Breast bud stage with elevation of breast and nipple; Enlargement of areola (the dark area surrounding the nipple) Height: 7-8 cm per year; Both boys and girls: Sparse growth of long, slightly pigmented pubic hair, straight or curled, at base of the penis or along the labia; Tanner stage 3. Boys: Enlargement of penis (length at first)
Tanner Stage 1 corresponds to the pre-pubertal form for all three sites of development with progression to Tanner Stage 5, the final adult form. Breast and genital staging, as well as other physical markers of puberty such as height velocity, should be relied on more than pubic hair staging to assess pubertal development because of the independent maturation of the adrenal axis.
Stage Two (approximately between 9 and 14) — Stage two is probably what most boys, parents and physicians are watching for and gets the most attention. Of hair, voice, skin and genital changes, the growth of the gonads is the easiest and most consistent sign that puberty has started and the growth spurt is beginning.
Tanner stage 1 describes a child’s appearance before any physical signs of puberty appear. Toward the end of stage 1, the brain is just starting to send signals to the body to prepare for changes.
Breast Tanner Scale is developmentally based, not size based. It’s not something interpretive, it is a physiological stage of development. Please refer to the chart below: Tanner 1 is where you start before HRT (hormone replacement therapy). Tanner 2 is where you will be at within 1-3 months most likely.
ADRIANE'S EASY TANNER SCALE. T1 - Pre HRT - Nothing to see here. T2 - Within 6 weeks of starting HRT - Breast area becomes tender and the formation of “buds,” under the nipple commences. If you squeeze your breast area with your finger tips the tissue under the nipple feels denser. It’s common for each breast to grow at different rates.
These "Tanner Stages" are used to indicate relative change that occurs in female breast development, and may tend to be a little ambiguous. Consequently, they …
The nipples or papilla start elevating above the level of chest wall at this stage. Though there is no formation of breast tissues in this stage and the breasts remain flat. This stage is mostly seen in 8 to 13 years old but basically it depends on the personal genetic makeup of the individual.
Significant development of the nipple also occurs during puberty. 42 The most marked increase in size and diameter of the nipple is seen between Tanner stages 3 and 5, particularly soon after menarche. 43 The average increase in diameter between Tanner stages 1 to 5 is 5 to 6 mm. 43 It is difficult to form measurable criteria of nipple diameter at each Tanner stage due to extensive variations found in …
Breast and nipple-areolar development is rarely as complete in MtF individuals on hormone supplementation as it is in genetic females and Tanner stage 5 is rarely reached. In the first 3 to 6 months of therapy, tender breast buds begin to form, and maximum development is usually achieved after 18 to 24 months of hormone therapy and is permanent. Male-to-female individuals may choose …
Summary: — Trans women on hormone therapy experience the development of breast tissue that is anatomically and histologically identical to cis women. Final breast size is typically reached within two years, although weight gain can also affect breast size. Other antiandrogens such as GnRH analogues, cyproterone acetate, and 5-alpha reductase inhibitors, are not associated with this outcome. Anatomy Timeframe Progestins. In MtF patients, the following changes are expected to occur: increased breast hemicircumference up to 12 cm , enlarged nipple and areole, decreased libido and erections, decreased testicular size. Meyer et al. However, a clinical comparison of feminization regimens with and without progestins found that the addition of progestins neither enhanced breast growth nor lowered serum levels of free testosterone Meyer et al. Clinicians are encouraged to review the evidence for efficacy, safety, and cost for various progestin agents, particularly for use as a second line agent to enhance breast development , while avoiding progestins in patients at high cardiovascular risk. Anatomy Timeframe Implants Abnormalities. In our centre, suppression of androgenic effects is achieved by the anti-androgen cyproterone acetate, while estrogen is the principal agent used to induce female characteristics. One of the desired effects of estrogen therapy is gradual growth of breast tissue. The latter effect is however highly variable, this is some patients will hardly develop some breast buds even after years of estrogen therapy while others have full breast development after 1—2 years. Sonographic density was equally scored by the radiologist. There is a significant correlation between the density on mammography and on sonography. There is no correlation between the presence of cysts and serum estradiol concentrations. In 5 patients abnormalities other than small cysts were visualized: 1 patient had a fibroadenoma, two had a lipoma, in 1 patient both prostheses were empty while in another rupture of one of the prostheses was suspected. Anatomy Timeframe Implants Antiandrogens. The breasts of transsexual natal males taking estrogen therapy follow the same stages of development as are seen in natal female puberty 2. As such, it takes 2 yr of therapy to achieve maximum growth 2. A baseline hormone screen was taken before any hormonal therapy was taken. There was no difference in hormone levels between the augmentation and control groups on the baseline hormone screen see Table 2. However, when subjects are categorized according to whether they self-medicated see Table 2 , the estradiol level was significantly higher at baseline in those who self-medicated and went on to require breast augmentation as compared with controls The testosterone levels of those in the self-medicating group who also required subsequent breast augmentation were higher , but this did not reach statistical significance These data appear to show that those people who self-medicate with estrogen are more likely to be referred for breast augmentation surgery than those who do not. The duration of estrogen exposure and the duration of estrogen use before attending the GIC and any subsequent mammoplasties resonate with the initial finding that self-medication is associated with greater need for breast augmentation. This is consistent with studies on puberty induction in natal girls in whom rapid estrogen exposure was found to lead to premature breast bud fusion and poor breast development 8. Those transwomen who self-medicate with estrogen may be taking too large a dose at initiation to promote appropriate subsequent breast growth, resulting in a poorer final breast outcome. As breast hemicircumference was not measured in this study; it was not possible to determine whether individuals who underwent breast augmentation had objectively smaller breasts. It should be noted, however, that unlike the situation in natal women, breast hemicircumference measurements are limited in their ability to quantify the appearance of breast development in transwomen. The median breast development in transwomen is reported to be 19 cm, which is near natal female norms 2. The use of spironolactone as an antiandrogen seemed also to be associated with an increased incidence of breast augmentation in transwomen. The other, more specific antiandrogens and GnRH analogs were not. Spironolactone is a mineralocorticoid receptor antagonist that acts as an androgen receptor partial antagonist as well as an estrogen receptor agonist. As such, in addition to blocking the androgen receptor which is its primary purpose in this situation , it also has a significant estrogenic action at the doses used in transwomen. One can postulate that this could lead to an excessive estrogenic action and consequent poorer breast outcome by the same mechanism as that seen when patients self-medicate with estrogens. It is interesting that the other antiandrogens, cyproterone acetate and finasteride, do not appear to be used more frequently in those requiring breast augmentation compared with controls, suggesting that this is not a class effect of antiandrogens. Anatomy Implants. Anatomy Histology Timeframe Antiandrogens Progestins. Notably, 41 trans women received cross-sex hormone treatment with a median of No difference in breast size was observed between trans women who received progestogens compared with the others. The authors observed that the increase in breast size usually begins within 2—3 months after the start of cross-sex hormone treatment and progresses over 2 years. Final breast size was not different in relation to which type of estrogen had been used conjugated estrogens or EE or to the dose of EE. The latter was in contrast with their previous cross-sectional study in 38 trans women whose breast size, measured by the maximal breast tissue circumference, differed according to the dose of estrogen therapy: trans women using EE 0. Orentrich et al. Seal et al. Kanhai et al.
This is because of the growth of the milk duct system and the formation of many more lobules. What should I do Reply. Morphological type I Branching ductal system with no or less than two dichotomous branchings Morphological type II Branching ductal system with more than two dichotomous branchings, but no terminal lobular units Morphological type III Branching ductal system with number of branchings and well developed lobular system Table 1 Summary of functional changes Functional type I All ducts and ductules are lined by secretory type of epithelium Functional type II Mixture of ducts lined by secretory and apocrine type epithelium Functional type III Almost all ducts lined by apocrine type of epithelium Functional type IV Mixture of ducts lined by apocrine type of epithelium and involuting ducts lined by multilayered epithelium. In trans women, shoulder width may also be an important factor of perceived breast size and configuration . The first 2 years of life are a critical period for some aspects of breast maturation as well as involution. Heidelberg, Germany: Springer-Verlag; The developmental process of breasts take 3 to 5 years from first stage to the pubertal years of development, even for some women it might take around 10 years. Tanner 5 is a fully formed mature breast. Adv Child Dev Behav. An increase in vascularity of the gland stroma soon after birth causes a visible difference between the light periductal connective tissue and the denser supporting stroma. Typically the rule of thumb for when to take Progesterone is at or after 1 year to allow full ductal breast development to take place and avoid stunting. Excess hormone production might be coming from anywhere along the complicated line of glands from the brain to the gonads and adrenals or other places via tumors. Branching ductal system with no or less than two dichotomous branchings. Breast development in the newborn. Abnormalities may be caused by idiopathic conditions, nutritional deficiencies,   HPG axis variations, or neoplastic and genetic disorders. Cellular Changes Underlying the extensive tissue remodeling that occurs at puberty is a mammary cell hierarchy composed of multipotent stem and lineage-restricted progenitor cells. That stimulates the ovaries to produce estradiol. Puberty: Tanner Stages — Boys July 28, Clinicians are encouraged to review the evidence for efficacy, safety, and cost for various progestin agents, particularly for use as a second line agent to enhance breast development , while avoiding progestins in patients at high cardiovascular risk. All healthcare workers, including nurses, nurse practitioners, physician assistants, and physicians who evaluate pediatric patients, should know the Tanner stages. Diagnostic considerations in breast disorders of children and adolescents. Final breast size is typically reached within two years, although weight gain can also affect breast size. Underarm and facial hair increase, become thicker and hair may begin to grow around the anus and on the chest, arms and legs. Ann Med. Cesk Patol. Dev Cogn Neurosci. Seal et al. Dewhurst J. Menarche, the onset of menses, arrives on average at age Actual growth in height starts quite slowly in stage two but increases velocity toward the end. Diagnostic evaluation of nipple discharge should begin with ultrasound if the patient is younger than 30 years old. Secondary epithelial buds appear from the indentations on the main mammary bud. C Transverse section of a mammary crest at the site of the developing mammary gland. E Histology section of the peripheral region of parenchyma seen in C. Conclusion The development of the human breast is distinctive due to the extensive remodeling it undergoes into adulthood. The mammary stem cells and progenitors do not express receptors for hormones and hormone receptor-positive cells generally do not proliferate. Mixture of ducts lined by secretory and apocrine type epithelium. The nipples become very sensitive at this time, and may have more sensations. The hormones begin flowing but no outward physical changes are usually noted; although, if one wanted to obtain blood samples, the surge in hormones could be measured. Rohn R D. These growth changes cause the breast wall to elevate a little along with budding of nipples. Oxf Rev Reprod Biol. The other, more specific antiandrogens and GnRH analogs were not. Progesterone is used as a component of feminizing hormone therapy for transgender women in combination with estrogens and antiandrogens. The first hormonal change in puberty is the pulsatile release of GnRH triggered by disinhibition of the hypothalamic-pituitary-gonadal HPG axis. Spironolactone is a mineralocorticoid receptor antagonist that acts as an androgen receptor partial antagonist as well as an estrogen receptor agonist. Virchows Arch. However, beneficial effects on breast development have been suggested, although clinical rather than experience based . At around 8 months I entered Tanner 4 because I had the formation of a secondary elevation of the areola. National Center for Biotechnology Information , U. Parenting about puberty can begin at 5 or 6 in a nonchalant way if the opportunity arises but short and casual discussions about pubertal body changes they can anticipate should begin for sure by seven or eight. Mammary gland development and cancer. Hope this helps Reply. Although breast problems are not really an emergency but delaying it can worsen them.
July 28, Boys and puberty — what a topic. James M. Tanner, a British pediatric endocrinologist trained in the U. A vintage photo of year-old boys taken for the school health program The study had been started during WWII at the Harpenden orphanage in order to study the effects of malnutrition on children. Remember, back then almost nothing specific and concrete was known about diet and nutrition except there was probably good and bad and you really needed to keep some foods cold. Why is there such a big range? Who knows! The fact is that the differences between children seen in school classrooms for grades 1 — 4 seem nothing compared to classrooms full of 5th through 7th graders — which become very strange indeed. The hormones begin flowing but no outward physical changes are usually noted; although, if one wanted to obtain blood samples, the surge in hormones could be measured. Growth rate is usually no greater than it has been through childhood. Erections, which in the first couple of months of life were frequent due to maternal hormones, are still infrequent. Actual growth in height starts quite slowly in stage two but increases velocity toward the end. A small amount of thin, light pubic hair begins at the base of the penis. Testicles and scrotum grow but the penis probably does not. Erections are becoming more frequent. The aureole, the dark skin around the nipple, darkens and increases in size — yes, even in boys. Appetite has increased even more as height growth velocity is reaching its peak — even slightly obese children often look like they are thinning out; and faces are changing, dramatically in some children. Breasts have darkened and may show some protrusion due to normal hormonal growth gynecomastia — yes in boys too. Underarm and facial hair increase, become thicker and hair may begin to grow around the anus and on the chest, arms and legs. The skin gets oilier and the voice continues to deepen. Genitals are adult male and erections are at adult levels and more controlled. Sweat glands have developed and acne has usually subsided. Any breast tissue development male gynecomastia has resolved or is much less prominent under the enlarged pectoral musculature. More on that in the last post of the series. Tanner did his work we have some logic now in the decision to begin the hormone workup necessary to diagnose the problem and not just be pushed by wishes and perceptions. To diagnose both delayed and premature puberty requires measuring several hormones to determine which are lacking or which are in excess. If a tumor is suspected, imaging of the suspect organ needs to be done as well, with x rays, computed tomography scans CT scans or magnetic resonance imaging MRI. Bone age is normally about 18 to 24 months behind the chronological age and, with the use of tables, allows us to estimate how long the growth plates still have before they close off and with that how much growth there still will be. The earliest triggers of puberty usually start by the time the bone age reaches 12 years of age in boys. Symptoms of precocious puberty in boys are those of normal puberty, just earlier: the development of a large penis and testicles, with spontaneous erections and the production of sperm. Hair growing on the face, under arms and in the pubic area, and acne. Excess hormone production might be coming from anywhere along the complicated line of glands from the brain to the gonads and adrenals or other places via tumors. Brain overproduction of hormones might also be the result of brain infections or injury. Because it is easy to determine the size of the testicles on a physical exam, having very small testicles or testicles that cannot be readily felt is a clue to the condition. If the penis is small but the testicles have begun to grow, other signs of puberty should appear in the next months. A monthly injection for several months different doctors use different doses and frequency until early genital changes and growth in height has occurred may be all it takes to then let the body take over on its own. Additionally, there are medications like those for ADHD which can cause loss of growth. The effects are a bit different in that there is usually also enough testosterone secreted to initiate male puberty changes as well. Remember, from your high school genetics course, virilizing requires abnormal male hormones in the female. Every embryo starts out life as female. Male hormones then transform it into male development if they are present. The process of puberty is far more unsettling and complicated than parents… well, probably any of us realize. The actual mechanics of generating and balancing and sequencing all the hormones and other components required to orchestrate puberty is at least as substantial as launching and building the space station. Parenting about puberty can begin at 5 or 6 in a nonchalant way if the opportunity arises but short and casual discussions about pubertal body changes they can anticipate should begin for sure by seven or eight. Do you really want to leave launching the space shuttle to chance? The follow-up discussions can then be short but recurring and informative but casual. Talks about hygiene can begin even before puberty sets in and pave the way for open discussions about bodily functions. This means taking more time to clean their body, especially the genitals. While children may get away with an every other day bath, adolescents should bathe every day; treating acne, using mouthwash and applying deodorant. Teens sweat more and the sweat contains different compounds which now give off odors. They should be instructed to wash their genitals every day. This includes washing the penis, the scrotum which holds the testicles, the anus, and pubic hair with water and mild soap. Uncircumcised boys need to be instructed that the foreskin should be pulled back daily to expose the tip of the penis, which should also then be washed with mild soap and water.