Puberty Males Referral Access Criteria
Puberty Males Referral Access Criteria
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Referrers should use this page when referring patients to public paediatric endocrinology and diabetes outpatient services for puberty (males). This RAC is applicable to referrals for patients aged <16 years only.
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| Emergency referral |
 If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region. |
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| Immediate referral |
 Immediately contact on-call registrar or service to arrange immediate paediatric endocrinology assessment (seen within 7 days):
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- Sudden changes in pubertal development with or without neurological symptoms (e.g. headache, blurred vision)
To contact the relevant service, see HealthPathways: Acute Paediatric Assessment (external site)
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| Presenting issues |
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
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- Early onset (aged <9 years)
- Lack of pubertal signs (aged >14 years)
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| Mandatory information |
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Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test due to financial reasons or geographical location).
This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
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| History |
- Relevant history, onset, duration and severity of symptoms
- Current medication list including any relevant medication use that may influence pubertal development
- Any known allergies
- Familial history of height, weight and onset of puberty
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| Examination |
- Indicate presence or absence of café au lait spots >1.5cm
- Serial measurements of height and weight (ideally 6-12 months) in a growth chart
- Tanner stage: pubic hair, genital development
- Testicular volume
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| Investigations |
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| Highly desirable |
| History |
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| Examination |
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| Investigations |
- XR left hand for bone age
- Androgen profile
- DHEAS
- TSH, free T4
- LH, FSH, testosterone
- Karyotype (in delayed puberty)
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| Indicative triage category |
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Category 1
Appointment within 30 days
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Precocious puberty
- Boys <9 years with testicular enlargement (>4mL or >2.5 cm) and/or penile enlargement
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Category 2
Appointment within 90 days
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Precocious puberty
- Multiple café au lait spots > 1.5cm (possible McCune Albright Syndrome)
Premature adrenarche
- Boys <7 years with one or more of the following signs: pubic hair, axillary hair, body odour, penile enlargement, accelerated growth; but NO testicular enlargement
- Boys 7–9 years with one or more of the above signs AND accelerated growth
Delayed puberty
- Boys at 14 years of age with no testicular enlargement (<4mL or <2.5cm)
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Category 3
Appointment within 365 days
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- No defined category 3 criteria
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| Exclusions |
- Presence of fine downy and non-pigmented short hair in the supra pubic area (not considered secondary sexual pubic hair)
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Last reviewed: 18-03-2024