Delayed Puberty in Boys May Signal Future Risk of Type 2 Diabetes

Credit: Adobe Stock/Monkey Business

A large study from Israel has found that boys who enter puberty later than average are more likely to develop Type 2 diabetes in early adulthood — even if they have a healthy weight and regardless of their socioeconomic background.

The findings were presented at the first Joint Congress between the European Society of Paediatric Endocrinology (ESPE) and the European Society of Endocrinology (ESE). Investigators found that boys with delayed puberty were 2.5 times more likely to develop Type 2 diabetes later in life compared with boys who began puberty at a typical age.

Type 2 diabetes — driven by a combination of genetic, environmental, demographic and socioeconomic factors — is a condition that results from the body’s inability to make enough of or properly use insulin. It is the most common form of diabetes, accounting for over 90% of cases, and it usually occurs in adults over 45. However, in recent years, more children, teens and young adults are being diagnosed. While rising obesity rates are a major factor, investigators at Sheba Medical Center wanted to explore whether the timing of puberty plays a role in the development of this disease.

What is delayed puberty?

Puberty timing varies from person to person, but in boys, it’s considered delayed if there are no signs of puberty by age 14. When this occurs, pediatric endocrinologists often prescribe a short course of testosterone to help jump-start development when needed.

“To our knowledge, our large-scale study is the first to report an association between delayed puberty in adolescent boys and an increased risk of developing Type 2 diabetes,” stated lead investigator Orit Pinhas-Hamiel, M.D., head of the Pediatric Endocrine and Diabetes Unit at the Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, in Israel.

The Study

The study included 964,108 adolescent boys aged 16 to 19 years who were recruited for military service between 1992 and 2015. Out of those, 4,307 were diagnosed with delayed puberty. Pinhas-Hamiel and her team followed these participants until the end of 2019.

Boys with delayed puberty were at a significantly higher risk of developing Type 2 diabetes even when adjusting for socioeconomic status, education level, birth year, birth country and cognitive function. Additionally, even after adjusting for body weight, teens with delayed puberty had a 37% higher risk of developing the condition. Among the individuals in the delayed puberty group, 140 per 100,000 developed diabetes each year, compared with only 41 per 100,000 teens without a delay.

“We think the higher risk of early Type 2 diabetes in boys with delayed puberty may be due to a window of opportunity during development when the body is especially sensitive to hormones and environmental factors — similar to how early childhood shapes language skills or how puberty affects bone strength,” Pinhas-Hamiel noted.

The team mentioned that the results were surprising considering delayed puberty is usually seen as a benign condition, but findings suggest it may have long-term health implications.

“Our findings contribute to a better understanding of how pubertal timing may influence long-term metabolic health and highlight the need for medical follow-up to enable early diagnosis of Type 2 diabetes,” Pinhas-Hamiel concluded. “Recognizing delayed puberty in males as an early-life marker for increased risk of Type 2 diabetes may help identify vulnerable individuals, allowing for targeted prevention strategies.”