Opinion: Empower kids, not their delayed puberty

Embodied Series: Our bodies, athletic abilities and identities all affect each other, and delayed puberty illustrates this interdependence in the kids who experience it. Combining personal experiences and experts’ insight can help us de-stigmatize delayed puberty and empower the kids who deal with it.

A coworker recently told me they were the friend who at 17 was sent into the liquor store because they looked over 21. I responded that when I was 17, I received discounted prices reserved for 12-and-under children.

I don’t use the word “hate” much, but when I was a teenager, I hated when people tried to talk to me about anything related to my delayed puberty. Now I’m interviewing experts and family about it and writing a publicly-available article. I guess I’ve grown in a few ways.

This is the second installation of the project Sport Embodied: Understanding Our Athletic Identities. I’m blending my experiences, others’ experiences, and experts’ insights to help us better understand how our bodies, identities, and athletic abilities all affect each other.

The graphic below illustrates that our bodies, identities, and athletic abilities are interdependent. That’s how I’m approaching the topic of delayed puberty. I’ll also include advice on how to communicate with kids experiencing this issue.

It’s important to note that while delayed puberty is hard for a teenager, there are much worse health issues to be faced. This is for the people who encounter the issue of delayed puberty in particular, especially boys.

What is (and is not) happening in a body with delayed puberty?

“In seventh grade, I was one of the small guys —not the small guy. Then freshman and sophomore year, I was the small guy. I was more of an outlier.”

My parents and I had consensus on this statement when I interviewed them. Dr. Joel Hahnke, pediatric endocrinologist at Banner Children Specialists in the Phoenix area, said it’s typical. Hahnke described his job as “(taking) care of pediatric patients for growth and hormonal issues. So for puberty, growth, thyroid, diabetes, hormone deficiency, delayed puberty, early puberty, short stature.”

“It seems pretty clear that you were a late bloomer,” he said. “I see a lot of patients for very similar issues. I think you were more of an extreme case, but I've seen patients like you. I saw one earlier today.”I showed him several photos of me competing in track and cross-country between seventh and 10th grade. His reaction?

This was a validating moment for me. I knew I wasn’t a medical mystery, but his use of the word “extreme” matched the disparity I felt between my body and my peers’ bodies as a teenager. 

Hahnke uses the terms “delayed puberty” and “late bloomer” interchangeably with constitutional growth delay (CGD). “Basically it means your body is programmed to have puberty develop later than average, and it’s a variation of normal development. We recognize this as a common thing. It tends to run in families,” he said. So, while my experience was “extreme,” it was also normal — not a disorder. And it made sense, because my uncle and cousin had very similar experiences.

According to Hahnke, the onset of puberty in boys typically occurs between 9 and 14 years of age. For me, puberty was simply programmed to start later and happen more gradually due to my genes. My anterior pituitary gland was genetically programmed to release growth hormone, luteinizing hormone, and follicle stimulating hormone later than my peers. These hormones catalyze the production of testosterone and the development of peak muscle mass, bone growth, lower voice, mature facial features, and hair follicles – basically most of the physical attributes that distinguish men from boys.

After ruling out more serious potential causes of delayed growth (including brain tumors), Hahnke said he focuses on trying to help kids understand what is going on and offer reassurance, because there’s only so much he can do.

“In the extreme cases where somebody is 15 or 16 and hasn't hit puberty yet and feeling self conscious, for boys especially, we tend to prescribe a brief course of testosterone… Usually that helps to trigger the system to accelerate delayed puberty… That's all the tricks we have up our sleeve,” he said. 

As one of those extreme cases, I received a small dose of something similar to what Hahnke described, but as he pointed out, the vast majority of the time, patients like me are healthy — just waiting. We don’t fit the bell curve of puberty for the whole population, but we’re right on track with our genetic programming. Sure, this can be a relief, but it also makes kids like me feel helpless, and gives delayed puberty power over kids’ identity and athletic ability.

How does delayed puberty affect athletic ability and identity?

“I played sports all the way through high school,” said my cousin, Tanner Cherry, who also went through delayed puberty. “Golf and soccer I excelled a lot more at than basketball, just from size, athletic ability, and whatnot. Especially in the younger years, it was hard. It was very — it’s hard to have a lot of confidence, I guess — when you’re both physically smaller than everybody and treated smaller than everybody.”

I quit basketball after two high school summer conditioning practices. I couldn’t stand my ground in a contact sport. They weren’t fouling me – it just didn’t take much to knock me down or make me drag my pivot foot.

Tanner stuck with basketball through high school, but working hard wasn’t working.

“It was tough,” he said. “I worked harder than most, if not all of my teammates. I’d go to the gym way too many hours and run miles and miles on the weekend trying to get in better shape. But then, after my sophomore year, my teammates came in and were 6-4 and 6-(feet) and dunking.” He said he pushed his body too much, illustrating how a desire for athletic ability affected his body.

Dr. Hahnke said sports are a common reason boys come to see him. “They feel like they can't keep up, or everyone’s doing conditioning training but they’re not putting on muscle the way their friends are because they don't have the testosterone levels that their friends do. It’s comparing apples to oranges.”

For Tanner and I, it felt more like comparing watermelons to grapes, and that disparity made it physically and mentally difficult to keep playing. That’s one reason I quit basketball, and a way that my athletic ability affected my body — I quit a sport because I couldn’t compete with my peers. I lost an avenue for exercise, coordination, and other physical benefits. Delayed puberty had power over my ability and decisions. I admire Tanner for continuing, especially because he wasn’t even strong enough to shoot the ball one-handed until his sophomore or junior year.

Patronizing adults and peers can also drive kids like us away from sports and their benefits. Tanner said, “I was the scrappy one but wasn’t athletic enough to play much, and wasn’t confident enough to play much. When it came to sprints or doing something outside of practice, work ethic wise, I was recognized for that. But it didn’t do much to bridge that gap.”

Being deemed scrappy and a hard worker is great, but if it doesn’t translate to playing time, that praise loses value and becomes frustrating. My experiences were similarly well-meaning, or at least neutral — not malicious. At a track practice my freshman year, a very athletic junior girl looked at me and exclaimed, “He’s soooo CUTE!” in front of our entire team. That’s not what a 15-year-old boy wants a barely-older girl to say about him. Right words. Wrong tone. She didn’t mean to, but she reinforced and publicized the power my delayed puberty had over me.

Tanner and I know we’re lucky to have been at very small high schools that needed kids to field teams. If we had gone somewhere bigger, who knows if we would have made the team? Then, we may have been shut out of school sports – our bodies determining our athletic abilities, which turn around and prevent our bodies from playing sports. 

We also felt like we were always playing from behind — that our bodies were an automatic strike against us, and anything else we did to hurt the team added to it. Tanner says, “It was so fragile of a point that I didn’t have any room for error, because I was already working from behind in a way… If I ever got yelled at for doing something or missed a shot even, I’d get super mental about it… I just couldn’t really recover from that point, so that made it tough. In college with ultimate Frisbee, I was a lot more confident because I didn’t feel like I was playing from behind.”

To clarify, Tanner grew several inches and gained 50 pounds, mostly of muscle, in college.

Tanner’s thoughts connected with an exchange I had with Sharon Robinson Kurpius, an Arizona State University professor of counseling psychology for over 40 years. She focuses on at-risk adolescents and identity development. I told her I felt like I didn’t have room for error in team sports because my body was already a liability to the team. I was letting my team down because my body was letting me down.

Robinson Kurpius reframed my thoughts. “Your body isn’t letting you down,” she said. “Your body is not matured yet to the point so that you can meet that expectation. It feels like body betrayal, but it’s not. Your body can’t help that that’s how you’re growing.”

Her wisdom resonates now, but when I was ending my basketball career at 14, I needed a place for the blame. I put it on my body to avoid putting it on myself. Separating the body and self like this can open an existential debate, but please don’t start that debate with a kid experiencing delayed puberty. If they’re anything like me, they want to distance who they perceive themselves to be from their body. Doing so separates them from the unrelenting grip that delayed puberty has on that body.

Robinson Kurpius also pointed out that I gravitated toward individual sports and suggested it could have been because I felt like my body was letting down my team. Yes, track and cross-country are team sports in high school, but not to the extent of something like basketball or football. Others could win a race for themselves even if I lost mine, and if I had a bad race, it seemed less likely that people would attribute it to my juvenile body than they would if I got knocked around in basketball. Individual sports took away some of delayed puberty’s power.

Tanner’s experience with golf, his best high school sport, was similar. “It didn’t matter how big you were. You just worked hard at it… It’s just you out there by yourself… If I let other people down, I felt like I was struggling, and it made it a lot different.”

Dr. Hahnke advocates that small and less-developed body types can also excel in team sports depending on the position. For example, if you love playing baseball but are a late-bloomer, pitcher and first baseman may not be your spot, because they’re typically held by taller guys. But a shortstop or outfielder with quickness and a good throwing technique can excel regardless of height and development.

One sport had no qualms about my size, but it would have capitalized upon my biggest insecurity. The wrestling guys recruited me hard. Did they think I would be a good wrestler? No. Did they need someone for the 103-pound weight class, and I fit the bill? Yes. They even told me I wouldn’t have to wrestle at most meets because the majority of teams didn’t have anyone that small. I could just walk out on the mat, the ref would raise my hand, and I’d score for the team. They meant no harm, but they only wanted me for the trait that I wanted everyone to ignore. Size aside, they never stood a chance of getting me to roll around on those mats, because I was very germaphobic at the time.

Many sports provide opportunities to disempower delayed puberty through reframing success and purpose, as emphasized by Diana Jacobson, a clinical associate professor in ASU’s Edson College of Nursing. In addition to nursing, Jacobson’s background includes pediatric mental and behavioral health. “Cross-country is so individualized you can show improvement,” she said. “Aad I think that's what I would focus on mostly, is what your times are now, and what is your next goal?”

She is under no illusion that many kids are in it for the competition, which requires comparison, but suggests this type of reframing for kids whose bodies don’t allow them the possibility of winning. 

“I think it’s focusing on the positive — why are you doing this? Why are you running? What does running give you that you wouldn’t get if you stayed home?” Reframing the “why” of sport like this can take away some of delayed puberty’s power.

What is happening in the mind of a teenager with delayed puberty?

“One of the common (reasons boys come in) we’ll hear is sports. When you’re a high school kid, or even a middle school kid, your sports are your main thing in life.” Dr. Hahnke concluded that, therefore, delayed puberty can strongly affect boys’ identity.

His words track with my experience. Sports were a significant part of why I saw a pediatric endocrinologist.

The worst part about delayed puberty was acknowledging it existed. As long as no one brought it up, I could at least pretend it wasn’t happening. At the same time, I wanted to understand it and fix it so I could look and compete like kids my age “should,” which meant confronting it head-on with a pediatric endocrinologist. My parents recognized this, as my mom, Joanne Brenneman, recounted. “I remember by the time it got to the point of going to the endocrinologist… I knew it bothered you, so therefore it bothered me because I could tell it was very difficult for you.”

I decided to confront these humiliating situations once every three to six months to try to resolve a situation that affected me every day. I decided to open up the power struggle with delayed puberty, but the visit itself reinforced several mentalities that I was trying to escape, and it gave away some power I was trying to take. Dr. Hahnke voiced several critiques of how I was treated, and I think I would have had a better experience with someone like him. 

In the waiting room, Sesame Street or Blue’s Clues were on television, and preschool children played with blocks. I was there because I was tired of looking and competing younger than I was, but everything around me was juvenile. I also had to put on a medical gown, which made me feel like there was something wrong with me, and I kept trying to grab the back to close the opening. Then the doctor talked about all-things-puberty with my mom in the room and didn’t ask if I wanted her to step outside. While the appointments helped us understand what was happening in my body, and I got a prescription to help my body, they somewhat undermined my efforts to establish an identity apart from my delayed puberty.

As a teenager, I had academic success, leadership positions, musical talent, and friend groups, but others with delayed puberty might not. Today, the trend is moving toward kids specializing in one sport or one activity year-round. What if that doesn’t work out for the child because their body “betrays” them? What else do they have to make them feel like they belong to a group or team? Like they’re good at something?

Robinson Kurpius notes that for me, “All these things helped you form this healthy sense of self, and you were very, very lucky. So many kids today don’t have all of these things, and they don’t have the ability to do sports, either, because their bodies are getting in the way.”

I knew to appreciate the diversification of my identity, but she reinforced that having many sources of self-worth took away a lot of delayed puberty’s power. Not everyone has that.

Dr. Hahnke explained, “I get the 16-year old who hasn't grown for two years because he was growing early and now he's done growing. I can't do anything about that. His growth plates are closed.”

The kids I most envied back then, those who hit puberty early, might have had it worse. They dominated sports in middle school, but were usually surpassed by others who developed later. Many went all-in on sports early and may not have invested in other interests like I did.

Jacobson summarized it well: “You excelled in other areas. In your heart, you wanted to participate in sports at the same level as your age group, but there were other things that mitigated that.” There were other things that chipped away at delayed puberty’s power over my identity.

Dr. Hahnke recommends counseling for some late bloomers to help them process the emotional and psychological side effects of their delay, especially when he notices high levels of anxiety connected to delayed puberty.

 “I think just being aware of how severely this is impacting a patient's life and how you can give the resources they need is the most important thing you can do,” he said.

David Mackinnon, foundation professor of psychology at ASU, is an expert on prevention and intervention for health behaviors in youth. He conducted a study that found physical ability (primarily strength) had direct effects on boy athletes’ self esteem and body image (as did body fat percentage, but that’s for January’s article). He warns that kids like me might be susceptible “to use supplements and steroids to get bigger, right? You’re at risk of doing that.” He also alluded to later-in-life trouble with overcompensating to get the kind of attention missing during the delayed puberty stage. If a kid turns to these coping behaviors, they are likely giving delayed puberty long-term power and consequences over themselves.

Jacobson and Robinson Kurpius both note isolation and withdrawal as potential negative coping behaviors. For a teen, especially if they don’t have an identity or friend group outside sports and lose interest or access to sports, withdrawal is quite common. Jacobson cautions, “A teen in isolation that doesn't feel like they fit in and they can't find a group, they can't find their identity, often will withdraw, and they don't participate in anything. I mean, they have to go to school so they do, but often their free time is TV or screen time because they don't have to show themself … often times you know that withdrawal is not only isolating, but it's also their mental health. They have negative thoughts about themselves and their futures.” 

Delayed puberty gains power over how they see themselves and what they choose to do.

What adults should or shouldn't say

“Don’t focus on the size,” Robinson Kurpius emphasizes. “Focus on all the other wonderful things about that human being. When you keep trying to be supportive about their most sensitive area, you’re just really reinforcing that that should be an area you need to be sensitive about.”

Many people did focus on the size, though. Tanner’s explanation sums up how it made us feel. “I tried to usually pull myself away from that conversation as quick as I could, or the people who I knew would bring it up in conversation,” he said. “I didn’t want to deal with it at the time… I just wanted to pretend I didn’t know about it, avoid talking about it, and hope other people didn’t notice it, even though they did. Those were times I dreaded.” Delayed puberty has immense power in these situations, especially if others don’t know what we need from them.

I wondered for a long time if Tanner, who is seven years younger than me, would have welcomed me bringing up our shared experience while he was going through it. He said yes, and that it helped to talk to his dad, who also had delayed puberty. It made him feel less “like you’re (alone) out there” to talk to someone who could relate.

Jacobson echoes this idea — that because delayed puberty often runs in families there are built-in people who can understand the experience, and that can be very helpful and relatable. If there isn’t anyone like that available, she promotes finding support groups for teens experiencing the same issues. Talking to others who can relate to the frustration dissolves some of that frustration’s strength.

Hahnke warns, though, that parents can be “a big part of the problem because they have such expectations for their children … you can tell the kid is worried because his mom and dad are worried. We have to be really aware of what we do and how that affects our kids, because the last thing I want to do to my kids is make them feel bad about something they have no control over and that nobody can change. I can't control how tall my kids are going to be when they're done growing, so should I make them feel worried, anxious, or bad just because I’m anxious about it?”

So what should a parent do? Robinson Kurpius says parents should foster opportunities in more individual sports or options in which body size doesn’t limit their kids, “but also recognize all the other dimensions. Does this kid sing? Can they act? Can they do well in school? Do they have some literature potential? Same for coaches. Coaches need to see how, with that person, you can maximize their abilities without pushing beyond. It takes a sensitivity, you know? It’s not ‘win at all costs.’ ”

Basically, listen to them, and ask them what they’d like to do and their goals in doing it. Then support that and get other adults on board as needed. Empower the child.

If you are the one experiencing delayed puberty, I’m sorry. It sucks. It’s okay to tune out when people tell you, “You’ll grow soon and appreciate the young looks when you’re older!” It’s okay to tell them you don’t like it when they say that, or anything else, about your body. It’s okay to feel very frustrated and helpless. It’s also okay to talk to a counselor or someone who has been through it (like me – seriously – you can email me). 

Also, though, think about yourself as an entire person. You are much more than this thing that sometimes feels like it has power over who you are and what you can do. In the future, people who know you now will forget this thing about you, and new people you meet will never know it happened unless you decide to tell them. Its power will be gone.

Luke Brenneman is a postdoctoral research scholar at the Global Sport Institute at Arizona State University and is conducting this project through the Global Sport Education and Research Lab

Editor’s note: For the 2019-2020 academic year, the Global Sport Institute’s research theme will be “Sport and the body.” The Institute will conduct and fund research and host events that will explore a myriad of topics related to the body.