Adolescence is an inevitable part of human maturation, and it appears to be increasingly important for individuals to understand their risk for poor health outcomes in the future. Studies in girls have demonstrated a significant relationship between disease risk and timing of onset during adolescence.
Early adolescence has been shown to increase the risk of diseases such as endometriosis, type 2 diabetes, heart disease, breast cancer, depression, eating disorders, uterine fibroids, and osteoarthritis, as well as higher all-cause mortality. Many of these health effects exist on a sliding scale, with risk increasing as the age of onset of puberty decreases. At the other end of the spectrum, delayed puberty is associated with celiac disease, asthma, and sleep deprivation, but it also has protective effects against some conditions. Both early and late adolescence (before age 8 and after age 13) are associated with early menopause, which comes with its own health risks.
Advances in this field have also revealed a relationship between the timing of female puberty and the onset of disease. For example, early onset exposes the body to hormones such as estrogen for longer periods of time, increasing the risk of diseases such as endometriosis and breast cancer. Because of shared genetic factors, the timing of puberty may also serve as an early warning system for metabolic and cardiovascular diseases, particularly type 2 diabetes and heart disease. There is also a psychosocial component to the relationship between mental health status and early onset of puberty. Girls who mature physically are more likely to be marginalized and bullied, which can have lifelong consequences.
Taken together, this research provides a detailed roadmap for women’s health that could one day help women live longer, higher-quality lives. But gaining similar health insights for men will require investment and new approaches. Little is known about male adolescence, as there are large gender differences in this area. Between 1990 and 2016, about 1.67 times more research papers were published on female adolescence than on male adolescence, and researchers are now calling for a change. They argue that a better understanding of the relationship between the timing of male puberty and disease risk could enhance the identification and prevention of chronic diseases.
One of the most notable proponents is Anders Juhl, professor of pediatric endocrinology at the University of Copenhagen and head of the Growth and Reproduction Department at Rigshospitalet. Juul has been researching adolescence for more than 30 years and is a leader in the field. “Increasing knowledge of the factors that regulate the timing of male puberty may be key to understanding men’s long-term health,” he said. This could be transformative for people who are known to have poor health conditions throughout their lives.
fill the gap
More than half of American male deaths in 2023 were thought to be due to premature birth. At the time, their average life expectancy was 75.8 years, 6.5 years less than men in the longest-lived high-income countries. The leading causes of these early deaths include heart disease, cancer, and diabetes, and these diseases are linked to the timing of puberty.
Is it “inevitable” that men die five years or more earlier than women?
Even when these illnesses are not fatal, they can significantly reduce quality of life, especially after age 65, and place the burden of care on close relatives (mostly women). This means that millions of fathers, sons and brothers will die or die too soon, and millions of mothers, daughters and sisters will be forced to juggle the challenges of harsh and unpaid care. Additionally, the five leading causes of death among U.S. men cost society an estimated $420.6 billion annually, including medical costs and lost income. Addressing patterns of poor health in men benefits everyone, proponents say, making a compelling case for expanding research on male adolescence.
One of the main reasons for the disproportionate focus on female puberty is that breast budding and menarche are clear and easily identifiable signs of pubertal development in girls. Juul said the closest thing for boys, the first ejaculation, is much harder to measure because boys may not even know it happened. Jules believes boys may be keeping quiet about their bodies because society doesn’t celebrate and welcome the onset of adolescence in the same way as girls.
Despite these challenges, research on male puberty can be facilitated by what we learn from research on women. Research in girls has revealed the main factors that influence the timing of puberty onset. About 50% to 80% of variation in timing is controlled by genetics, and about two-thirds of the genetic variations (small changes in DNA) that affect the timing of puberty are shared between men and women. Other factors that influence when girls start puberty include ethnicity, nutrition, body fat, socioeconomic status, mental health, and exposure to endocrine disrupting chemicals.
Previous research on male puberty has identified a similar, albeit preliminary, relationship between the timing of puberty and adverse health outcomes for boys. A 2015 study using data from 500,000 people from the UK Biobank found that earlier puberty in boys and girls was associated with a total of 48 negative outcomes, including “various cancer, cardiometabolic, gynecological/obstetric, gastrointestinal, musculoskeletal, and neurocognitive categories.” However, the authors noted that more research is needed to better understand these findings in men.
Federal Men’s Health Agency closer than ever, but probably still years away
Other studies have linked early puberty in boys to a higher risk of diseases such as heart attack, type 2 diabetes, obesity, depression, and ADHD. A 2024 study also found a strong genetic link between a man’s hair color and the timing of puberty. Young people with red, dark brown or black hair are “progressively more likely” to hit puberty early. This may be due to the fact that androgens control pigmentation in the body. Although the association between early puberty in women and the development of breast cancer later in life is well established, the relationship between early puberty and prostate cancer in men remains unclear.
Late adolescence comes with its own health risks for boys and men, including an increased risk of anxiety, panic attacks, depression, asthma, eczema, and poor overall health. Although late adolescence may not have many negative health effects, Elizabeth Shirtcliffe, a scientist in the Department of Psychiatry and Behavioral Sciences at Boston Children’s Hospital and Harvard Medical School, said that after puberty, children are more likely to be bullied, which can worsen or cause low self-esteem and mental health problems.
But there are potential benefits to male longevity that are worth noting. One study found that men would live nine months longer if the onset of puberty did not occur every year. There is also progress in understanding the unique genetic influences specific to the timing of male puberty, with 76 independent genetic variants identified to date.
Advances in research on male puberty are encouraging for experts focused on improving the health outcomes of boys. Jennifer Pfeiffer, co-director of the Center for Translational Neuroscience at the University of Oregon, believes expanding what is known about male puberty will provide more evidence about how best to meet boys’ needs.
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In 2024, an international team led by researchers from the University of Cambridge analyzed the DNA of 800,000 women from Europe, North America, China, Japan and South Korea to publish the largest ever genetic study of puberty in girls. They discovered more than 1,000 mutations related to the timing of menarche. According to the authors, some have a direct effect on age at puberty, while others have an indirect effect by increasing weight gain. Importantly, the exhaustive list of variants allowed the team to generate a genetic risk score that can be used to predict the timing of puberty in girls.
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One of the authors, Ken Ong, a Cambridge researcher and co-leader of the team that independently identified 76 genetic signals associated with male puberty, pointed out that the UK’s National Health Service is running a clinical trial of whole genome sequencing at birth in 100,000 infants, and that combining such sequencing results with puberty risk scores could soon enable the identification of girls at risk of early or late puberty, as well as interventions to increase pubertal risk. Long-term health outcomes. “This may be important for their health as adults,” he said in a university news release.
That possibility does not yet exist for boys because of the lack of genetic research on male puberty. However, it is not impossible to use predictions of pubertal timing to target interventions that may improve long-term health in men, but this will require more clinical longitudinal research. Such long-term research has also begun. The Copenhagen Adolescence Study, led by Joule, began in the 1990s. His research has already identified a phenomenon known as mini-adolescence, confirmed that the average age of puberty onset is decreasing, and identified a relationship between pubertal timing and risk for mental illness and behavioral conditions.
Juhl and his team are now focused on better understanding the environmental and lifestyle factors that influence the timing of puberty and the health risks associated with onset outside of puberty.
Recent technological innovations may aid the research being conducted in this area. A 2023 study used children’s testosterone and DHEA levels in conjunction with measurements of body hair growth, growth spurts, skin changes, facial hair development, and voice changes to successfully develop a highly accurate measure of puberty. This demonstrates the value of more comprehensive measures of puberty, especially in men, which Shirtcliffe has long advocated. The same team also developed an artificial intelligence model that uses this data to calculate a child’s “age of puberty” and pinpoint their risk of developing mental health conditions during adolescence.
For men’s health experts like Lee Ponsky, director of the Urology Institute at University Hospitals and a urological oncologist at University Medical Center Cleveland, research like this has the potential to one day change his job. Pomsky has dedicated his career to improving men’s health and quality of life. “Anything that enables (better) screening, diagnosis, and intervention for men that improves outcomes and saves lives, I’m very happy,” he said. He hopes that clinical research in this area will expand so that doctors can understand whether this is a viable path to helping patients in the future.
As for what that support might look like, non-invasive practices such as lifestyle and behavioral interventions can significantly improve health outcomes in childhood and beyond. This could mean, for example, dietary changes and nutrition education for children at high risk of diabetes, and preventive mental health support for children at high risk of developing depression and anxiety. If this type of intervention proves effective, drugs may also be used to alter the timing of a child’s puberty. But ultimately, “we need to know more if we want to take precautions,” Juhl said.
STAT’s reporting on health issues facing men and boys is supported by Rise Together. Rise Together is a donor-advised fund sponsored and managed by the National Philanthropic Trust and established by Richard Reeves, founding president of the American Association of Boys and Men. and by the Boston Foundation. Our financial supporters have no input into any decisions about our journalism.
