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Why more and more girls are hitting puberty early.

Updated: Nov 14, 2022

A pandemic-era rise in early puberty may help physicians to better understand its causes.

Reprinted from The New Yorker, October 27, 2022

This is a great article on a topic that affects many of our young people. There are still many possible reasons, sleep deprivation, chemicals in our foods, higher BMIs and increased stress. Please read and let me know your thoughts! - Cydelle Berlin, Ph.D.

Megan Gray was eight years old when she got her first period. She was playing hide-and-seek with her older sister and a friend at their friend’s house in suburban Sacramento. She was wearing pink jeans, which she had saved up for a long time to buy. She tied a sweatshirt around her waist to hide the bloodstain, and, later, threw the ruined pink jeans away; when her mother asked where they’d gone, she threw a tantrum to deflect the question. Gray had a close relationship with her mom, but she was so young that they’d had no conversations about puberty; her older sister had not yet gotten her period. “There was nothing, no context for understanding,” Gray told me. “I knew what a period was—I didn’t think I was dying or anything. But still, I didn’t tell anyone for months. I just used wadded-up toilet paper. It felt so awkward and shameful.” She did eventually talk with her mom about it. But this was the nineteen-eighties. “It wasn’t some big informational session. It was very Gen X—you just dealt with things by yourself and got on with it.”

Gray was taller than her peers and wore layers of tops to conceal her developing breasts. She estimates that she was a C-cup by fifth grade. “There were assumptions about me because I had boobs. And I had never even kissed anyone. I was lucky, because nothing traumatic occurred. Yet I do think that there is a trauma in being sexualized.”

Maritza Gualy got her first period when she was eight going on nine, at the end of the eighties. Her mom showed her how to use a thick Kotex pad. Eventually, her older sister introduced her to o.b. tampons—the ones with no applicator; they were small and easier to hide. The sisters, whose parents were Colombian immigrants, attended a majority-white Catholic school in Nashville. Her school uniform had no pockets, so whenever Gualy had her period, she had to hide tampons in her bra or in the waistband of her skirt. One day, an o.b. fell out of her skirt when she and her classmates were sitting on the rug together. Later, when they were back at their desks for a spelling test, Gualy recalled, “the teacher went around from kid to kid with the tampon. ‘Is this yours?’ ‘Is this yours?’ Except she was only asking the more well-developed girls! I knew I wasn’t going to admit to it.”

In fifth grade, Gualy’s best friend got her period, and she was upset to learn that Gualy had started hers more than a year earlier and hadn’t mentioned anything. “But I already felt so othered,” Gualy said, “and I didn’t want to add to that.”

When Gray and Gualy were kids, pediatricians thought that the average age of onset of puberty in girls—defined in most medical literature as thelarche, when breast tissue begins to develop—was about eleven years old. Menarche, or first period, was thought to happen around age thirteen. Only a small percentage of girls had started puberty by the age of eight, much less started menstruating. But, by the two-thousands, new research had found that eighteen per cent of white girls, thirty-one per cent of Hispanic girls, and forty-three per cent of Black girls had entered thelarche by age eight, according to a study published in 2010. Often, these girls were taller than most of their peers and showed other signs of accelerated physical maturation, such as pubic hair and underarm odor. Thelarche typically presages the onset of menstruation by two to three years, meaning that some of these girls would have to deal with the mess and discomfort of a monthly period before they’d finished elementary school. Researchers and physicians hypothesized about possible causes for the increase in early puberty, such as increasing rates of obesity; greater exposure to endocrine-disrupting chemicals found in food, plastics, and personal-care products; and stressful or abusive home environments.

Then, during the coronavirus pandemic, pediatric endocrinologists saw a new surge of referrals for girls with early puberty. Recent retrospective studies from Germany and Turkey show that the number of these referrals doubled or even tripled during the lockdown periods of 2020 (this at a time when many families may have been avoiding non-emergency doctor’s visits for fear of covid-19). A paper published in August in the journal Frontiers in Pediatrics, which analyzed data from South Korea’s national statistics portal, found that the number of children diagnosed with precocious puberty almost doubled between 2016 and 2021, with a sharp post-2020 spike. The rise in early puberty “is a phenomenon that is occurring all over the world,” Frank M. Biro, the former director of the adolescent-medicine division at Cincinnati Children’s Hospital Medical Center, told me. (Although there has also been a rise among boys, girls experiencing early puberty still vastly outnumber them.)

Then, during the coronavirus pandemic, pediatric endocrinologists saw a new surge of referrals for girls with early puberty. Recent retrospective studies from Germany and Turkey show that the number of these referrals doubled or even tripled during the lockdown periods of 2020 (this at a time when many families may have been avoiding non-emergency doctor’s visits for fear of covid-19). A paper published in August in the journal Frontiers in Pediatrics, which analyzed data from South Korea’s national statistics portal, found that the number of children diagnosed with precocious puberty almost doubled between 2016 and 2021, with a sharp post-2020 spike. The rise in early puberty “is a phenomenon that is occurring all over the world,” Frank M. Biro, the former director of the adolescent-medicine division at Cincinnati Children’s Hospital Medical Center, told me. (Although there has also been a rise among boys, girls experiencing early puberty still vastly outnumber them.)

The new data may offer some safety in numbers to early-developing girls—if Gray and Gualy were growing up today, they might have found a friend or two on the same accelerated track. But early puberty is associated with a daunting list of adverse physical and psychological outcomes: various studies have suggested that early-maturing girls are at greater risk for developing obesity, breast cancer, eating disorders, depression, and a range of behavioral issues. Especially in the midst of what is increasingly understood to be a post-covid youth mental-health crisis, the startling new uptick in early puberty is troubling to some physicians and parents. But, because the spike appears to have been triggered within a compressed, well-defined timeframe, it also offers rich terrain for better understanding the condition’s causes and effects. It also provides a chance to rethink puberty: to see it not as a gateway into adulthood but as another stage of childhood—one that is highly variable from kid to kid and need not be cause for alarm.

“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,” Louise Greenspan, a pediatric endocrinologist at Kaiser Permanente, San Francisco, said. “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.”

For generations, pediatricians have referred to a table of pubertal development known as Tanner stages, named for the pediatric endocrinologist James Tanner, one of the lead investigators of the landmark Harpenden Growth Study, conducted from 1949 to 1971 at a charity home for orphaned and neglected children in a suburb of London. There, hundreds of boys and girls were photographed naked at three-month intervals. Although the data for the Tanner scale were gathered from kids of a narrow demographic—white, thin, and bearing the internal scars of trauma or adversity in their formative years—it established, in a pair of papers published in 1969, our modern benchmarks of puberty: five distinct stages, ranging from prepubertal to fully developed. On average, the girls in the study began showing breast buds—the “Tanner II” stage—at age eleven or so, and began menstruating between thirteen and fourteen.

Early puberty is identified through physical examination, blood tests to measure levels of sex hormones, and a bone X-ray to estimate “bone age”—how close a child’s skeletal system is to reaching maturation. Puberty typically begins in girls when the pituitary gland starts secreting hormones known as gonadotropins; these hormones cause the ovaries to grow and to produce estrogen, the sex hormone that triggers the development of secondary sex characteristics. These changes usually happen alongside a distinct process called adrenarche, or the awakening of the adrenal gland, which provokes the development of pubic and underarm hair and underarm odor. In formulating his scale, Tanner was careful to present puberty as a spectrum, not a strict schedule; he emphasized that a healthy girl might start her period at age ten or age sixteen, and that every child’s progress through puberty had its own rhythms and tempo. Some of the numbers in the Harpenden Growth Study have held up remarkably well: the average age for a first period, for example, has only dropped to about twelve and a half.

But other norms set down by the Tanner stages began to come into question as early as the late nineteen-eighties, when a physician’s associate named Marcia Herman-Giddens, who worked in a pediatric clinic at the Duke University Medical Center, observed girls as young as six or seven presenting with breast buds or pubic hair. Herman-Giddens went on to lead a study of pubertal development in some seventeen thousand girls in the U.S., published in the journal Pediatrics in 1997. It found that the average age for Black girls to develop breast buds was just short of nine years old; for white girls, it was closer to ten on the dot. A moderately more rigorous longitudinal study, conducted in three U.S. cities and also published in Pediatrics, in 2010, showed those averages dropping even further, if only by a few more months.

When researchers investigated possible reasons that more girls were entering puberty sooner, they focused on three main factors. One was stress—they hypothesized that higher cortisol levels might contribute to the premature activation of the pituitary and adrenal glands. (Some of Herman-Giddens’s work was with early-maturing girls who were believed to have been physically and sexually abused, which prompted a causality question that has never been definitively resolved: whether abuse triggers premature puberty, or whether girls who enter puberty earlier are at greater risk for abuse.) A second factor was exposure to endocrine-disrupting chemicals, which can scramble or mimic the body’s naturally occurring hormones. E.D.C.s include parabens (preservatives that are used in cosmetics, food, and pharmaceuticals), phthalates (which are added to plastics to enhance their durability and flexibility), and the dreaded bisphenol A, or BPA, a chemical compound that the Food and Drug Administration banned for use in baby bottles and sippy cups in 2012.

But determining the role of E.D.C.s in a given health condition is a conundrum for any scientist attempting to design a controlled study, because “we live in an ocean of chemicals,” Biro, of Cincinnati Children’s Hospital Medical Center, told me. “How you can measure exposure in an individual is a major issue. Some of these substances are in and out of the body in seventy-two hours, some take three or four years. Different people metabolize them at different rates.”

Speculation about the main causes of early puberty eventually coalesced around a third factor, one that was easier to isolate: body-mass index. Average B.M.I. and obesity rates in girls had risen somewhat in tandem with rates of early puberty. Some research suggested as well that both elevated cortisol levels and high exposure to E.D.C.s are associated with higher B.M.I. Meanwhile, structural racism and failures of environmental justice have ensured that Black and brown girls are more vulnerable to all three of these factors than are white or Asian girls, who tend to enter puberty later.

The correlation between B.M.I. and early puberty has to do with a hormone called leptin, which is one of the necessary components for the pituitary gland to begin producing gonadotropins. 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. (This relationship also helps to explain why some very thin girls and women don’t menstruate: they don’t have enough fat tissue to make leptin.)

“Leptin is not so much the trigger for puberty as it’s permissive,” Paul Kaplowitz, a professor emeritus of pediatrics in the division of endocrinology at Children’s National Hospital in Washington, D.C., told me. “An adequate level of fat tissue is a requirement for puberty to progress. But we don’t know for sure if fat is the only reason why girls in the twenty-first century are maturing earlier than girls in the latter part of the twentieth century. Obesity is a big part of the story. It’s not the whole story.”

Given everything we understand about the mechanisms of puberty, it feels intuitive and logical that some percentage of lockdown kids, who might have otherwise followed a more Tanner-like progression in their physical development, may have tipped into early puberty thanks to a conspiracy of increased calorie intake, more fatty and processed foods, and decreased exercise, as well as the manifold sources of stress and anxiety that the pandemic generated during a pivotal stage of their development. Like early puberty itself, mental-health problems among children and teen-agers were on the rise before the pandemic, and skyrocketed during and after it. Between 2009 and 2019, according to data from the U.S. Surgeon General’s office, rates of depression and suicidal ideation among high-school students all rose significantly. Approximately one in three kids in this age group reported “persistent feelings of sadness or hopelessness”; in a C.D.C. study of high-school students conducted in 2021, this number had risen to forty-four per cent. Mental-health-related emergency-room visits for children ages five to eleven increased by twenty-four per cent from March to October, 2020, as compared with the same period in 2019; for kids ages twelve to seventeen, the figure was thirty-one per cent. Child psychologists are overwhelmed with new-patient requests, and many have stopped taking insurance. The National Association of School Psychologists has stated that there is roughly one school psychologist for every twelve hundred students in the U.S.

A crucial, perhaps overlooked link between early puberty and the youth mental-health crisis is sleep. Marlon Goering, a doctoral student in psychology at the University of Alabama at Birmingham, studies the relationship between pubertal timing and behavioral challenges in young people. He told me that melatonin, the sleep-regulating hormone that the brain produces in response to darkness, may have contributed to the pandemic-era jump in early puberty. 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. The melatonin-disrupting effects of blue light may have persisted long past the acute phase of the pandemic: many schools and students have continued using the iPads and Chromebooks that they acquired to facilitate remote learning, and many households never reset the screen-time rules that they had in place before lockdown obliterated them.

Some pediatric endocrinologists suspect that the recent spike in early puberty may be subtly different from the decades-long rise that preceded it. Greenspan, of Kaiser Permanente, San Francisco, and other colleagues have noticed that, among their consultations for early puberty, they are not seeing as many girls with higher B.M.I. as they did pre-pandemic. She also said that pubertal tempo—the total time it takes to progress from thelarche to menarche—is speeding up among her patients, regardless of B.M.I. If large-scale data eventually bear out Greenspan’s observations, it would likely mean that the average age of first period, which has remained relatively stable over the last eighty years, may begin to drop more noticeably, even if only for a micro-generation of kids.

Much of the time, early puberty does not require medical intervention (although, in rare cases, it may be caused by a brain tumor or by a disorder of the patient’s ability to produce cortisol). “I can’t tell you how many kids come into my practice who have their periods early, and when the parents don’t make a deal out of it, the kids tend to be fine—‘Yeah, it’s kind of annoying, but Mommy showed me how to change the pad.’ And you’re talking to a third grader,” Greenspan said.

“We’re cognizant of trying not to medicalize things that are a normal part of life,” Deanna Adkins, a pediatric endocrinologist and the director of the Duke Child and Adolescent Gender Care Clinic, said. “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.’ ”

Recently, a parent whom I will call R.—she asked that I not use her name, to protect her daughter’s privacy—phoned her pediatrician’s office because her seven-year-old had developed a breast bud. R., who is a college professor and lives in Brooklyn, spoke first with a nurse. “She said, ‘You’re the third or fourth mom this week who’s called about this. Puberty is starting earlier and earlier. It’s very normal, Mom.’ When we saw the pediatrician, it was the same thing: ‘Oh, Mom, it’s normal.’ ”

R. found the pediatrician’s response dismissive without being reassuring. “There was no wider analysis about the consequences related to her socialization at school, her relationships with boys and men—all these things that it opened up,” R. said. She was especially uneasy because her daughter has experienced unusual stressors in the last couple of years, including a concussion and her parents’ divorce. Adding the possibility of early puberty, R. said, “just feels like insult to injury—like, can we give this kid a childhood?”

I spoke with R. again after she and her daughter had a more satisfying appointment with a pediatric endocrinologist. “There was a straight-up acknowledgement, from the beginning, that this is a big deal. It was O.K. to think of this as something to be attentive to.” Now, mother and daughter await the results of blood tests and a bone X-ray; it’s safe to say that, of the two, R. is the more anxious. When they first broached the topic of early puberty, her daughter was excited. “Yes! Now I can get a bra!” she exclaimed. Puberty in a younger girl could be a simpler rite of passage, at times even a thrilling one, R. said, “if there wasn’t society out there to worry about.”

Even in the absence of an acute medical crisis, some families do decide to halt the process of puberty temporarily, with medication that blocks the release of sex hormones—most commonly, a drug called Lupron. Lupron is sometimes prescribed off-label to children with gender dysphoria, and, due to efforts in many states to limit or ban gender-affirming pediatric care, the drug has become controversial. A puberty blocker such as Lupron may inhibit bone mineralization, when calcium and phosphate act on collagen to increase bone mass; this process accelerates during adolescence. Anecdotal reports have proliferated for years about women who took Lupron for precocious puberty in childhood and went on to suffer osteoporosis, joint disorders, and chronic pain in adulthood, but most research on puberty blockers and bone health is reassuring. In any case, it is difficult to adjudicate concerns about any long-term effects when those concerns are weaponized by, say, the Arkansas state legislature, which is attempting to prohibit gender-affirming pediatric care in the state with a bill known as the Save Adolescents from Experimentation (safe) Act, or the state attorney general’s office in Texas, which has proposed that administering puberty blockers to children with gender dysphoria may constitute “child abuse.” (Studies have repeatedly shown that mental-health outcomes for L.G.B.T.Q. youth were disproportionately impacted by the pandemic, and advocates for trans young people have warned that the ongoing proliferation of anti-trans legislation will compound those effects.)

Adkins told me that she has not seen long-term issues such as low bone density or higher rates of fractures in patients who took Lupron. “When kids are in early puberty, they’re already starting to add calcium to their bones,” she said. “Pausing that for a period of time slows down their growth spurt and slows down their calcium spurt. But once you stop the medication, all of that restarts.” Children with precocious puberty typically stay on blockers until they reach a bone age of around eleven or twelve. “They’ll be accruing calcium in their bones from the restart of puberty all the way to the age of thirty or so,” Adkins said. “There’s plenty of time to catch up.”

There are two main criteria to consider when deciding to start a child on Lupron, Adkins told me. One is if the child’s projected adult height falls below the fifth-percentile range, due to rapid bone maturation; stalling puberty buys the kid more time to add some inches. The other is more subjective, and has to do with physical or developmental challenges that the child might face in addition to precocious puberty.

V., who is an occupational therapist in Orlando, has a daughter who is on the autism spectrum. She noticed that her daughter’s body began rapidly transforming in the late spring of 2020, when she was six and a half: breast buds, a huge growth spurt. By age eight, she had pubic hair and wore clothes in an adult-size extra-small. She frequently felt “off” in ways that she couldn’t precisely articulate—fatigued and headache-y. Her social status was changing, too. “She told me that boys were giving her more attention at school,” V. said. “She was like, ‘You’ve never noticed me before. Now, all of a sudden, I’m interesting? What?’ ”

V. brought her daughter to a developmental pediatrician and a pediatric endocrinologist; the latter was a four-month wait. An X-ray showed that her “bone age” outpaced her chronological age by about two years. Her doctor guessed that she might begin her period within a few months, which seemed too soon for her. In the spring, her daughter began taking Vitamin D supplements, which aid in calcium absorption. She received her first dose of Lupron in August, two months before her ninth birthday. “I felt as if she needed more time to work on her social-emotional skills before she had to deal with a period every month,” V. said. “I want her to feel like, ‘O.K., I’m ready for this.’ But honestly, I need some time to adjust, too.”

In Judy Blume’s 1970 young-adult novel “Are You There God? It’s Me, Margaret,” which has served as a puberty handbook of sorts for generations of girls, a character named Laura Danker looms awkwardly on the periphery. Laura is studious, very shy, and very tall. When the eleven-year-old narrator of the book, Margaret Simon, sees Laura on the first day of school, she mistakes her for a teacher, not a fellow sixth grader. “You could see the outline of her bra through her blouse and you could also tell from the front that it wasn’t the smallest size,” Margaret observes. “She sat down alone and didn’t talk to anyone.” Margaret has just moved to town and easily makes new friends, who giggle and gossip about “the big blonde with the big you know whats.” “She’s got a bad reputation,” one girl says. “She’s been wearing a bra since fourth grade and I bet she gets her period,” another alleges.

Laura’s body commands a chaotic attention from her peers: by turns affronted and leering, repelled and keenly envious. Her body provokes their imagination, then serves to corroborate whatever they might imagine. Laura belongs nowhere: a head taller than all the boys, arms crossed over her chest, feeling the shame and confusion of the eleven-year-old she is but does not look like.

In Blume, the fast-developing girl is sympathetic but mostly a cipher, a narrative device; in Elena Ferrante’s “My Brilliant Friend,” she gets to tell the story. In the book—the first of Ferrante’s Neapolitan Novels—young Lenù, the narrator, gets her period without knowing what it is; she is comforted by an older friend, who’s had hers for a year already. Lenù’s best friend, Lila, shows no signs of development; for this, Lenù seems to pity her. “Suddenly, she seemed small, smaller than I had ever seen her…she didn’t know what the blood was. And no boy had ever made a declaration to her.” For an instant, it doesn’t entirely make sense that they are peers, much less friends.

Lenù is wrung out by a classical pubertal funk: moodiness, anxiety, impulsivity (she flashes her breasts at some classmates for ten lire). Like Laura in “Are You There God?,” Lenù feels herself to be at once conspicuous and isolated. “I felt at the mercy of obscure forces acting inside my body,” she says. She is “besieged by boys.” She searches for respite. “I sneaked away, I compressed my bosom by holding my arms crossed over it, I felt mysteriously guilty and alone with my guilt.”

The stigma of early development in girls is particularly painful because, in some cases, it may perpetuate a vicious cycle. An article published in the Journal of Pediatric and Adolescent Gynecology, in May, found that early puberty put girls at higher risk for obesity, type-2 diabetes, breast cancer, and heart disease along with “depression, anxiety, eating disorders, and antisocial behaviors,” “earlier onset of sexual activity, higher number of sexual partners, and higher likelihood of substance use, delinquency, and low academic achievement.” The journal Hormones and Behavior, in 2013, argued that “early maturing girls are at unique risk for psychopathology.” A Pediatrics article titled “Early Puberty, Negative Peer Influence, and Problem Behaviors in Adolescent Girls,” from 2013, stated, “Early timing of puberty and affiliation with deviant friends are associated with higher levels of delinquent and aggressive behavior. Early-maturing adolescents tend to affiliate with more-deviant peers and appear more susceptible to negative peer influences.” (Free book-title idea for Elena Ferrante: “My Deviant Friend.”)

Kaplowitz, of Children’s National Hospital, and Greenspan both advised caution about the most doom-saying studies of girls who experience early puberty. Some of the results are derived from brief questionnaires. Others are based on self-reported data, which can render wobblier conclusions (for example, most women can pinpoint when their period began, more or less, but not as many know precisely when their breasts began to bud). “Many of these studies are not well controlled, and many of them don’t have a large number of subjects,” Kaplowitz said. “I don’t think these are settled issues.”

Because more Black girls enter puberty at a younger age, and because Black girls tend to come under more punitive surveillance no matter what Tanner stage they happen to occupy, the onus of early puberty can be especially harmful to them. A 2017 report from the Georgetown Law School’s Center on Poverty and Inequality studied the impact of “adultification,” a phenomenon in which children are socialized to act older than they are, and in which Black kids, specifically, are perceived as “less innocent and more adult-like than their white peers”—less in need, or less deserving, of the kinds of protections that childhood confers. Adultification has effects across the education and juvenile-justice systems: Black girls are more likely to be disciplined than white girls of the same age for the same infractions, and they have higher rates of school suspensions, referrals to law enforcement, and arrests.

The emotional and behavioral haywire of adolescence is driven by a pair of interlocking mechanisms: the hormonal and the social. The hormones that are released in puberty can lead to increased risk-taking and sensation-seeking; a nine-year-old who is newly doused in these hormones may not have the same self-regulating ability to manage them that a thirteen-year-old does. And just how much self-regulation an early-developing girl must exhibit depends on her surroundings: not just the scrutiny she receives from adults, which in turn is mediated by race and class, but by the tendencies of the children and young adults with whom she interacts. An older-looking girl might be more likely to hang out with actually older girls, and do the things they do.

Among the adverse outcomes linked to early puberty that are most strongly supported by data, causation is not always clear. “We know that people who have menarche earlier do tend to have a higher rate of depression,” Greenspan said. “But we don’t know if that’s a biological thing or a social thing. Is it the biological effects of estrogen on the developing brain? Or is it the stress of looking older than your peers, and having to deal with that?” Even the ways in which a girl looks older than her peers is heavily dependent on her social context. “Are you in a school with uniforms, where everybody looks kind of shapeless? Or are you in an environment where clothes are tighter, and everyone is looking at you? You might feel uncomfortable or even miserable in your body—and that could lead to depression, that could lead to body dysmorphia,” Greenspan said.

Several pediatric endocrinologists told me that parents are often highly agitated by the likelihood that their children are becoming sexual beings and that others are going to sexualize them. But, Greenspan said, “puberty 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.” In Greenspan’s view, families can choose to see puberty not as a Rubicon but as one among many points on a decades-long continuum of transformation. “Kids’ bodies are constantly changing. They need new shoes because their feet are bigger; they can’t fit into their clothes because they’re getting taller; they’re banging into furniture because they no longer know where their body is in space.” In these prepubertal developmental stages—when kids are sprouting and molting and falling over and spilling their teeth on the floor—the adults, while attuned to these metamorphoses, are not especially fazed by them. The ordeal of puberty, Greenspan said, should be similarly understood: as a station of childhood, not its terminus.

More than once in my conversations with Greenspan, she said that adults “have to let kids be the age they are.” But early puberty presents something of a physics problem—how do we measure the passage of time? The bone X-ray may best illustrate the dilemma: a medical assessment that assigns the child to a skeleton that is older than the child herself. A tall, developed ten-year-old who has reached menarche may not be chronologically older than a petite, flat-chested ten-year-old who has not—but she is, in a real sense, physically and even experientially older. Adults and other children will almost inevitably relate to the girl differently—and not necessarily even in a sexualized way, although that is of grave concern; but intellectually, socially, emotionally. They may have advanced expectations of her, and she may strive to meet those expectations or fail to, and, either way, that cycle of stimulus and response is determining her place in her social milieu, conjuring a mirror in which she sees herself, and wiring her brain in configurations that subtly differ from those of her average-developing peers. Nature begets nurture. For this girl, the hands of the clock simply go faster.

Megan Gray is now forty-six, works as a writer in Los Angeles, and has two kids, ages ten and eight. She looks back on the shock of early puberty with an affecting sort of analytical melancholy. “When your hormones change when you’re that young, your body is flooded with such an intensity of emotions that you’re not nearly mature enough to deal with it,” she told me. “I mean, nobody is, ever, and that’s why junior high is the worst.” But she was only eight years old. “Everything is felt so powerfully, but your brain has not caught up with that,” she went on. “For me, that manifested in depression.” Developing early, Gray said, clouded her ability to see the romantic and sexual possibilities that her adult life promised. “When you’re shamed at a young age for a sexuality that you don’t even have, I think it inhibits you from developing a sexuality. I began to associate people seeing me in a sexual way, or even as attractive, as a negative. At the same time, when you’re entering that age, you do want people to like you. And you want to like other people. There was that constant tension of, you know, liking is good, but attraction is bad, even if, on a rational level, I understood that wasn’t true. That contradiction started very young.”

Gray and Maritza Gualy, who is now forty-one and a product designer in Los Angeles, both said that developing early had a positive influence on how they approach the subject of puberty with their own kids. “My husband and I want to talk to them preemptively, openly, and answer their questions honestly,” Gualy said. Her children, who are nine and eight, have already had “the puberty talk,” she went on, “and they have no shame about it—yet. They have fun detecting their body changes and announcing them.” Recently, a speaker visited her daughter’s Girl Scout troop to discuss puberty; now her daughter is putting together an emergency period kit to keep in her backpack, “just in case she or one of her friends needs it while at school,” Gualy said.

Gray told me, “Our generation of parents is hopefully doing things differently. My son may never forgive me for making him do a two-hour Zoom for the Sex-Positive Families puberty workshop. But I’d rather my kids grew up to tell the story about how their mom gave them too much information than not enough.”

She also recognizes that indulging too much in parental anxieties can have a conjuring power; that awareness of the past, and of the possibilities it may show you, doesn’t have to force upon you any foreboding premonitions. “I want to avoid the mistakes that the grownups in my life made,” Gray said. “At the same time, I don’t want to put any of that baggage on my kids. I don’t want to make any assumptions about their experiences just because I had some trauma surrounding puberty. I’m trying to remain neutral, and to listen when they tell me how they feel about it.” ♦

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