We look at the effect of the pandemic—which accelerated the number of little girls entering puberty at a very young age. But should we be “blocking” their development using pills? Or should we be embracing this early onset as the ‘new normal’? In the first instalment of this two-part series, we looked at what we know about puberty and the factors that trigger it.
Editor's Note: We have been hit by simultaneous medical emergencies and will not be publishing Big Stories for the next couple of days. All of our other sections are updated as usual. Instead, we are resurfacing some of our best Big Stories from our extensive archive that we think are definitely worth a read. Thank you for your patience!:)
A quick recap on early puberty
For decades, the age of girls entering puberty has been declining. This is particularly notable for the second stage—and girls as young as eight have begun to develop “breast buds.” Experts don’t exactly know why this is happening. But there is strong evidence for three key factors:
Obesity: A hormone called leptin. Released by fat cells, it both acts to inhibit hunger—and is involved in triggering menstruation: “Leptin is produced in the fat tissue and plays a role in raising the body’s estrogen levels. Typically, as estrogen increases, so does fat and leptin, which can create a feedback loop—weight gain spurs puberty, and puberty spurs weight gain.”
But the research isn’t conclusive. And plenty of girls who experience early puberty are not overweight.
Chemicals: Specifically, endocrine-disrupting chemicals or EDCs—found in food, plastics and even baby bottles. They are known to disrupt hormones in the human body. But there is no evidence of a direct causal link between a specific chemical and puberty.
Stress: The main hypothesis is that higher cortisol levels—also known as “stress hormones”—activate the organs responsible for triggering puberty. The child enters puberty—and with great speed because these cortisols also mimic sex hormones: “Instead of it being this slow, long process, it goes much quicker because development in a stress context causes hormones to come on very fast.”
The pandemic effect on puberty
The data: from around the world shows that the trend toward age decline accelerated during the pandemic. Referrals for girls with early puberty to paediatric endocrinologists doubled or even tripled in places like Germany and Turkey. In Germany, the age dropped by 10 months in just a couple of years—from 7.6 on average to 6.8. In South Korea, the number of children diagnosed with ‘precocious puberty’ almost doubled between 2016 and 2021—with a steep post-2020 spike. In Italy, 328 girls were referred for suspected precocious puberty over seven months between March and September 2020—as opposed to 140 during the same period in 2019.
As for India: The data is more anecdotal. All we have is a single Pune study that showed a jump of 3.6X in referrals for precocious puberty. In a number of cases, girls as young as 5 started developing breasts—and those younger than 8 began menstruation.
The pandemic effect: Experts don’t exactly know why the pandemic affected hormonal triggers for puberty. The consensus is that the lockdown exacerbated known factors—and revealed potential new triggers.
The known factors: Since children were at home, various studies found that girls with precocious puberty got less exercise and were more prone to putting on weight. Also an issue: increased exposure to chemicals in household products—and Covid-related routines like using hand sanitisers.
A ‘blue light’ crisis: As we noted, stress is one of key suspects in triggering early puberty. So it makes sense that the sharp spike in mental health issues among kids could have played a role. And one key symptom of stress is the lack of sleep. The pandemic revealed a potential link with the sleep-regulating hormone melatonin—which is produced by the brain in response to darkness:
“During the lockdowns, many children got less sleep and more irregular sleep, and they spent vastly more time in front of the blue light of screens, which inhibited their ability to secrete melatonin. A drop in melatonin can contribute to symptoms of anxiety and depression; it also activates an increase in a protein called kisspeptin, which is another of the trigger hormones for puberty.”
A Turkish study on rats found that high blue light exposure can alter reproductive hormone levels and cause earlier puberty onset—“the longer the exposure, the earlier the onset." Female rats exposed to double the duration of blue light each day underwent puberty at a relatively younger age—and they had lower melatonin levels and higher levels of the reproductive chemical signals.
But, but, but: The results of the study—which were not peer-reviewed—were debunked by many experts. That said, the relationship between melatonin and puberty is well-established. Melatonin acts as a puberty-blocker when a child is young—and its levels fall steeply once a child starts to mature.
The great debate over early puberty
The medical community is divided over whether to treat this accelerating trend as a “disorder” to be “fixed.” And for parents, the toxic social factors involved in the sexual maturity of girls makes everything more complicated.
The ‘new normal’: A number of experts argue that we should just accept the reality that the age of girls entering puberty has declined:
“[T]he age threshold for alarm should be lowered. Otherwise, they said, healthy children could be referred to specialists and undergo unnecessary medical procedures, which can be physically taxing and expensive.”
And doctors say there is great harm in making the child feel ‘abnormal’:
“We’re cognizant of trying not to medicalize things that are a normal part of life. Early puberty is early, but it’s still normal in most cases. We do the best we can to not make a child feel like, ‘My parents are bringing me to the doctor because there’s something wrong with me.’ ”
But, but, but: Medical research shows that early puberty can also have significant consequences:
“Regardless of a person’s sex, early puberty is linked to short stature in adulthood, as well as serious health conditions, such as heart disease, type 2 diabetes and some cancers. Early puberty has also been associated with certain mental health problems, such as anxiety in boys and depression in girls.”
Other studies have shown that “early maturing girls are at unique risk for psychopathology.” Another found that “early-maturing adolescents tend to affiliate with more-deviant peers and appear more susceptible to negative peer influences.”
Most importantly: A twelve-year-old’s ability to manage the disruptive changes of puberty may be vastly different than that of an eight-year-old. For starters, there is nothing scarier for a prepubescent child than looking ‘different’: "It's a time when you don't want to be distinguished from your peers in any way, shape or form." Also this:
"These kids have levels of cognitive, social and emotional development completely consistent with their age, but physically, they look older. That mismatch is thought to be at the heart of the difficulties."
Even harder for girls: Society closely links puberty or “coming of age” to a girl’s sexual development. As one doctor admits: "In particular, there are changes in thinking of yourself as sexually desirable or physically attractive that get emphasized for girls at puberty." Hence, it makes parents even more anxious that their kids are losing their childhood early. A parent frustrated with doctors who want to ‘normalise’ her child’s early puberty says: “There was no wider analysis about the consequences related to her socialisation at school, her relationships with boys and men—all these things that it opened up.”
In India: There is a push-pull cultural dynamic. On the one hand, parents may prefer to block early puberty using pills—to save the girl the social “embarrassment” or “torture” of developing early. But they may also refuse to do so for equally traditional reasons: “In many cases, parents refuse treatment for precocious puberty as they believe menstruation is a doing of God, and that meddling with menses would mean insulting the deities.”
Parents matter: Irrespective of whether a child is treated for early puberty or not, how parents deal with the situation has a huge impact. Studies have shown that nurturing parents can mitigate many of the negative psychological effects of early puberty. The key to being more positive: take the sex out of puberty:
“[P]uberty and sexuality can be separated. A seven- or eight-year-old girl going through puberty isn’t necessarily going to associate that with pregnancy and sex unless someone makes that association for her.”
Doctors advocate looking at puberty not as the end of childhood but a way station in “a decades-long continuum of transformation.”
The bottomline: Most experts agree that the end of the pandemic will likely reset the number of early puberty cases. But for a certain generation of girls, the impact of this two-year period may be lifelong:
“We are in a great natural experiment at the moment, and we might not know the results of it for another ten years or more. I do wonder if this is going to be a cohort of kids whose puberty was more rapid because they were in a critical window of susceptibility during a time of great social upheaval.”
Reading list
The New Yorker has the most on the debate over whether to embrace early puberty or not. The Conversation has a very useful guide to puberty blockers. The Washington Post has a good report on early puberty during the pandemic in India. This American Psychological Association piece has more on the risks of early puberty. The first part of our early puberty series has lots more background on puberty—and its own reading list.
