Just the other day, a mom sat in my clinic, a familiar worry in her eyes. “My daughter, she’s only seven,” she began, “and I think… I think she’s starting to have body odor. Is this… normal? Is she starting puberty already?” It’s a question I hear quite a bit, and it often leads us to a chat about something called adrenarche. It sounds like a big word, but it’s a completely natural step in your child’s journey of growing up, often starting quietly between the ages of 6 and 8.
What Exactly Is Adrenarche, Doc?
So, what’s happening during adrenarche (pronounced ad-dren-ARK-ee)? Think of it as a gentle nudge from your child’s adrenal glands – those small but mighty glands that sit on top of their kidneys. These glands start to produce more of a hormone called dehydroepiandrosterone, or DHEA for short.
Now, DHEA is what we call a precursor hormone. This means your child’s body then cleverly converts DHEA into other, more active hormones. These include androgens (like testosterone and androstenedione) and even some estrogen. Androgens are a group of sex hormones that play a role in kicking off some of the early changes we associate with puberty. We can tell adrenarche is underway when we detect a form of DHEA called DHEAS (dehydroepiandrosterone-sulfate) in the blood, though we don’t routinely test for this since it’s an expected process.
It’s like a specific inner layer of these adrenal glands, the zona reticularis, really kicks into gear and matures. This ramp-up in DHEA and its related androgens is what starts to activate:
- Sebaceous glands: These are tiny glands in the skin that make oils (sebum). This can lead to oilier skin and hair.
- Apocrine glands: These are special sweat glands, mostly under the arms and in the genital area. They’re pretty quiet until these adrenal hormones switch them on, which is what can lead to body odor.
- Development of pubic and armpit (axillary) hair.
It’s important to remember that these adrenal hormones are different from the ones that trigger breast development in girls or penis growth in boys later on. That part of puberty, driven by the ovaries or testes waking up, is a separate process called gonadarche. Adrenarche and gonadarche are two distinct, independent steps. Scientists are still figuring out exactly what flips the switch for adrenarche to begin.
Typically, adrenarche chugs along for about two years before what we call pubarche – the first appearance of pubic hair – begins. But your child’s adrenal glands will keep making DHEA well into adulthood; in fact, levels peak in the early 20s!
Spotting the Signs: What Happens During Adrenarche?
When adrenarche first starts, with that initial increase in DHEA, you won’t see any outward physical changes in your child. It’s all happening internally.
The more noticeable signs usually appear about two years after adrenarche kicks off, marking the beginning of pubarche. This is what parents often notice first. These signs can include:
- The first wisps of pubic hair.
- Some underarm (axillary) hair developing.
- A new body odor (that apocrine gland activity we talked about).
- Their skin and hair might seem a bit oilier.
- Occasionally, some mild acne.
When does pubic hair usually show up? Well, it varies a bit, and studies show slight differences based on sex, race, and ethnicity. Here in the U.S., the averages look something like this:
- For non-Hispanic Black girls: around 9.5 years.
- For Mexican-American girls: around 10.3 years.
- For non-Hispanic white girls: around 10.5 years.
- For non-Hispanic Black boys: around 11.1 years.
- For non-Hispanic white boys: around 12 years.
- For Mexican-American boys: around 12.3 years.
But please remember, every child has their own unique timeline. If you have any questions or worries about your child’s development, that’s what I’m here for – let’s talk.
What If These Changes Seem Too Soon? Understanding Premature Adrenarche
Sometimes, these signs – pubic hair, underarm hair, body odor – can appear earlier than we’d typically expect. We call this premature adrenarche. This usually means seeing these changes before age 8 in girls or before age 9 in boys. Technically, it’s premature pubarche, because we only know adrenarche started early once we see these physical signs. Interestingly, it seems to happen about nine times more often in girls than in boys. We’re still not entirely sure what causes it.
The main signs of premature adrenarche are:
- Pubic and/or underarm hair appearing in girls younger than 8 or boys younger than 9.
- Body odor that might even lead to needing deodorant.
Children with premature adrenarche might also be a bit taller than their peers, often in the higher percentile ranges for height.
One crucial thing to note: premature adrenarche doesn’t involve early breast development in girls or enlargement of the penis in boys. If those signs are present too, we’re likely looking at something called precocious (early) puberty, which is different.
How We Look Into Premature Adrenarche
If your little one is showing signs of premature adrenarche, it’s natural to feel concerned. As your doctor, I’d want to make sure there isn’t another underlying reason for these early changes. We’d want to rule out a few things, just to be thorough:
- Precocious puberty (the true, full-on early puberty).
- Congenital adrenal hyperplasia (a condition affecting the adrenal glands from birth).
- Exposure to androgens from an outside source (like certain creams or medications).
- Very rarely, androgen-secreting tumors.
To figure this out, we’ll start with a gentle physical exam. This will include looking at your child’s genital area, and of course, I’ll always ask for your permission first. We might also consider:
- Some blood tests to check hormone levels.
- Possibly some imaging tests.
Sometimes, I might suggest a visit to a pediatric endocrinologist, a doctor who’s an expert in children’s hormones. If all these other conditions are ruled out, then it’s very likely premature adrenarche. In fact, about 90% of cases of early pubic hair growth are due to premature adrenarche.
Living with Premature Adrenarche: What Parents Should Know
It can be a bit startling to see these “growing up” signs earlier than you expected. But the good news is, premature adrenarche itself isn’t usually physically dangerous.
Research does suggest it might slightly increase the chances of developing things like obesity, insulin resistance (where the body doesn’t use insulin well), polycystic ovary syndrome (PCOS) in girls, or even some mood disorders down the line. These are things we can keep an eye on together.
However, the emotional side of things can be a big deal for your child. Developing differently from their friends can bring up feelings of being “other,” maybe some embarrassment or shame. It could also, unfortunately, make them a target for teasing or unwanted attention. If you notice your child is struggling with these feelings, talking to a mental health professional, like a child psychologist, can be incredibly helpful.
Currently, there isn’t a treatment that can stop or reverse pubic or armpit hair once it has started. Medications that work for precocious puberty don’t affect the hormones involved in adrenarche.
And can you prevent premature adrenarche? Generally, no. But some studies have pointed to a few factors that might slightly increase the risk, such as:
- A low birth weight (under 5 pounds, 8 ounces).
- Being born preterm (before 37 weeks of pregnancy).
- A history of brain injury (this can also be a risk for precocious puberty).
Key Takeaways on Adrenarche for You
It’s a lot to take in, I know! So, let’s break down the main points about adrenarche:
- Adrenarche is a normal developmental stage where your child’s adrenal glands start producing more DHEA, usually between ages 6 and 8.
- This leads to the development of pubic hair (pubarche), underarm hair, body odor, and oily skin/hair, typically about two years after adrenarche begins.
- Premature adrenarche is when these signs appear before age 8 in girls or age 9 in boys.
- If signs appear early, we’ll want to rule out other conditions, but most often it’s just premature adrenarche.
- While generally not physically harmful, premature adrenarche can have emotional impacts, so supporting your child is key.
- There’s no specific treatment to stop it, and it’s usually not preventable.
You’re not alone in navigating these changes with your child. If anything feels off, or if you just want to chat about what’s happening, please don’t hesitate to reach out. We’re in this together.
