Formation of genital organs in adolescence. Puberty of boys

Puberty in boys begins at the age of twelve and continues until the age of seventeen. It is during these 5 years that adolescents turn into representatives of the stronger sex through the action of hormones, due to which the process of restructuring occurs. This restructuring concerns not only the physiological side of the teenager, but also the psychological one, so parents must have at least minimal knowledge in order to be able to help cope with them if any problems arise.

As a rule, the ability to procreate in boys appears by the age of fifteen, however, at this age they have not yet reached maturity. As for the emotional, intellectual and social side, boys still continue to grow and, as is generally accepted, this process ends at the age of twenty-two.

It is worth noting that not all changes that are observed in children at this age are of a pleasant nature. Since during puberty most teenagers begin to pay more attention to their appearance, for example, too low self-esteem can cause self-doubt, which leads to problems communicating with peers.

Puberty occurs differently for everyone. The differences are manifested in the fact that some boys experience premature development, which is why they often face ridicule from their peers. During puberty, most teenagers begin to experience negative attitudes towards themselves and their own bodies.

It is possible that such an attitude may serve as an initial signal to parents about possible problems that are associated with psychological and sexual development. It is during such a period that the support of his parents is important for a boy, who should explain to him about the changes occurring in his body. Only then does the child overcome the period of maturation without any emotional upheaval.

The sexual development of boys differs significantly from girls - these are two incomparable processes.

Girls begin their development much earlier than boys, and the perception of this process also occurs differently. For example, in girls, precocious development is quite common, while in boys it is more the exception to the rule than the norm. Currently, there are certain frameworks according to which the stages of puberty in both boys and girls should not differ.

Premature maturation in boys should begin at the age of ten, and in girls at the age of eight. The latest development period for boys is fourteen years, and for girls twelve. If the specified age has already passed, but puberty has not yet arrived, then it is necessary to seek qualified help.

The characteristic signs of puberty in a boy become noticeable already at the age of twelve, that is, on average, 2 years later than in girls. Puberty is associated with accelerated growth and significant enlargement of the entire body.

It is quite natural that many changes happen to boys during this period. It often happens that in a few months teenagers can grow by more than three centimeters. Rapid growth continues until the age of eighteen, and in some cases longer. Premature development, in terms of the onset of characteristic signs, does not differ in any way from the normal period of maturation.

• Characteristic signs of puberty include:
• A characteristic feature is a noticeable enlargement of the gonads - this is a clear sign that the child is entering puberty;
• During puberty, there is an increase in hair growth throughout the body;
• Changes associated with the voice, it becomes more masculine. Usually such a change does not take much time and occurs quickly;
• The child's figure also undergoes certain changes. Teenagers broaden their shoulders, while the pelvis remains narrow;
• Due to the influence of sex hormones, the smell of sweat secreted also changes, it becomes more pungent. The skin becomes oily, resulting in rashes on the face and back;

The end of puberty in a boy ends at approximately eighteen years of age, by which time the formation of the reproductive system ends. Despite the fact that puberty has already ended, on a psychological level the teenager is not yet ready to continue his family line and start a family.

Parents should also be aware that puberty may begin prematurely, and the teenager may experience problems with mental development, despite the fact that physical development will continue at a normal level. Premature maturation is mainly a genetic predisposition or individual structural features of the body.

In relationships with others during such a period, childish traits may still be visible. With premature development, boys may be embarrassed by their awkward appearance; they begin to slouch in order not to stand out particularly from their peers. When precocious puberty sets in, most boys experience bouts of irritability and aggression.

During puberty, many teenagers begin to look for their own individual style in order to please girls. It is important for parents not to miss the moment of their child growing up, so that he is not afraid to discuss his problems and experiences with them.

Late maturation

In addition to precocious puberty, boys may also experience delayed development. The most important symptoms to look out for are: no enlargement of the testicles by the age of thirteen and no growth of pubic hair by the age of fifteen.

Delayed or impaired puberty in a boy can be caused by various types of diseases or chromosomal pathologies. To find out the initial cause of late puberty, it is necessary to undergo an appropriate examination and tests.

The blood is sent to the laboratory, where, thanks to modern technologies, tests are made for pathologies associated with chromosomes and the causes of changes in hormone levels are identified. A blood test can help identify and diagnose diabetes and anemia, which can be the main cause of delayed puberty in a boy.

Additional examination methods include x-rays, computed tomography and magnetic resonance imaging, which help identify possible brain abnormalities. An X-ray examination allows us to assess the condition of a teenager’s bones.

The main reasons for the late development of a teenager:

• Pathologies of chromosomes, which are characterized by the presence of an extra chromosome in the genotype;
• Diseases identified at the genetic level, which are characterized by impaired hormone production;
• A significant decrease in the stimulation of hormones on which the normal and timely development of the genital organs depends;
• Chronic forms of diseases, such as diabetes and kidney failure.

The treatment method should be prescribed only by a specialist after deciphering the results obtained. Treatment of late puberty in boys will be aimed at eliminating the original cause that contributed to the development of this process. In the case where the cause is a chronic disease, the rate of maturation will return to normal after adequate treatment. If there is a delay in development for natural reasons, then the boys do not need any treatment and parents have nothing to worry about, since over time all processes return to normal.

But a condition characterized by a genetic pathological process cannot be treated, however, when the missing hormones are replenished, further development of sexual characteristics may be observed. When the cause of developmental delay is a brain tumor, immediate surgical intervention is required. Both premature and late puberty in boys should be a cause for concern for parents.

Most parents are constantly interested in the question of what exactly determines the age of puberty and when it ends. Any specialist will answer that the age at which puberty begins and ends is associated with many factors. Despite the fact that developmental delay is generally not caused by any serious reasons, it is still worth playing it safe and seeing a specialist.

Parents should be tactful and discuss all the details with the doctor in the presence of the teenager, since an unbalanced psychological state can lead to depression.

For parents, children always remain children. However, not much time will pass, and suddenly it turns out that the time for kindergarten has long passed, school is in full swing, and the child has begun to experience some changes in appearance and character. It's simple - your son began to grow up, gradually turning into a real man.

And although your son swaggers around and tries to look mature and independent, it is at this time that he most needs the support of people close to him. Therefore, parents should have an idea of ​​how boys mature sexually in order to be able to help their child cope with the difficulties that await a teenager during this rather difficult period.

Puberty: initial stages

Puberty in boys is a rather complex process of maturation, which results in the ability to reproduce.

The period of puberty lasts for several years, but the active stages are preceded by the initial stages, which play an important role in the future growth of the boy. Without going through the initial stages, it will be impossible to enter the active phase of puberty.

1. Development in the mother's womb. It is possible to determine the sex of the unborn child starting from 12-16 weeks of pregnancy, when the sexual characteristics of the fetus are already formed. The penis and scrotum become visible, although the testicles continue to remain in the abdominal cavity for a long time.
2. Childhood (infantile period) is the stage of initial puberty, which usually lasts until the age of ten. This is the period of normal child growth, when the penis and scrotum grow along with the body, and the boy looks the same as his peers. And although an erection can be observed from the first months of a baby’s life and in early childhood, its occurrence is not associated with sexual desire, but appears mechanically.

The boy himself is completely asexual, his emotional state does not undergo changes in mood and emotions and is stable.

Puberty of a child: features of each stage

The initial stages of puberty in boys are followed by the following: initial, active phase and final.

Puberty or early puberty

It begins at the age of 10-13 and is a fairly significant stage, because it is during this period that the body is seriously prepared for subsequent transformations, as a result of which the boy will become a man.

Now the pituitary gland begins to actively produce somatotropin and follitropin, hormones that affect the growth of muscle cells and bone tissue, as well as the function of the gonads, which leads to accelerated growth of the testicles and penis, these are the main signs of sexual development of this period.

The first fine hairs on the pubic area are also beginning to appear, while under the arms and on the face there is no hair growth yet, this will happen a little later. This period is also characterized by growth of the larynx, the vocal cords thicken, as a result of which the boy’s voice begins to change sharply, disappear, become thinner or become coarser from time to time; this process is popularly called “breaking” of the voice. The changes can last six months to a year; the voice is finally established around the age of fifteen.

Such changes can frighten the child and lead to his isolation, timidity, or, conversely, to inexplicable aggression. Therefore, this time is very suitable to explain to the child that all the changes that occur to him are completely normal. The ideal option would be for a close man whom he considers a role model to talk to the boy and reveal to him the secrets of adult life.

The period of puberty in boys, which is characterized by activation of the production of androgens and estrogens

The action of androgen leads to active growth of the penis and testicles with the scrotum. Fine pubic hairs become coarser and turn into dark, coarse hairs. After some time, hair also begins to grow under the arms, on the chest, and on the face. It’s too early to talk about a beard, but a mustache can be quite noticeable. With an excess of estrogen, gynecomastia can develop, the signs of which are enlarged mammary glands.

After some time, such changes will disappear on their own. Hormones cause the production of germ cells at an accelerated rate in the boy’s body, as a result of which erections begin around the age of thirteen, and emissions can occur during sleep. The penis will reach its final size at about fifteen years of age.

Delicate baby skin begins to roughen, the function of the sebaceous glands changes, which leads to excessive production of sebum. As a result, the skin becomes oily, inflamed, and blackheads appear on it, which cannot be squeezed out so that scars do not form on the skin. A cosmetologist will help solve such problems. During the same period, signs of puberty in boys are observed, such as sharp growth, at this time he can already outgrow his mother and father, the pelvic bones also undergo changes, the bones of the legs and arms lengthen, the jaw enlarges, and the bones of the shoulders become larger.

Warn your child that bone growth occurs in spurts and is not simultaneous. Therefore, at first there is a feeling that the body is a little disproportionate, but this condition is quite normal, over time the dimensions will correspond to the size of an adult man. At the same time, the proportion of adipose tissue decreases, so boys most often remain thin, although they have an excellent appetite due to excessive hormonal activity.

At approximately 14-15 years of age, the active work of the apocrine glands, which produce sweat, begins. The smell of these secretions is quite specific and can cause discomfort and even some complexities; hygiene procedures with regular changes of linen can be a solution. This stage lasts until approximately the age of sixteen.

The boy has already become a man, so it is very important to talk with him about masculine topics, to have conversations as equals, to talk about existing methods of contraception, and about the naturalness of wet dreams.

Parents also need to know that during this period, for the full development and health of a teenager, a balanced diet plays an important role, the guy’s muscle mass is actively growing, his lungs increase in volume, and the heart is also actively growing - during this period, the heart becomes twice as heavy, his work slows down.

The final stage of puberty, which lasts until 17-18 years of age

True, sometimes it can last up to 20-22 years. By the end of this period, secondary sexual characteristics in boys are fully formed: the size of the genitals corresponds to the size of the organs of adult men, the hairline also corresponds to the male type, and children’s rounded facial features have long changed, becoming masculine.

However, despite the completion of puberty, psychologically a young man, who most recently was a boy, is not ready to form a family and procreate.

How does sexual development occur in boys and girls?

Sex education

For the development of a child’s personality as a representative of the stronger sex, sex education for boys should be an obligatory part of the entire process of raising a child. The main goal of this is to prepare the boy for adulthood, to raise a man capable of building normal relationships with people not only of his own sex, but also of the opposite sex in accordance with existing moral standards.

Sex education should not be based on fears of possible sexually transmitted diseases or an unwanted pregnancy of a friend; such methods can only lead to aggression in a teenager, the development of many complexes and the inability to build full-fledged relationships based on respect.

The topic of violence when raising a teenager should be prohibited, so as not to discourage the boy from ever wanting to communicate with the weaker sex or, conversely, not to instill in the child the idea that any family issues can be resolved exclusively with the use of force.

Answers to all the boy’s questions must be sincere and understandable, and also age appropriate. That is, there is no need for a seven-year-old child to read excerpts from an encyclopedia on medicine or anatomy, or to tell a ten-year-old son about the stork that brought him.

Also, it is very desirable that the father or other close male person deal with sex education issues with the boy, with whom the boy can talk without embarrassment or fear.

It is very important that the boy receives ideas and information about the hygienic aspects of sexual issues from family members close to him, and not from older comrades on the street.

During this period, the boy’s psyche undergoes significant transformations, his character and life views are developed, and principles of behavior in society and family are laid. If during this period the boy received good psychological support and training from his parents and other people close to him, then in adult life he has nothing to fear.

IT IS IMPORTANT TO KNOW!

Weak potency, a flaccid penis, lack of a long-term erection are not a death sentence for a man’s sex life, but a signal that the body needs help and male strength is weakening. There are a large number of drugs that help a man gain a stable erection for sex, but they all have their own disadvantages and contraindications, especially if the man is already 30-40 years old. Capsules help not only to get an erection HERE AND NOW, but act as a preventive measure and accumulation of male power, allowing a man to remain sexually active for many years!

Timing of puberty

Puberty begins at approximately 10-11 years of age and ends by 17-18 years. At the same time, various factors may influence the timing of the completion of the entire period:

• the state of the child’s health; a delay may occur in the presence of certain chronic diseases, injuries or surgical interventions;
• the timing can also be influenced by the state of the child’s nervous and endocrine systems;
• Genetic predisposition can also lead to delayed sexual development in boys.

At the same time, you need to know that the beginning, as well as the completion of this process, is very individual.

We can talk about early puberty when it occurs before the age of ten. This can be caused by abnormal development of the genital organs, endocrine system disorders, brain tumors, consequences of head injuries and other reasons. Moreover, most often the early maturation of boys occurs due to genetic predisposition, which is observed in almost 80% of such cases.

The main negative consequence of early puberty is the cessation of a boy's growth, however, in our time this can be successfully treated. The main condition for this is a timely visit to a doctor in order to identify signs of this process and determine the appropriate method of therapy.

Late puberty can be said if a boy is short in stature, if by the age of 15 his testicles have not enlarged and there is no hair in the pubic area. This may occur due to genetic factors, as well as the presence of hormonal disorders in the teenager’s body.

Disorders of sexual development in boys are associated with pathology of the secretion or action of androgens. The clinical picture depends on the age at which the problem arose.

The formation of the male reproductive system continues continuously until the end of adolescence. Doctors distinguish 3 stages of differentiation of the genital organs. Each of them is characterized by its own dominant influences and a certain physiological meaning.

Stages of formation:

• intrauterine;
• prepubescent;
• pubertal.

Prenatal period

The intrauterine period begins with conception and ends with the birth of a child. At the moment of fertilization of the egg, the chromosomal sex of the child is determined. The obtained genetic information remains unchanged and influences further ontogenesis. In humans, the XY set determines male sex. Until 5-6 weeks, female and male embryos develop equally. Primary germ cells have the opportunity to differentiate in one or the other way up to the 7th week of pregnancy. Before this period, two internal ducts are formed: Wolffian (mesonephric) and Müllerian (paramesonephric). The primary gonad is indifferent until the 7th week (indistinguishable in boys and girls). It consists of a cortex and a medulla.

After 6 weeks of development, sexual differences appear in differentiation. Their occurrence is due to the influence of the SKY gene, which is located on the short arm of the Y chromosome. This gene encodes a specific “male membrane protein” H-Y antigen (testicular development factor). The antigen affects the cells of the primary indifferent gonad, causing it to transform into the male type.

Embryogenesis of the testicle:

• formation of sex cords from the cortex of the primary gonad;
• appearance of Leydig and Sertoli cells;
• formation of convoluted seminiferous tubules from reproductive cords;
• formation of the tunica albuginea from the cortex.

Leydig cells begin to secrete testosterone, and Sertoli cells begin to secrete anti-Mullerian factor.

At the 9th week of intrauterine development, the genital ducts are affected by the influence of chromosomal and gonadal sex. Anti-Mullerian factor causes atrophy of the paramesonephric duct. Without this influence, the uterus, fallopian tubes, and upper third of the vagina are formed from the duct. The regression factor leaves only rudiments in the male body.

Testosterone stimulates the development of Wolffian ducts. By the beginning of the 14th week, the fetus has formed epididymis, seminal vesicles, and vas deferens and ejaculatory ducts. Primary germ cells transform into spermatogonia.

At the intrauterine stage, great influence belongs to dihydrotestosterone. This hormone is produced from testosterone using the enzyme 5a-reductase. Dihydrotestosterone is involved in the formation of external organs (penis, scrotum).

During the prenatal period, the testicles descend into the scrotum. By birth, this process is completed in 97% of full-term boys and in 79% of premature ones.

• defects of the guide ligament;
• gonadal dysgenesis;
• hypogonadism in the prenatal period;
• immaturity of the genital femoral nerve;
• anatomical barriers to testicular movement;
• weakening of the muscle tone of the abdominal wall;
• violation of the synthesis and action of testosterone.

Pre-pubertal period

The pre-pubertal period is characterized by relative functional rest. In the first months after birth, high levels can be detected in the baby’s blood (due to maternal intake). Further, the concentration of FSH and LH, as well as testosterone, drops to extremely low values. The pre-pubertal period is called the “juvenile pause”. It lasts until the end of prepuberty.

Puberty

During the pubertal stage, testosterone synthesis in the testicle is activated. First, at 7-8 years old, the level of androgens in the blood increases due to the adrenal glands (adrenarche). Then, at the age of 9-10 years, inhibition in the hypothalamic centers responsible for sexual development decreases. This increases the levels of GnRH, LH and FSH. These hormones affect the testicle, increasing testosterone production.

Male sex steroids:

• enhance the growth of internal and external genital organs;
• influence the development of accessory glands;
• form sexual characteristics (secondary, tertiary);
• enhance linear body growth;
• increase the percentage of muscle tissue;
• influence the distribution of subcutaneous fat.

At puberty, the maturation of germ cells and the formation of mature sperm begin.

Normal onset of puberty and determination of its delay

Puberty in boys starts with an increase. The average age of onset of this symptom is 11 years.

Table 1 - Average values ​​of testicular volume at different age periods (according to Jockenhovel F., 2004).

The rate of puberty is the rate at which signs of puberty appear.

Possible rates:

• average (all signs are formed in 2-2.5 years);
• accelerated (formation occurs in less than 2 years);
• slow (formation takes 5 or more years).

The normal sequence of signs of puberty during puberty:

1. enlarged testicles (10-11 years);
2. penis enlargement (10-11 years);
3. development of the prostate, increase in the size of the larynx (11-12 years);
4. significant enlargement of the testicles and penis (12-14 years);
5. female-type pubic hair growth (12-13 years);
6. nodulation in the mammary glands (13-14 years);
7. the beginning of voice mutation (13-14 years);
8. the appearance of hair in the armpits and on the face (14-15 years);
9. pigmentation of the skin of the scrotum, first ejaculation (14-15 years);
10. sperm maturation (15-16 years);
11. pubic hair of the male type (16-17 years);
12. stopping the growth of skeletal bones (after 17 years).

The stage of puberty is assessed using the Tanner method.

Table 2 - Assessment of the stage of sexual development according to Tanner.

Delayed puberty in boys

Delayed sexual development is determined if a boy by the age of 14 has a testicular volume of less than 4 ml, no growth of the penis in length and no enlargement of the scrotum. In this case, it is necessary to begin an examination to identify the cause of the pathology.

Causes

Delayed sexual development may be due to:

• constitutional features (family);
• disorders of hypothalamic-pituitary regulation ();
• primary failure of testicular tissue ();
• severe somatic pathology.

Diagnostics

• taking anamnesis;
• heredity assessment;
• bone age assessment using radiographs;
• general examination;
• examination of the external genitalia, assessment of the volume of the testicles and the size of the scrotum;
• hormonal profile (LH, FSH, testosterone, prolactin, TSH);
• brain tomography, skull x-ray;
• cytogenetic study.

Treatment

Treatment depends on the causes of delayed puberty.

Familial forms of delayed sexual development can be corrected with the help. To prevent short stature, adolescents with this form of the disease are prescribed anabolic steroids.

For secondary hypogonadism, gonadotropins and gonadorelin are used in treatment. This therapy is a prevention of infertility in the future. The use of hormones from the hypothalamic-pituitary region stimulates the development of the testicles and.

With primary hypogonadism, from the age of 14, boys are prescribed testosterone replacement therapy.

Premature puberty in boys

The appearance of signs of puberty in boys under 9 years of age is considered premature. This condition can lead to social maladjustment. In addition, premature sexual development is one of the causes of short stature.

Causes

Premature sexual development is divided into:

• true (related to the work of the hypothalamic-pituitary region);
• false (associated with autonomous secretion of hormones by the adrenal glands or tumors).

True premature sexual development is complete (there are signs of masculinization and activation of spermatogenesis).

The reason for this condition may be:

• idiopathic;
• associated with diseases of the central nervous system;
• associated with the primary;
• arising against the background of prolonged hyperandrogenism (for example, with tumors of the adrenal glands).

False precocious puberty is usually not accompanied by activation of spermatogenesis (except in cases of familial testosterone toxicosis).

Causes of false premature sexual development:

• congenital hyperplasia of the adrenal cortex;
• , testicles;
• Cushing's syndrome;
• secreting tumors;
• Leydig cell hyperplasia (familial testosterone toxicosis);
• androgen treatment;
• isolated premature adrenarche.

Diagnostics

Examination for signs of precocious puberty includes:

• taking anamnesis;
• general examination;
• examination of the genitals;
• hormone tests (LH, FSH, testosterone, TSH, );
• tests with gonadoliberin;
• bone age study;
• X-ray of the skull, tomography of the brain, etc.

Treatment

To treat true precocious puberty, synthetic analogues of GnRH are used. This drug suppresses the pulsatile secretion of LH and FSH. If the cause of the disease is a pathology of the central nervous system, then the patient is prescribed appropriate treatment (by a neurologist, neurosurgeon).

Treatment of false precocious puberty depends on the reasons that caused it. If the pathology is associated with isolated adrenarche, only observation is carried out. If a hormonally active tumor is detected, radical treatment is performed (surgery, radiation therapy). In cases of congenital adrenal hyperplasia, corticosteroid therapy is selected.

Endocrinologist Tsvetkova I. G.

All processes in the human body are interconnected. That is why any deviations from the norm indirectly or directly affect the development and proper functioning of each organ. Early maturation is also considered a pathology that affects not only the appearance of the child, but also all systems of the body. If we are talking about the early maturation of a boy, then you need to understand that this terminology applies only to children under 10 years of age. This is a dangerous condition that can provoke disruption of the functioning of internal organs, the development of bone and muscle tissue, as well as the child’s adaptation to society.

Causes of early puberty in boys

Early sexual development of boys is divided into:

True

This process is characterized by the full development of the entire genitourinary system and external genitalia. Characteristic pubic hair appears, along with an increase in the volume of the scrotum and testicles. The child also looks much older than his peers.

The following reasons are recognized:

• excessive production of the hormone gonadotropin;
• dysfunction of the pituitary gland or hypothalamus;
• the presence of a tumor in the brain area;
• genetic predisposition to these disorders.

False

It is characterized by a change only in the boy’s appearance. The child is actively growing, external signs of maturation appear:

• Adam's apple develops;
• hair growth on the chest, face;
• voice change (hardening);
• great height (taller than peers, but shorter than an adult).

However, the reproductive organs remain the same as those of a child of a given developmental period. The causes of this pathology are considered to be excessive production of androgen, which can also be the result of the presence of a tumor of the adrenal gland or testicle.

Signs of early puberty in boys

Signs of early maturation differ depending on the reasons that provoked the development of this disease. If we are talking about false maturation, then the baby is only externally an adult, but in terms of gender characteristics and the development of the external and internal genital organs, he is a child. True maturation is characterized by a complete change in both appearance and many systems. Growth, as in all cases, can be in spurts: sharp growth can be up to 10 cm in 1-2 months. The active growth phase is associated with the simultaneous development of external signs.

Problems of early puberty in boys

The external factor is not the most important problem with this disease. The main point that the doctor pays attention to is the condition of all the child’s organs, as well as the reasons why this pathology became possible. Most often, disorders of excessive early hormone production are the result of a malignant formation in the pituitary gland, hypothalamus or adrenal glands. There are also problems with the child's growth. Spurts of active growth are replaced by sharp ossification of the skeleton. Upon completion of the maturation process, the teenager looks significantly lower than his peers. It will be impossible to influence the growth phase after ossification.

Why is early puberty dangerous in boys?

Early developmental syndrome is dangerous for physical and emotional health. The skeleton develops extremely actively, and as a result of such a load, the bones do not have time to adapt to external changes. The process of hardening and ossification of bones is a protective factor for this phenomenon. The boy eventually becomes significantly shorter than his still growing peers. The second risk factor is underdevelopment of the genitourinary system.

What are the consequences of early puberty?

The consequences of the disorder are psychological dependence on phobias, underdevelopment of the reproductive system, poor-quality sex life, and often immaturity of the reproductive function. An adult man may have problems of the genitourinary organs of a different nature: from tumors to cyst formation. The moral aspect should also not be overlooked in such a situation: it is difficult (often impossible) for a boy with this pathology to adapt to realities and society in adulthood. Persistent phobias and psychological problems are formed.

Treatment of early puberty in boys

Treatment of the disease depends on the etiology of the disease and the general clinical picture:

• disruption of the hypothalamus and pituitary gland will require hormonal therapy and elimination of the tumor, if present;
• hormonal disorders without a clear diagnosis are treated with hormone therapy (gonadotropin-releasing leuprolide antagonist);
• proper diet. During the active growth phase, the boy feels a constant pang of hunger. It is necessary to limit the consumption of carbohydrate and protein foods.

Hormonal therapy and its duration depend on age: if the development of precocious puberty began at the age of 8 years, then taking medications will last until the age of 14 on average. The use of necessary medications is carried out exclusively as prescribed by a doctor. Not only the dose is controlled, but also the duration of the course.

Sexual development of boys



Many sexual deviations have their roots in childhood or adolescence, but this area of ​​human life is still so little studied that it is premature to talk about it and give any specific recommendations. To avoid such deviations, proper sex education of the child is necessary, which will be discussed in the next section.

Prenatal period

Strictly speaking, a boy’s sexual development begins from the moment of fertilization, when a sperm carrying the Y chromosome, which determines the sex of the unborn child, penetrates the egg. The creation of the reproductive system in the process of embryonic development is determined by the correct implementation of the genetic mechanism for the formation of a male individual, the presence of the appropriate hormonal background of the fetus and mother, and the absence of damaging influences from the external environment.

In the early stages of embryogenesis, the reproductive system has the anlages of both female and male external genitalia. Under conditions of autonomous development, both female and male embryos always develop according to the female type. The uterus, fallopian tubes, and vagina are formed. Thus, nature always strives to create "woman". In order for the male genetic code to be realized, it is necessary to have a full-fledged embryonic testicle, which secretes a special protein substance that suppresses the development of female genital organs. In the female body, the ovary does not determine the development of the genital organs. The external genitalia are formed from the 12th to the 20th week of intrauterine development. For the correct development of male genitalia, the normal functioning of the embryonic testicle is necessary. The seminal vesicles, vas deferens, penis, scrotum, and male urethra are formed only when there is a sufficient amount of androgens (male sex hormones, mainly testosterone) produced by the testicle. During this period, the concentration of testosterone in the blood of the fetus reaches values ​​characteristic of adult men. The high concentration of testosterone continues after the birth of the child, and from 3 months of age begins to gradually decrease.

Violation of the normal functioning of the fetal testicles leads to various defects and diseases of the male reproductive system. Therefore, children with testicular pathology (cryptorchidism, monorchidism, decreased testicular size) should be examined and observed by a specialist to exclude concomitant pathology of the genital area.

Brain structures also take part in the regulation of sexual development: the hypothalamus, pituitary gland and pineal gland.

The pituitary gland (a small spherical endocrine gland located in the sella turcica of the skull and connected by a stalk to the hypothalamus) produces the main hormones that regulate the development and normal functioning of the human reproductive system: follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin. The secretory activity of the pituitary gland is controlled by the hypothalamus.

The hypothalamus is the highest vegetative center of the brain, controlling the activity of all organs in the implementation of plant functions of the body (nutrition, respiration, reproduction, excretion, etc.). The nerve cells of the hypothalamus receive signals from the higher parts of the brain. It produces substances that regulate the release of hormones by the pituitary gland. In turn, androgens produced by the testicle regulate the function of the hypothalamus by feedback type: a high level of testosterone in the blood inhibits the production of hormones in the pituitary gland.

Another, still mysterious, formation of the brain takes part in the process of sexual regulation - the pineal gland, or pineal body, which is sometimes called the “third eye” in popular scientific literature. The pineal gland (an endocrine gland located in the posterior part of the brain, in the region of the third ventricle) produces melatonin. Melatonin is produced at night and is involved in regulating seasonal changes in fertility in regions characterized by significant variations in day length. The longer the dark period of the day, the higher the concentration of melatonin and, as a result, the lower the likelihood of fertilization. On the contrary, in high light conditions the concentration of melatonin decreases and the possibility of conception increases. Therefore, in the conditions of the middle zone, the summer months are the most favorable for conception. It is no coincidence that a large number of children are born in the spring (and not just because of the holiday period and good weather).

Period of relative rest

After a stormy intrauterine period and the first months after birth, a period of relative rest begins in the boy’s body until the onset of puberty. At this time, the reproductive system seems to be asleep. The external genitalia are infantile (not developed, childlike) (Fig. 1).

Infantile (children's) external genitalia of a two-year-old boy
Fig.1. Infantile (children's) external genitalia of a two-year-old boy

The scrotum and penis are small in size. The volume of the testicles can vary from 0.7 to 3 cubic meters. cm, and the length of the penis is from 2.5 to 5.5 cm. The growth of the penis and scrotum is proportional to the increase in the size of the child himself. Pubic hair is completely absent. During this period, the seminiferous tubules in the testicle do not have a lumen, which is filled with immature cells - the precursors of sperm. The cells in which testosterone is produced, having fulfilled their initial role in the proper formation and development of the male body, almost completely degenerate by the age of one year.

The biological clock ticks, and between the ages of 6-8 years the male reproductive system begins to gradually awaken. The growth of the testicles begins, a lumen appears in the seminiferous tubules, the process of differentiation of cells, the precursors of sperm, begins, and the number of cells producing testosterone increases.

Puberty

The most rapid processes of sexual development occur during the so-called puberty period (from Latin - puberty). The period of puberty is a time when miraculous transformations occur in a child’s body over the course of several years, like a stormy spring, as a result of which the child becomes an adult, a man capable of producing offspring. This period is one of the most important, if not the most important, in a person’s life. In a short period of time, the genitals reach their final development, secondary sexual characteristics are formed, and the body acquires its final proportions and shapes. Nature makes, if not the last, then the most important stroke on the individual portrait of a developing personality. During this same period, profound psychological changes occur. The restructuring of a teenager’s inner world is enormous and, as a result, vulnerable and sensitive. Growing up is one of the most difficult and vulnerable periods of life for both a teenager and his parents. The onset of puberty in a child is largely genetically determined. In addition to the genetically programmed individual, racial and national characteristics of the puberty period, its course is to some extent influenced by the child’s economic, social, and cultural level of life.

The complex transformation of a boy’s body into a man’s body takes a period of 10 to 18 years. A boy's sexual development is a strictly individual process. The time of onset of puberty, its duration and intensity are individual. Therefore, we can only speak conditionally about the timing of the appearance of various sexual characteristics. A delay or advance in the appearance of a particular symptom for up to two years is within the physiological norm and does not require treatment. However, in this case, a visit to the doctor will not be superfluous and will help rule out more serious problems of puberty.

Nowadays, for most children of the European race, the onset of sexual development occurs in the 11th year of life. The first sign that the process has begun is a significant increase in the size of the testicles. The increase in testicular size is the result of increased growth of seminiferous tubules - structures responsible for spermatogenesis. Despite the fact that during this period testosterone production by the testicle increases 10 times, the contribution of hormone-producing cells to the overall size of the testicle is insignificant, since they occupy less than 10% of its volume. Testicular growth continues throughout puberty, and the testicles reach their final size by 17–18 years. In parallel with the enlargement of the testicles, the scrotum also grows (Fig. 1).

Rice. 1. The onset of puberty is characterized by enlargement of the testicles (11 year old boy)
The onset of puberty is characterized by enlargement of the testicles (11 year old boy)
Behind the testicles, with a delay of 6 months to 1 year, the penis begins to grow. First, the penis grows in length, then, in parallel, it increases in diameter. Penis growth ends at about 16 years of age. Along with the enlargement of the testicles and the growth of the penis, pigmentation of the penis and scrotum appears. The skin of the scrotum becomes folded, sebaceous and sweat glands develop. For most adolescents, growth of the external genitalia ends by age 16. After this age, the size of the penis remains virtually unchanged.

Rice. 2. Beginning of pubic hair growth (boy 12 years old)
Beginning of pubic hair growth (12 year old boy)
At 12-13 years old, pubic hair begins to grow (Fig. 2). At first it is single, straight, long hair at the base of the penis, then the hair becomes thicker, more wavy and gradually spreads to the pubis, taking on the shape of a triangle, pointing downwards.
By the age of 16-18 years, the development of pubic hair reaches the severity characteristic of adult men (Fig. 3).

Rice. 3. External genitalia of a 14-year-old boy
External genitalia of a 14 year old boy
For most men, hair growth continues. Like a victorious army led by its commander-in-chief - testosterone, the hair over time takes over the inner thighs and spreads along the linea alba. This process is individual in nature, and the absence of such pronounced hair growth is not evidence of androgen deficiency or any abnormalities in the male body.

At the age of 13-14 years, hair growth in the armpits begins. This process also goes through several stages: from single and straight hair to thick and curly hair that occupies the entire armpit. Most children already have significant axillary hair growth by the age of 16.

The last, but most noticeable evidence of a teenager’s maturation to others is the growth of a beard and mustache. This process is long. The first vellus hair above the upper lip can appear in a boy at the age of 14, and the final formation of facial hair growth occurs by the age of 20 and even later.

At about 14 years of age, a normally developing boy begins to experience wet dreams (involuntary ejaculation of seminal fluid in men, usually during sleep). By the age of 15, half of adolescents have them, and by 16, the majority have them. Wet dreams are a very important sign of normal sexual development, indicating the maturation of the fertile (fertility, ability to bear children) function of the testicle.
In parallel with the external genital organs, the internal ones also develop: the prostate and seminal vesicles.

Simultaneously with puberty, the boy’s physical development also occurs. Moreover, the processes of body growth and muscle mass increase are closely related to the degree of sexual development of the child. During puberty, the more pronounced a boy’s secondary sexual characteristics are, the more physically developed he is, as a rule. The proportions of the body change, the belt of the upper extremities develops - the teenager “sounds out in the shoulders”, the timbre of the voice decreases, and it “breaks”. Growth continues as long as epiphyseal cartilages are present, due to which the tubular bones increase in length. Under the influence of testosterone, growth plates gradually close, which occurs on average at 21 years of age.

Rice. 4. Gynecomastia in a 12-year-old boy
Gynecomastia in a 12 year old boy
Sometimes during puberty, a teenager's mammary glands may enlarge, which is temporary and does not require treatment. Any visible or palpable enlargement of the mammary gland in boys is called gynecomastia (Fig. 4). As a rule, the process is two-way. Occasionally, enlarged glands may be accompanied by painful sensations. With physiological teenage gynecomastia, there is no discharge from the nipples. In very rare cases, with large glands or long-term gynecomastia, leading to a change in the psycho-emotional state of a teenager, surgical removal of the enlarged glands is resorted to. Negative manifestations of puberty include the appearance of acne on the face.

Omitting the complex biochemical processes that occur in the body of a teenager during puberty, we can simply say that the transformation of a boy into a man (this includes the reproductive system and physical development) occurs under the influence of testosterone, the main male hormone. Under the influence of testosterone and its metabolites, the development of the penis, prostate, growth of facial hair, increase in muscle mass, formation of the male larynx, etc. occur.

Puberty disorder

Disturbance of puberty is one of the main reasons for the formation of mental disorders in adolescents.

Delayed sexual development of 1.5-2 years due to constitutional, national, and family characteristics is not a pathology and in most cases does not require treatment. Delayed sexual development in 70% of cases is genetically determined. Remember how your puberty proceeded, when your first menstruation or wet dream appeared, pubic hair; If possible, ask your parents and brothers and sisters, and you will know approximately what awaits your offspring. By the way, if there are cases of delayed puberty in a family, this primarily affects the development of boys, in whom disorders occur 2.5 times more often than in women. And men, as we regret to say, are more “to blame” for the genetically unfavorable burden, for the improper development of the genital organs in boys, than the female half of their relatives. When collecting your family history, it is advisable to find out whether there have been cases of cryptorchidism, infertility, various anomalies in the structure of the genital organs, and menstrual dysfunction in your family. In such adolescents, as a result, although with a delay, all the signs of an adult man develop and, as a rule, the ability to bear children and hormonal function do not suffer. Moreover, the final expression of sexual characteristics, the size of the penis, the ability to have sex and conceive children do not depend on the speed of sexual development.

However, some children with delayed sexual development, as they say, “withdraw into themselves,” become withdrawn, try to avoid groups of peers, washing together in a bathhouse, or swimming in a pool. Difficulties arise in communicating with parents. Comparing themselves with normally developed classmates, such children consider themselves defective, inferior, freaks, the only ones in the world. For such a teenager, the whole world and all thoughts are focused on the small size of the penis and the lack of pubic hair. This group of children often has suicidal thoughts, and if the people around them are careless, suicidal attempts are also possible. Another part of the children become, on the contrary, aggressive, trying to prove their masculinity to themselves and others. Teenagers start smoking and drinking alcohol early. As an external manifestation of masculinity, they often get tattoos and are prone to a disdainful attitude towards the opposite sex, masking their inner vulnerability with external rudeness. The pain suppressed by such behavior and the hidden feeling of inferiority can sometimes break through (especially after unsuccessful sexual intercourse) by attempting to die.

If during this period of a teenager’s life no help is provided (by parents, teachers, a doctor), then disturbances in the formation of the child’s personality may develop. And if in the future, most likely, he will catch up with his peers in sexual development, the genitals will develop, and sexual activity will begin, then mental problems will haunt him throughout his life. In many ways, a person’s fate is determined by these few years, called puberty. The male psyche is structured in such a way that the basis of a successful life is consistency in the sexual sphere.

Even if disorders of puberty are programmed genetically, the degree of formation of the disease largely depends on the external influence of various unfavorable factors. Everything that is beneficial to the body as a whole has a beneficial effect on the reproductive system, and the negative influence of the environment primarily affects the reproductive organs most strongly. As trivial as this may sound, we will again talk about proper nutrition, the dangers of alcohol and tobacco, and first of all we need to start with the parents. Unfavorable factors affecting the development of the male body include various stresses during pregnancy and infectious diseases (especially those occurring in the first half of pregnancy). The presence of occupational hazards among parents (working with paints, herbicides, pesticides, etc.) has a negative impact. The strongest factor influencing the development of a child’s reproductive system is parental exposure to radiation. According to our data, 13% of children who had serious genital defects had fathers who worked with rocket fuel or ionizing radiation immediately before conceiving the child.

With a decrease in the hormone-producing function of the testicles, a boy may develop a pathological condition - hypogonadism, the clinical manifestations of which are underdevelopment of the external and internal genital organs and secondary sexual characteristics. Previously, such conditions were called eunuchoidism (eunuch - eunuch, castrate; castrated servant in a harem). Now this term is not used, but it allows us to better understand the causes and external manifestations of this condition. Before the onset of puberty, if there are no pronounced changes in the external genitalia, it is difficult to diagnose hypogonadism. Such boys are practically no different in development from their peers. During sexual development, they gradually develop a typical appearance. The external genitalia remain infantile: the length of the penis is less than 5 cm, the volume of the testicles is less than 5 cubic meters. see. Absent or weakly expressed pubic and axillary hair. There is no folding or pigmentation of the scrotum, the voice remains high. There are no wet dreams. The appearance of such patients is characteristic. Growth, as a rule, does not suffer, even above normal. The limbs are long, the waist is high. The hips are wide, exceeding the size of the shoulder girdle. The deposition of subcutaneous fat is characteristic of the iliac crests, lower abdomen, and mammary gland area. Adolescents with constitutionally determined delayed sexual development, which does not require treatment, may have the same appearance. However, in 50% of cases it is characteristic of true hypogonadism. Such children must be observed by specialists for differential diagnosis. The effectiveness of treatment for disorders of puberty in hypogonadism decreases with the age of the child.

Many cases of sexual dysfunction in adulthood associated with infertility, impotence, and neuropsychiatric disorders are likely the result of hypogonadism missed in childhood and untreated.

In addition to the delay, sexual development may be ahead of the physiological norm. In boys, the appearance of secondary sexual characteristics before the age of 10 is considered premature. Early sexual development leads to a rapid increase in body length and closure of bone growth zones, which leads to short stature in such children. They need careful examination and treatment.

Like delayed sexual development, its acceleration can be constitutional, familial, or genetically determined. In this case, secondary sexual characteristics appear in boys at 10-11 years of age. Such children develop normally in the future; they do not require treatment, but observation is necessary.

Hermaphroditism

A separate group of patients consists of children with a disorder of sexual differentiation, in which the structure of the external genitalia has features of bisexuality (i.e., elements of both the male and female reproductive systems are present simultaneously), the so-called patients with hermaphroditism (Fig. 1).

Rice. 1. External genitalia of a patient with one of the forms of hermaphroditism. Along with the penis there is a rudimentary vagina
External genitalia of a hermaphrodite

Such boys may exhibit derivatives of the female reproductive system:

- the fallopian tubes,
- uterus,
- vagina
- bisexual external genitalia.
This pathology is rare, heterogeneous in its composition, difficult to diagnose and treat, and there is no point in talking about it in detail in this book.

Normally formed genitals do not mean that the boy has turned into a normal man.

Correct anatomy must be complemented by male psychological characteristics. The presence of a Y chromosome in the embryo, in its genetic makeup, does not mean that it will develop into a psychosexually correctly formed male personality. The concept of "gender" is not as simple as it may seem -
at first glance. In addition to genetic, there is also gonadal, hormonal, anatomical sex, depending on which gonads will develop in the embryo, how they will function and what appearance the genitals will acquire. And besides this, they also distinguish between civil gender (the gender of the child recorded in documents), mental gender (in which gender the individual feels himself), and social gender (the gender of his upbringing). With hermaphroditism, there are cases when a person of male genetic sex, based on female external genitalia, is registered in another gender, receives a passport as a woman, but mentally identifies himself as male. Moreover, when in such or similar cases at the birth of a child, a council of doctors decides in which sex to register, raise and treat the baby, the last thing they pay attention to is its chromosomal sex. The defining point is the possibility of correction of the external genitalia.

Hermaphrodite (Louvre)
Rice. 2. Hermaphrodite (Louvre)

In Greek mythology, a hermaphrodite was the name given to the son of Hermes and Aphrodite, united by the gods with the nymph Salmacis so that their bodies formed one whole (Fig. 2).

In the future, if a boy is raised as a girl and he receives appropriate hormonal treatment, he feels himself in the female gender with the ensuing female gender role behavior. The child chooses girlish games, feminine character traits are formed, and sexual attraction to the male sex develops. However, such a transformation from one gender to another is possible only in very early childhood, until the child has formed an idea of ​​his gender. This usually occurs by age 3. At first, the baby determines his gender by the way he urinates (boys pee while standing, and girls while sitting), without relating to anatomical differences and considering it possible to change his gender. By the age of 4, the child already accurately distinguishes the gender of the children around him by the external attributes of gender: differences in clothes, toys, etc. A period of “gender” exploration of oneself and the world around him begins. At this time, children are characterized by games with spilling, playing "doctor", studying their genitals and interest in the external genitalia of the other sex. Gradually, the child accumulates data in a form accessible to him about the structure of the male and female body, pregnancy, childbirth, and sexual life. By the age of 6-7 years, a child already understands that he will remain a boy or a girl for the rest of his life, he is precisely aware of his gender, and knows the sex-role and anatomical features of each gender. During adolescence, the psychosexual orientation of a teenager is formed. It is largely determined by hormonal levels, but sexual interests are largely determined by sex education and the environment.

It is still not entirely clear how a child’s sexual consciousness is formed. There are only theories of such formation. Perhaps the child unconsciously imitates the behavior of an adult of the same sex, especially his parents.

Gradually, this behavior becomes fixed in the mind. According to another theory, a child’s self-awareness in his or her gender is achieved through social learning by parents and surrounding people. It all starts with choosing a name. The child dresses according to his gender, and appropriate toys are bought for him.

Parents constantly reward gender-specific behavior and react negatively to gender-inappropriate actions: - “boys don’t cry,”
- "they don't play with dolls"
- "Girls don't fight."

Such encouragement and condemnation leads to the fact that the child tries to behave “as it should,” which is gradually consolidated and formed into stable gender-role behavior characteristic of a given gender.

However, in our opinion, such and similar theories describe only part of the mechanism of a child’s psychosexual development. We know from life that already 5-6 month old children exhibit behavioral signs of one gender or another. And if we draw an analogy with the animal world, then the flawed nature of such theories becomes obvious. Apparently, genetic makeup and, more importantly, hormonal levels are essential components of sexual development.

With all this, we should not forget that man is a social being, and therefore, upbringing and the influence of the surrounding society plays a primary role in the formationgender role behavior.

Child sexology as a science is just beginning to develop. Basically, information about childhood sexuality is obtained by collecting anamnesis from adult patients with sexual deviations. At the same time, in the practice of an andrologist, children and adolescents with various forms of sexual deviations are often encountered.

Transsexualism

Transsexualism is a persistent awareness of one’s belonging to the opposite sex, despite the correct formation of the external and internal genital organs and secondary sexual characteristics. Transsexualism is characteristic of the male sex and occurs in 1-3 cases per 100 thousand male population. The causes of this condition are unknown.

In childhood, transsexualism manifests itself as a violation of gender-role behavior. Such boys choose games of the opposite sex, try to wear girlish clothes, and come up with feminine names for themselves. Already at the age of 5-7 they are clearly aware of the imbalance between their own sexual identity and their place in society. During adolescence, contradictions intensify. For such children, it is real agony to be in a field in which they do not feel themselves. Their desire to change their destined gender is incredible. The goal of life becomes the need to form an outer shell corresponding to their inner content. Such boys secretly or openly dress in women's clothing and use cosmetics. The struggle begins with anatomy that does not correspond to their ideas. The penis is bandaged to the leg so that it does not stand out, and facial hair is carefully shaved. Their dream is to surgically change their gender, remove the penis they hate, and get mammary glands.

Sexual desire in such adolescents corresponds to their psychosexual state. Genetically and externally correctly formed men experience attraction to their own, but mentally opposite, male sex.
This is the fundamental difference between transsexualism and homosexuality, in which an individual experiences sexual attraction specifically to a member of his own sex.

How to help such children?

There is only one way out: undergoing sex reassignment surgery, changing one’s civil and social status. It has now been proven that such a life transition is optimally carried out precisely at puberty in order to save the teenager from sometimes many years of suffering.

Violation of the psychosexual orientation of boys can be expressed in so-called temporary teenage homosexuality. This condition is fundamentally different from true homosexuality, is temporary in nature and is associated with the complexity of psychological restructuring during adolescence.

During the puberty period, characterized by hypersexuality, sexual desire in boys is so intense that the line between the sexes is partially erased and the child begins to experience interest in his own gender. A similar condition occurs in 30-40% of young men. However, homosexual attraction exists only in the form of attraction, without an active search for and implementation of homosexual contacts.

Interest in girls remains (this is different from true homosexuality). Teenage homosexuality is especially typical in closed boy groups: camps, sports sections, special schools. The impossibility or prohibition of communication with the opposite sex, associated with the cultural characteristics of the family, plays a role.

Adolescent homosexuality is temporary, but it is important that this psychosexual orientation is not fixed for life. For this, a teenager urgently needs communication with the opposite sex. It is also necessary to protect the child’s still unformed psyche from contact with homosexual culture: adults with homosexual inclinations, books and pornographic films with corresponding content.