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What Is Delayed Puberty in Boys?
Delayed puberty in boys is characterized by lack of growth and functional activity of the male gonads, called testes or testicals, to produce testosterone by age 14 and failure to grow pubic hair by age 15. Later changes affected are deepening of voice and increase in musculature.
Puberty is the life period when a boy grows into a man and begins with an increase in testicular volume.1
Q: What is an increase in testicular volume?
A: Testes are male reproductive glands that produce reproductive cells called spermatozoa. Spermatozoa first become detectable in specimens of boys’ spontaneously produced morning urine at a mean age of 13.4 years (spermarche). As the testes become larger in the ensuing years, the maturation of spermatogenesis is completed.2
Delayed puberty may be due to excessive exercising, malnutrition, chronic disease, obesity, genetic disorders, chromosomal abnormalities, or tumors that damage the pituitary gland. The pituitary normally secretes gonadotropin stimulating hormone (GSH) telling the gonads to produce testosterone and inhibitin, or the hypothalamus, which tells the pituitary gland to release GSH.
Who is Affected in the General Population?
Delayed puberty occurs in approximately 3% of children.1
What Is Delayed Puberty In Boys In Celiac Disease and/or Gluten Sensitivity?
- Relationship between delayed puberty in boys and celiac disease. Delayed puberty in boys is a classic reproductive symptom of untreated celiac disease and is a common presenting feature.
- Relationship between delayed puberty in boys and androgen resistance. Studies have found an abnormality pattern suggesting androgen resistance specific for celiac disease. Gonadal dysfunction is believed to be due to reduced conversion of testosterone to dihydrotestosterone caused by low levels of 5 alpha-reductase in celiac disease. This leads to derangement of the hypothalmic-pituitary axis.3 Hormone alterations are reversible upon the start of a gluten free diet, emphasizing the importance of early diagnosis.
- Relationship between delayed puberty in boys and folic acid deficiency. As regards the nutritional aspects, the folic acid deficiency of celiac disease can affect rapidly proliferating tissues such as the seminiferous epithelium in the testes where speratozoa are produced.
- Relationship between delayed puberty in boys and fat-soluble vitamin deficiencies. More attention should be paid to deficiencies of fat-soluble vitamins, such as A and D, observed in celiac disease.4
- Vitamin A is important for Sertoli cell function as well as for early spermatogenetic phases.
- Vitamin E supports the correct differentiation and function of epidydimal epithelium, spermatid maturation and secretion of proteins by the prostate.
- Relationship between delayed puberty in boys and early diagnosis. Celiac disease male patients should be regarded as vulnerable subjects, thus the detection of early biomarkers of andrological or endocrinological dysfunctions should trigger timely strategies for prevention and treatment.4
How Prevalent Is Delayed Puberty In Boys In Celiac Disease and/or Gluten Sensitivity?
Delayed puberty has increased frequency in boys with untreated celiac disease. 31% of patients diagnosed with celiac disease at a hospital endocrinology department in India had delayed puberty.5
What Are The Symptoms Of Delayed Puberty In Boys?
Delayed puberty in boys is marked by these symptoms:
- Immature secondary sex characteristics including absent growth of facial, underarm and perineal hair.
- High-pitched voice.
- Smooth skin.
- Low metabolism.
- Lack of sexual desire.
- Sterility.
How Does Delayed Puberty In Boys Develop In Celiac Disease and/or Gluten Sensitivity?
- Delayed puberty in boys results from unclear etiology involving gluten exposure and deficiencies of vitamin A, vitamin E, vitamin D, zinc, iron, folic acid, and group B vitamins.
- In celiac disease there is a high level of autoantibodies directed against self-antigens, so there could be antibodies against hormones or organs critical for pubertal development.
- Moreover, in celiac disease there could be a selective malabsorption of micronutrients essential for the metabolism of carrier or receptor proteins for sex hormones.6
Does Delayed Puberty In Boys Respond To Gluten-Free Diet?
Yes. Celiac disease-related delayed puberty responds to gluten free diet.7
6 Steps To Improve Delayed Puberty In Boys In Celiac Disease and/or Gluten Sensitivity:
- 1Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:
- Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
- A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
- Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.
Correct Your Individual Nutritional Needs.
- Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
- Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.
Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the absorbing cells that make up the surface lining of your small intestine are better able to function.
- Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
- Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.8
- The intestinal lining may take up to a year to heal.
- 2 Reduce Inflammation. Foods to Eat and Foods Not to Eat:
Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).
- Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.9
- Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
- Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.9
- Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.9.
- Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.9
- Refined Sugars. Includes white sugar, corn fructose and high fructose corn syrup.
- Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.9
- Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.9
- Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
- Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes lettuce, kale, onion, broccoli, garlic, and others.
- High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
- Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
- Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
- Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
- Prebiotics/ High Fiber Foods. Food with fiber keeps our population of colonic microbes healthy.
- Protective Herbs and Spices. See below #6 below for examples.
- 3 Information Sheet You Can Take to Your Doctor or Other Health Professional:
- 4 Manage Your Medications Safely:
Certain prescription drugs cause deficiencies of these nutrients: vitamin A, vitamin E, vitamin D, zinc, iron, folic acid, and group B vitamins that can cause delayed puberty in boys. Ask your doctor or pharmacist about this possible adverse effect if taking any of the drugs listed below. Do not stop prescribed medications without supervision.
This is not a complete listing.
ANTACIDS / ULCER MEDICATIONS
- Pepcid®, Tagamet®, Zantac® deplete Calcium, Chromium, Folic Acid, Iron, Vitamin A, Zinc, Vitamin B12.
- Magnesium and Aluminum Antacid preparations (Gaviscon®, Maalox®, Mylanta®) deplete Folic Acid, Iron, Vitamin A, Zinc, Vitamin B12.
- Prevacid®, Prilosec® deplete Vitamin B12.
- Alka Seltzer®, Baking Soda deplete Folic Acid.
ANTI-DEPRESSANTS
- Adapin®, Aventyl®, Elavil®, Pamelor®, and others deplete Riboflavin, Vitamin B12.
ANTIBIOTICS disrupt intestinal permeability.
- Gentomycin, Neomycin, Streptomycin, Cephalosporins, Penicillins deplete B Vitamins.
- Tetracyclines deplete Iron, Zinc, Riboflavin.
- Cipro depletes Zinc.
ANTI-INFLAMMATORIES disrupt intestinal permeability.
- Corticosteroids (Prednisone, Medrol®, Aristocort®, Decadron) deplete Zinc, Folic Acid.
- NSAIDS (Motrin®, Aleve®, Advil®, Anaprox®, Dolobid®, Feldene®, Naprosyn® and others) deplete Folic acid.
- Aspirin and Salicylates deplete Folic acid, Iron.
ANTICONVULSANTS
- Phenobarbital and Barbituates; and Dilantin®, Tegretol®, Mysoline®, Depakane/Depacon® deplete Folic Acid, Vitamin B12, Vitamin B1, Zinc.
ANTIVIRAL AGENTS
- Zidovudine (Retrovir®, AZT and other related drugs) deplete Zinc, Vitamin B12.
DIURETICS
- Thiazide Diuretics (Hydrochlorothiazide, Enduron®, Diuril®, Lozol®, Zaroxolyn®, Hygroton® and others) deplete Zinc.
- Loop Diuretics (Lasix®, Bumex®, Edecrin®) depletes Vitamin B1, Vitamin B6, Zinc.
- Potassium Sparing Diuretics (Midamor®, Aldactone®, Dyrenium® and others) deplete Folic Acid, Zinc.
- 5Nutritional Supplements To Help Correct Deficiencies:
The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.
- Multivitamin/mineral combination once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications. Contain the B vitamins including folic acid.
- B-Complex vitamin as prescribed if deficient following blood test for status.
- Ferrous fumarate or gluconate if deficient following blood test for status as prescribed. Do not take at same time as calcium because they compete for absorption.
- Vitamin A as prescribed if deficient following blood test for status.
- Chelated zinc if deficient following blood test for status as prescribed. Do not take at same time as calcium because they compete for absorption.
Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.
- 6Manage Natural Remedies:
- Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
- If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
- Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
- What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.
Carminative Food Remedies:
- Raspberry.
- Carrot is also a cleansing digestive tonic.
- Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
- Redbeets also stimulate and improve digestion and are easily digested.
- Cabbage also stimulates and improves digestion and is also a liver decongestant.
- Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
- Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.
Carminative Herb Remedies:
- Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa. Drink as tea or use in cooking.
- Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
- Parsley also relieves indigestion.
- Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
- Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.
Carminative Spice Remedies:
- Cloves are also antispasmodic.
- Nutmeg is also useful for indigestion.
- Ginger.
Exercise improves circulation and rids the body of toxins.
- Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
- Weight training builds muscle. Read more about Exercise and Fitness.
- Stretching improves flexibilty. Read more about Exercise and Fitness.
Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal.
What Do Medical Research Studies Tell About Delayed Puberty In Boys In Celiac Disease and/or Gluten Sensitivity?
RESEARCH STUDY SUMMARIES
“Endocrine manifestations of celiac disease.” This study investigating the prevalence of endocrinopathies in 36 patients who were diagnosed with celiac disease at a hospital endocrinology department found delayed puberty present in 31% of patients.
The endocrine manifestations include (after complete evaluation) short stature (58%), elevated alkaline phosphatase (67%), low calcium (22%), X-rays suggestive of osteomalacia or rickets (8%), carpopedal spasm (6%), and night blindness (6%). Anti-TPO antibody positivity was found in 53%, hypothyroidism in 28%, subclinical hypothyroidism in 17%, and type-1 DM in 25% of the patients. A total of 14% patients had no GI symptoms.5
“Male gonadal function in coeliac disease: III. Pituitary regulation. Clinical Endocrinology.” This study investigating pituitary regulation of gonadal function in treated and untreated male patients with Celiac Disease demonstrated a derangement of pituitary regulation of gonadal function. Exaggerated responses of follicle-stimulating hormone(FSH) (89%) and luteinizing hormone (LH) (49%) to luteinizing hormone-releasing hormone (LHRH) were found in celiacs with sub-total villous atrophy and were commonly found when basal gonadotropin concentrations were normal. LH response was closely linked to jejunal morphology.10
- Brämswig J, Dübbers A. Disorders of pubertal development. Dtsch Arztebl Int. 2009 Apr;106(17):295-303; quiz 304. doi: 10.3238/arztebl.2009.0295. [↩] [↩]
- Brämswig J, Dübbers A. Disorders of pubertal development. Dtsch Arztebl Int. 2009 Apr;106(17):295-303; quiz 304. doi: 10.3238/arztebl.2009.0295. [↩]
- Bona G, Marinello D, Orderda G. Mechanisms of abnormal puberty in coeliac disease. Hormone Research. 2002;57(Suppl 2):63,3p. [↩]
- Stazi AV, Mantovani A. Celiac disease and its endocrine and nutritional implications on male reproduction. Minerva Medica. Jun 2004;95(3):243-54. [↩] [↩]
- Philip R, Patidar P, Saran S, Agarwal P, Gupta K. Endocrine manifestations of celiac disease. Indian J Endocrinol Metab. 2012 December; 16(Suppl 2): S506–S508. [↩] [↩]
- Valentino R, Savastano S, Tommaselli AP. Unusual association of thyroiditis, Addison’s disease, ovarian failure and celiac disease in a young woman. Journal of Endocrinological Investigation. May 1999;22(5):390-4. [↩]
- Stazi AV, Mantovani A. Celiac disease and its endocrine and nutritional implications on male reproduction. Minerva Medica. Jun 2004;95(3):243-54. [↩]
- Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
- Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
- Farthing MJ, Rees LH, Edwards CR, Dawson AM. Male gonadal function in coeliac disease: III. Pituitary regulation. Clinical Endocrinology. Dec 1983;19(6):661-71. [↩]