Pubertal staging

Tanner stages – verbal descriptions but images helpful esp for self assessment.

Pubic Hair Scale (both males and females)

  • Stage 1: No hair
  • Stage 2: Downy hair
  • Stage 3: Scant terminal hair
  • Stage 4: Terminal hair that fills the entire triangle overlying the pubic region
  • Stage 5: Terminal hair that extends beyond the inguinal crease onto the thigh

Female Breast Development Scale

  • Stage 1: No glandular breast tissue palpable 
  • Stage 2: Breast bud palpable under the areola (1st pubertal sign in females)
  • Stage 3: Breast tissue palpable outside areola; no areolar development
  • Stage 4: Areola elevated above the contour of the breast, forming a “double scoop” appearance
  • Stage 5: Areolar mound recedes into single breast contour with areolar hyperpigmentation, papillae development, and nipple protrusion

For males you then have testicular volume, measured by orchidometer (between £26 and £208):

  • 4 ml (1.8cm long by formula below) is first pubertal sign
  • Adult is >20 ml (or >3 cm long)

Cadbury’s Teasers and Truffles (from Celebrations box) are 8ml, equivalent to 50th centile at age 13.

If you only have a ruler, use maximum width in millimetres and the formula: (W-1.5)3 x 0.88, where ss is double scrotal skin thickness (for Tanner stages 1, 2, and 3).