly and connect more. But the frontal lobe in the brain develops last. The frontal lobe controls planning, impulses, judgment and prioritisation. It finishes development and maturation only in the mid- to late 20s. That is why your adolescent or teenager may not exhibit good judgment sometimes. When they are impulsive, the thought process is known as hot cognition, the opposite of cold cognition, which represents logic. Are adolescents more emotional? Sometimes. They begin to become more self-aware of their own emotions and other people's emotions, especially their classmates and social circles. Their self-esteem means a lot to them at this age, especially as they are self-conscious of their own bodies and appearances. They may also develop romantic, and even sexual, relationships; spend less time with their parents and more with their friends as they explore their independence; and/or feel more anxious or depressed than when they were children. These days, adolescents spend a lot of time on social media, which can be a negative influence. They can feel bad about themselves when comparing with their friends and social media influencers of around the same age, especially when many of these people only show what they want to show and much of it isn't even real. During this time, it would be good of parents to really be there for their adolescent, but remember not to helicopter-parent them. Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, email starhealth@ The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
