What are the long-term impacts of early puberty?

Abnormal puberty timing is linked to a number of physical and psychosocial problems like increases in:¹

• Breast cancer
• Endometrial cancer
• Obesity
• Type 2 diabetes
• Cardiovascular disease
• Shortened height
• Increased mortality

On the physiological end, the effects of early puberty can be clinically correlated through assessments and studies over time. Katherine Kutney, MD, a pediatric endocrinologist at Rainbow Babies and Children’s Hospital in Cleveland, says treatments with medications like gonadotropin-releasing hormone agonists (GnRHa) can help to pause the onset of puberty until a more acceptable age range. Once these medications are stopped, puberty resumes.

“Fertility is generally accepted to be ‘normal’ after treatment with GnRH agonists once the medication is stopped and puberty is allowed to progress normally,” Kutney says.

Some concerns have been raised about lower bone density in girls who are treated for CPP, but GnRHa’s remain the “gold standard” for treating CPP and are regarded as generally safe. Kutney says at this time, there is no evidence to strongly support these concerns.²

Another concerning issue to be considered with CPP beyond the physical impact is the psychological impact of early puberty. As children develop before their peers, a lot of emotions can arise. Additionally, an early increase in puberty symptoms can sometimes be followed by a “pause” in the progression of puberty, Kutney says. These changes can be difficult for children—especially when it happens at different rates than their peers.

“There are studies linking earlier puberty to adverse psychological outcomes such as higher rates of depression, anxiety, substance abuse, and criminal behavior. Other studies suggest that children who develop earlier may have higher rates of sexual activity,” Kutney says, cautioning that there are also limitations to these reports. “Many of these studies are self-report and are not limited to children with true CPP.”

Overall, there appears to be a lack of reliable tools to assess the true psychological and psychosocial impact of early puberty and CPP, but Kutney says that a small study from 2009 of girls before and after GnRHa therapy showed little impact of treatment on psychological function or self-perception. Other studies have confirmed that GnRHa’s are important for preventing the negative long-term consequences of CPP and result in few, if any, adverse effects.³ Better, larger-scale studies are needed, according to several papers.

References

1. Howard S. Timing of Puberty: Why Is It Changing and Why Does It Matter? Endocrinologist. 2019;134. https://www.endocrinology.org/endocrinologist/134-winter19/features/timing-of-puberty-why-is-it-changing-and-why-does-it-matter/
2. Krishna BK, et al. Use of Gonadotropin-Releasing Hormone Analogs in Children: Update by an International Consortium. Horm Res in Paediatr. 2019;91(6). doi:10.1159/000501336.
   https://www.karger.com/Article/FullText/501336
3. Kim EY. Long-term effects of gonadotropin-releasing hormone analogs in girls with central precocious puberty. Korean J Pediatr. 2015;58(1):1-7. doi:10.3345/kjp.2015.58.1.1