CPP: Not Happening Within a Vacuum

Central Precocious Puberty is not happening within a vacuum.

What I mean by this is that over time the average age of pubertal changes has dropped. (Here is a related article, although it's dense and covers many other aspects of this issue, as well.)

Younger starting ages have become normalized in the sense that as the age has dropped, we seem to continue to say, "Well, maybe that's just happening these days..."

As an example, the PubMed Health (U.S. National Library of Medicine) link included in my first blog post says, "Some evidence suggests that it may be normal for these changes to occur as early as age 7 in Caucasian girls and age 6 in African-American girls."

If precocious puberty is considered to be under eight for girls now, next year will we say that age seven is normal? And why make a statement that brings the normal age even lower for African-American girls?  

One article I found says, "All puberty that appears to begin with breast development when a girl is age 6 or 7 is not precocious puberty.  Puberty among those with early onset may be progressing at a slower pace, or the initial appearance of breast growth may not herald the real onset of puberty."

The author's argument suggests that early breast development that is not then followed by more advanced breast development or the earlier start of menstruation should not count as precocious puberty.

I would argue that even slight breast development can seriously affect a six or seven year old girl's interactions with friends, her comfort changing in the girls locker room, the way boys and other people see her, and the way she thinks about herself.  If so, how unhelpful to ask the parent to wait to see how fast the puberty progresses, particularly given that once it does, it is usually impossible to reverse its effects.

Rather than taking a "this is the new normal" attitude, we should try to protect childhood more and ask harder questions about what is going on here.

Some Background: Normal Steps to Puberty and the 2 Types of Precocious Puberty

I appreciate the clear background given by the Mayo Clinic site, and so am essentially re-posting it here:

A Review of How Puberty Normally Starts

First: Part of the brain makes a hormone called gonadotropin-releasing hormone (Gn-RH).

Second: Gn-RH causes the pituitary gland — a small bean-shaped gland at the base of your brain — to release two more hormones. The hormones are called luteinizing hormone (LH) and follicle-stimulating hormone (FSH).

Third: LH and FSH cause the ovaries to produce hormones involved in the growth and development of female sexual characteristics (estrogen) and the testicles to produce hormones responsible for the growth and development of male sexual characteristics (testosterone). The body will also begin to make estrogen and testosterone.

Fourth: The production of estrogen and testosterone causes the physical changes of puberty.

The Two Types of Precocious Puberty

The reason puberty begins early in some children depends on the type of precocious puberty they have: central precocious puberty or peripheral precocious puberty.

In central precocious puberty (CPP), the brain starts the process of puberty too soon. Although they begin earlier than they should, the pattern and timing of the steps in the process are otherwise normal. For the majority of children with this condition, there's no underlying medical problem and no identifiable reason for the early puberty.

Peripheral precocious puberty (PPP) is less common than central precocious puberty and happens without the involvement of your brain triggering the start of puberty. Instead, the cause is release of estrogen or testosterone into the body because of problems with the ovaries, testicles, adrenal glands or pituitary gland or some other cause.

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Because most cases of precocious puberty are CPP, that's what this blog will address. Based on what's written above, CPP starts when the brain for some reason sends the "start puberty now" message early -- but what might explain why this is happening?

Precocious Puberty: The Basics

I wish that there was no reason to write this blog, but there is and it's a big one.

A disturbing phenomenon has been underway.  Maybe you've heard about it through the media. Maybe you know someone who is dealing with it within their own family.

The condition is called "precocious puberty" and it has been on the rise for reasons largely unknown.

There are plenty of Web-sites offering medical information about precocious puberty.  The basic symptom of this condition is when any sign of puberty is detected in girls younger than eight or in boys younger than 9.

So what we are talking about is very young children, mostly girls, who, along with their families, are confronting this reality much sooner than anyone had expected -- and in the majority of cases the cause is unknown.

This is where things get really interesting.

Yes, in the majority of cases the cause is unknown, but there is plenty of research and speculation about what could be behind the rise of precocious puberty.  The purpose of this blog is to go through these hypotheses and studies one by one to evaluate the rigor of their methods and to discuss their findings.