Why Are Girls Hitting Puberty Younger? with Jessica Winter

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Over the last couple of years, pediatric endocrinologists have observed an unusual surge in the number

of referrals of girls with early puberty.

In fact, a recent study found that the number of girls with precocious puberty almost doubled

between 2016 and 2021.

In this trend, it's been observed all over the world, with similar studies and findings

in Turkey, Germany, and South Korea.

What's going on?

Why are girls hitting puberty younger and younger?

Well, that's the topic of our episode today.

We'll get into all the causes that have led to this acceleration.

Hint, we'll be talking about the pandemic again, and all of the ways we can make this

experience easier.

But before we get to all that, let's take a step back.

I remember watching that quote, miracle of life video in my 7th grade health class with

about 50 other mortified tweens as we watched grainy footage of a child being born.

Our science teacher, the stand-in health teacher, was one of the coolest teachers in school.

Dude looked just like Matthew Broderick, which gave him an easy air with students of the

1990s.

Usually collected and self-confident, he just kinda looked at the ground while the video

was playing.

I mean, I don't blame the man.

Talking about one of the most awkward topics with a collection of awkward preteens going

through that awkward phase all at the same time?

That can't be easy.

But it's so profoundly important.

Nearly all of us experience puberty and the concomitant changes that come with it in some

form or another.

But the experience remains so profoundly shrouded by stigma that we really need more straightforward,

empowering conversations about it.

I'll be honest though, I gotta check my blind spots on this one.

I'm a cis straight dude who was pretty athletic through my childhood.

That means I had, we'll call it, puberty privilege.

That's not to say that it wasn't awkward as all getup.

But for the most part, it meant that over the course of one summer I could run faster,

jump higher, lift more, and my voice turned into this smooth baritone you tune into every

week.

There was, of course, the awkward management of a whole slew of more vivid emotions.

But even if it was awkward, I can't say it was terrible.

There were the, you're a man now, speeches from men trying to awkwardly teach me masculine

scripts.

And sometimes that meant being expected to hide my emotions behind a certain stoicism.

But that didn't really change with puberty.

It'd been there all along.

So I had puberty privilege.

My version of it didn't involve newfound monthly bleeding from my genitals.

I can't imagine what my response to that would have been at that age.

It also didn't come with being forced to grow up too soon, as people with more physical

power than me objectified my body, as so often happens to post-pubescent girls who are catcalled

or worse by grown men.

And puberty never forced me to contend with my gender identity or sexual orientation as

it does for LGBTQ youth.

I gotta tell you why I'm so concerned about this, though.

It's precisely because of those blind spots.

As a parent, it's always those aspects of your kid's experiences that you understand

least that keep you up most at night.

You can either pretend like you understand or actually seek to understand.

And puberty is one of those things I'm trying to get a jump on.

Because as you probably know by now, I have two daughters.

My girls are still a long way away from this, I hope.

But as with all things parenting, parenting has a way of absolutely obliterating time.

It feels like just yesterday that my eldest, now five, was born.

And well, given the data, I might not have as much time as I thought I might.

New studies are finding that some girls are hitting puberty earlier and earlier.

During the past few decades, little girls have been going through puberty at a younger age.

Studies show every decade it starts around three months earlier.

But during the pandemic, the age change was dramatic.

Puberty is happening a lot earlier now than it ever has.

The pandemic accelerated this trend, and early puberty just makes all the hard parts even harder.

It gives parents, teachers, and other caring adults less time to have the necessary conversations.

And it forces those conversations with a child that's less emotionally or cognitively mature.

It also exposes a child to the worst of how society treats young women far earlier.

All of this should move us to be a lot more proactive about the way we engage the subject of puberty.

Along with destigmatizing things like periods and protecting women and girls from the objectification

that is far too normal in many places,

we also have to prepare these kids for the changes in their bodies that they'll experience.

I first learned about this trend toward earlier puberty in girls from an article in The New Yorker

written by our guest today, Jessica Winter.

I wanted to invite her on the podcast to share what she learned in her reporting

and think with me about everything that ought to change,

from sex ed to the conversations we have about puberty in our own homes.

Here's my conversation with Jessica Winter.

All right, can you introduce yourself for the tape?

Sure, my name is Jessica Winter and I work at The New Yorker

where I write about family and early education.

So I want to ask, you know, what got you interested in writing about early puberty in girls?

So I had heard kind of anecdotally that this was in the air,

that this was more and more of a concern among moms that I knew about their girls.

And I had also seen this kind of raft of really sensational seeming headlines

that they read to the effect of screen time causes puberty,

or, you know, excessive screen time triggers early puberty.

And I thought, well, that can't be true, that sounds strange.

So I just started drilling into that a little bit and looking at

what these studies were actually saying and how credible it was.

And I realized that there is a lot of research out there

and that early puberty spiking during the pandemic was a real thing.

And there's a growing body of research showing that it's happening

and hypothesizing about why it's happening.

You know, it's interesting, right, because puberty is something that,

by definition, every adult goes through some form of.

And it's also one of those life-defining events

that happens in a relatively awkward part of your life,

in part because of the circularity of puberty being awkward

and people being awkward about puberty.

And so, you know, in particular, it ends up being

one of these deeply stigmatized experiences

that people go through in a particularly vulnerable time of their life.

And yet we don't really do much work to de-stigmatize it.

And obviously, I've only ever experienced one type of puberty,

and that's, you know, cis-male puberty.

And the experience I can imagine

is very, very different for boys than for girls.

For boys, the experience of puberty is, you know,

aside from smelling kind of funny and your skin getting weird,

it's kind of great.

You go from not being able to run very fast to being able to run a lot faster.

You go from not being able to do many push-ups or pull-ups

And, you know, you start experiencing a set of sort of realizations

in the world that are themselves, if awkward,

you know, they open your eyes to a lot of things.

And I can imagine the reason that all of this is generally a good experience

is because you don't start bleeding from your genitalia.

And I can imagine male puberty would be a lot more traumatic

if that was the case.

And yet for half of this world,

we still don't do a good job explaining, preparing,

engaging people with that.

And so we leave, you know, young people in a very vulnerable situation

in their lives, shamed and stigmatized

for doing the completely normal thing of going through puberty.

Why do you think we allow this to persist?

This awkwardness of this experience?

And why haven't we de-stigmatized it,

taken away the shame from it, empowered a conversation through it?

I know there are a lot of great organizations that do it.

It's just, you know, we're still not there yet.

Why do you think that is?

Well, first of all, I had never thought about this in these terms

until I heard you articulating it, that when boys go through puberty,

they are becoming what they're supposed to be.

They're becoming a man, stronger, faster, better every day, right?

And I think for a lot of girls, not every girl,

but I think for a lot of girls, when they go through puberty,

they're being taken away or what they were supposed to be

or the best version of themselves, I guess, is ending.

And it's something to be mourned.

It's a lost innocence, right?

We never frame it that way with boys.

With boys, it's a triumph.

And with girls, it's, if approached in the wrong way, it's a loss.

It's innocence lost.

And I just never framed it as an either or

until I heard you describing it that way.

I think that a lot of this is socially prescribed, obviously.

When we're looking at early puberty,

maybe 75% or more of girls whose parents bring them to clinics

and say, I think something's up with puberty starting too early,

about 75% of those kids are girls and about 25% are boys.

And I didn't report on boys in my piece for The New Yorker,

so I can't really talk with much authority on it.

But I can say that experts wonder if early puberty in boys is underdiagnosed.

And that's because it's not externally visible and it's not seen as a problem.

So early puberty in girls is defined as the development of breast tissue.

That's the first stage of it.

The counterpart, the analogous stage in boys,

is that their testes and their penis start to grow.

And a lot of boys don't really notice that this is happening.

They don't know when it's supposed to be happening.

Their parents don't notice.

And obviously, no one can see it happening.

For girls, the counterpart is they're developing breasts.

And that is obvious to other people.

And so it becomes a quote-unquote problem when it can be seen.

And I think that's really interesting, that this is a problem for one

rather than the other because it's externally legible.

I think a lot of the stigma of early development in girls,

in particular, is unfortunately at least ostensibly backed up by research.

There are absolutely endless studies of widely varying quality and depth

that correlate early puberty with every adverse consequence under the sun.

Like an edited list would be obesity, type 2 diabetes, breast cancer,

heart disease, depression, anxiety, body dysmorphia, eating disorders,

antisocial behavior, bad grades, substance abuse, on and on and on.

So in addition to what we were talking about earlier about the sense of innocence lost,

there is all of this research, supposedly, out there

tying early puberty to all of these bad outcomes.

A lot of these studies are small or they're based on questionnaires.

Some of these outcomes, like the percentage of risk is very, very small when you look at it.

And so a lot of it in broad strokes feels really alarmist to me.

The ways that we try to clinically back up this stigma feels a little bit alarmist.

And so I think that the most useful takeaway from this particular body of literature

about all the bad outcomes of early puberty

is that a lot of these consequences are contextual.

They have to do with the adults and the peers in this girl's life.

There is nothing innate in the mechanism of early puberty

that makes a kid, you know, break bad or something.

Like a good example is depression.

There is a strong causal relationship established in research

that girls who go through puberty earlier are at a higher risk for clinical depression.

And so I think a parent is completely within their rights to

worry that their early developing girl is going to be depressed.

But we don't know why that is, right?

Is it because of the effects of estrogen on the developing brain?

Or is it because early puberty is really stressful and kind of sorrowful in some cases?

And that that sadness and stress triggered something in a young girl?

You know, we just don't know.

But I think it's one more reason that we have to work as parents, as educators,

as a society to de-stigmatize early puberty in girls and puberty in general.

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You know, it's interesting when I heard you feed back to me

your perspective on what I had shared.

You know, as we think about puberty, it really is the most potent moment

when we gender someone, right?

Because it is the onset of an adult form of gender, right?

And a more sexualized form of gender.

And, you know, the degree to which the connotation of gender stereotypes

and this notion that you talked about of like arrival versus departure,

the degree to which that shapes the way you think about the future,

I think, is quite profound.

You know, and the other part of it is, you know,

we can't disentangle this from the notion that for a lot of people,

their experience of puberty is not the normative one

that we ascribe to two genders, right?

And you can imagine how much more complex it is

for a child who identifies as non-binary or trans

that this moment of this change in biology

takes on, you know, even a different meaning

than the ones that have been socially ascribed

firmly within the median of two genders.

And then there's the interaction, right, across the two.

And, you know, I think about this, I have two daughters,

and my daughters are very young, five and six weeks.

But it's one of those things, like, as I think about preparing myself as a parent,

you know, there are the things that you think you understand

about your child's experience.

And then there are the things you know you don't understand,

recognizing that you probably don't understand much of it

simply because, you know, 30 years is a long time

between two shared experiences and the world changes.

So, you know, even if your child was a carbon copy of you,

growing up 30 years later,

their experiences are gonna be different than yours.

But this one around, you know, thinking about gender stereotypes

and the ways that those change across a life course

is one that I've really tried to be very cognizant of,

you know, just already in the compliments or the criticisms

that my older daughter will get.

And you start to think, well, you know, when people say,

oh, she's beautiful, I shudder a little bit, right?

Because what are we setting her up to think about herself

and the value that she adds?

And then how does that change when, you know, the nature of what is,

quote, beautiful goes from what you expect in a five-year-old girl

to what you expect in a 15 or a 25-year-old woman.

And, you know, I think in this case,

trying to be empathic about it,

I can imagine somebody who's going through puberty at nine or 10

for whom the conversation about what they are and who they are,

you know, the connotation implied in she's beautiful changes.

I can imagine that to be extremely jarring

and extremely challenging.

And I think as a boy, right, there's never, you know,

the kind of compliments that you associate traditionally with a boy,

oh, you're so strong, you're so brave, right?

Those don't take on a different connotation pre- and post-puberty, right?

And in some respects, you're only more so, right?

And there's not an objectified sort of version of that

in the same way as you could imagine for a girl.

And then not to mention all of the complexity

that must be experienced by people who don't identify firmly

in either male or female.

And so I want to sort of jump to just the statistics here.

What is the average age of telarchy today?

And how has that changed?

So our understanding for a long time

was that the development of breast tissue

happened typically around age 11

and that menstruation began maybe around 13 or so.

And the understanding of that schedule came from a long-term study

that was conducted from the 1940s

until the beginning of the 1970s in England.

It was the famous Tanner study.

That was what established our understanding of the schedule.

And it really, it still drives our understanding of the schedule today.

That understanding, at least in the U.S.,

began to change in the late 90s, early 2000s

when pediatricians started seeing younger and younger girls coming in,

having either entered theolarchy,

the development of breast tissue, or menarche, menstruation.

By the late 1990s,

close to one in five white girls, for example,

were entering puberty early,

meaning before the age of eight,

they were developing breast tissue.

And something like 40 or 45% of black girls were, for example.

And there were a lot of hypotheses about why this was the case

and we can get into that.

Nowadays, I believe the average for white and Asian girls is around 10.

And for black girls, it's around nine.

And for Hispanic girls, it's in between, I think.

There's a fair amount of variance and noise in various studies,

but that's about where we are now.

I want to get to the pandemic experience in a second.

But what were the hypotheses about why there had been

a slow, steady movement upward in the life course?

So there were a lot of hypotheses about this

and they eventually coalesced around three factors.

They were BMI, body mass index,

EDCs, endocrine disrupting chemicals,

and stress.

So we can take those one by one, I guess, in reverse order.

So stress results in higher cortisol levels.

And cortisol may prematurely activate the pituitary gland

and the adrenal gland and get everything going for puberty.

Just to make sure I understand.

So the idea here is that when you have external stressors,

your body's response is cortisol secretion,

which mediates the long-term stress response.

And that having cortisol on board activates

the hormone centers in the body that then activate puberty.

Absolutely right.

The pituitary gland starts secreting gonadotropins.

In girls, gonadotropins cause the ovaries to grow

and produce estrogen.

Estrogen triggers the development

of secondary sex characteristics and so forth.

And one of the things I want people to understand

who are listening is that,

you know, we often think about hormone centers

as being either ovaries or testes,

but all of that is mediated centrally in the brain,

actually in the hypothalamus.

And so, you know, when we talk about the brain-body axis,

it is absolutely real and folks should understand that.

Yeah, and it's realer than real in early puberty.

This is a really good example

of how to illustrate that idea, definitely.

So one of the factors was stress.

A second factor was EDCs.

So these are things like parabens,

the preservatives that are used in cosmetics

and food and pharmaceuticals.

Phthalates, which in our plastics.

And these, as I'm sure your listeners know,

scramble, bibic the body's naturally occurring hormones.

They possibly confuse the endocrine system

in ways that, again, could contribute

to the onset of puberty

because of their relationship with estrogen.

It's really difficult to study this

because we are swimming in these chemicals all the time.

We metabolize them at different times

and at different paces.

It's almost impossible to design

a controlled experiment to parse out these effects,

but we know that the effects are there.

And just so folks understand,

for us to be able to actually

causally interpret the impact of this,

you have to have a contrast group.

And because these things are so ubiquitous,

you can't actually generate a contrast

of people who've never been exposed

to parabens or other plastics.

It's just part of what we live in.

And so this very well might be the case

and you might be able to say,

well, look, there's this long-term change

as we've used more and more of these,

but that just gets us to the problem.

We call it endogeneity.

It's like, this is the problem we're describing.

So we really don't have a contrast group

to be able to get a study

that shows us definitively a causal effect.

And it sounds really technical

in terms of what we're trying to explain,

but it keeps us from being able to infer

the impact at all,

even if we think this very well might be it.

Exactly.

We can't escape what we need to compare

to another thing.

So there's EDCs, there's stress,

and then there's BMI.

And the correlation between BMI

and early puberty has to do

with a hormone called leptin.

Leptin is one of the triggers

for the pituitary gland

to begin producing those gonadotropins.

Leptin is produced in the fat tissue

and it raises the body's estrogen levels.

So typically as estrogen increases,

so does fat and so does leptin.

And it creates a feedback loop.

Weight gain spurs puberty,

puberty spurs weight gain.

And indeed, a lot of the pediatricians

in the 90s and 2000s

who were seeing these girls

entering early puberty,

these girls had BMIs often

above the average.

And so the pandemic sort of created

this one moment in time

that helped us to understand

a little bit more

because where early puberty

had been creeping backwards

in a life earlier before the pandemic,

all of a sudden during the pandemic,

we saw this, you know,

great leap backward almost

in puberty time.

Can you tell us what we saw,

what we observed during the pandemic?

And then how did scientists use that

to better understand early puberty?

Right.

So the first signs of this

were just referrals to clinics.

There were clinics all over the world.

It was a global phenomenon

that we're seeing doublings,

even triplings of referrals

to pediatric endocrinologists

for suspected early puberty.

There were early studies out of Turkey,

Israel, Italy, South Korea,

India, as well as in the US.

And this was particularly striking

because these kids were coming in

during pandemic times

when a lot of families

were maybe setting aside

what they might've seen