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A Whole New Ball Game

Why testicular volume has become the gold standard

of research into male puberty.
By L.V. Anderson

A study says that puberty is starting earlier in boys. How can you tell when a boy is
going through puberty?

A new study published in Pediatrics indicates that American boys are beginning
puberty earlier than previously indicated, with the first signs appearing at age 9.14 for
African-American boys, 10.04 for Hispanic white boys, and 10.14 for non-Hispanic
white boys. What do scientists measure to determine the onset of puberty in boys?

L.V. Anderson

L.V. Anderson is a former Slate associate editor.

Testes size. The earliest sign of puberty in boys is the enlargement of the testicles.
Tanner staging, a method of visually assessing the development of secondary sex
characteristics (breast development in girls, genital development in boys, and pubic hair
growth in both sexes), uses the visual appearance of the testes to determine their length.
But the new study used a more precise technique known as orchidometry to determine
testicular volume. An orchidometer, also known as Prader beads, is a string of ovoid
plastic or wooden beads ranging from 1 milliliter to 25 or 30 milliliters in volume.
Prepubertal boys typically have a testicular volume of 1 to 2 milliliters; boys in the early
stage of puberty have a testicular volume of 3 to 4 milliliters. (Adult men usually have a
testicular volume between 15 and 25 milliliters.) To use an orchidometer, doctors gently
pull the testicle to the bottom of a boy’s scrotum and use touch and sight to find the
bead that matches it in volume.

Orchidometry is a clear improvement over visual assessments of testis size, since it

takes a testicle’s three-dimensional nature into account and isn’t affected by scrotal
tension. However, it has the drawback of being more invasive than a visual assessment.
More reliable still is an ultrasound, which (unlike orchidometry) can’t be distorted by
the thickness of scrotal skin. But since ultrasounds are even more invasive than
orchidometers, researchers are unlikely to do any large-scale research on testis size
using this method anytime soon. (For clinical rather than research purposes,
endocrinologists sometimes prescribe testicular ultrasounds when they suspect
developmental abnormalities in boys.)

Only one previous study has documented American boys’ testicular volume using
orchidometry, and it was on a smaller scale than the new study, so it’s unclear whether
boys are really beginning puberty earlier than they used to—we simply don’t have
comparable data from earlier decades.

Though testicle growth is the first sign of puberty in boys, later signs of puberty—
including penis growth, thinning of the scrotal skin, changes in scrotal color, and the
development of pubic hair—can and have been measured by researchers. Researchers
use textbook pictures (either photographs or drawings) to determine which Tanner stage
a boy is in. (The Tanner stages range from 1, prepubertal, to 5, fully developed.) Of
course, there’s some subjectivity in rating phallic appearance and pubic hair thickness,
for instance, which makes measuring these developments across populations difficult.
Furthermore, pubic hair growth can sometimes be spurred by hormones released by the
adrenal glands instead of those released by the pituitary gland in the course of puberty,
which means that pubic hair appearance on its own is not a fully reliable source of
information. Although puberty is associated with hormonal changes, measuring
hormones in the bloodstream or urine is not considered a useful way of measuring
development by most puberty researchers because the correlation between hormonal
increases and physical changes is highly variable.

Ideally, puberty researchers would be able to track the physical development of a large
number of boys over several years to get a better sense of the average rate of genital
growth and timing of specific developments. Unfortunately, this kind of longitudinal
study is highly impractical both because of its costs and because of the difficulty of
finding boys whose families are willing to enroll them in a multiyear study that involves
somewhat invasive measuring techniques. James Tanner did do a longitudinal study of
boys to determine the contours of his famous Tanner stages—but that’s because he had
a captive sample of 228 institutionalized orphan boys in the 1960s. Performing research
on such populations is highly frowned upon today.

Got a question about today’s news? Ask the Explainer.

Explainer thanks Laura Bachrach of Stanford University, Frank M. Biro of Cincinnati
Children’s Hospital, and Marcia Herman-Giddens of the University of North Carolina.