Experts warn of unprecedented rise in early puberty, list dangers

Experts have warned of an unprecedented rise in the incidence of early puberty, especially among girls since the start of the COVID pandemic.

Early puberty, also known as precocious puberty, has historically been rare, affecting approximately 1 in 5,000 to 10,000 children. The female-to-male ratio of incidence is about 10-to-1 in favor of girls.

But for some as-yet-unknown reason, since early 2020, doctors around the world have seen a surprising increase in cases, predominantly if not exclusively among girls, with girls as young as 5 sprouting breasts and menstruation starting in girls younger than 8.

Typically, breast development begins around age 10 to 11, with menstruation starting two years later.

Dr. Vaishakhi Rustagi, a pediatric endocrinologist in Delhi, India, told The Fuller Project that he normally sees about 20 cases of early puberty each year, but since June 2020, she’s seen more than 300 such patients.

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In Italy, a survey of five pediatric endocrinology sites found 328 girls had been referred for suspected early puberty between March and September 2020, up from 140 during the same seven-month period in 2019.

Another Italian study found patients previously diagnosed with slow-progressing early puberty experienced an acceleration of pubertal progression during and/or after lockdown.

Similar findings have emerged from Turkey, where early puberty cases reported between April 2020 and March 2021 were more than double that of any of the preceding three years (58 cases during the pandemic year compared to a total of 66 cases for the previous three years combined).

While on the surface this may not seem like a catastrophe, it can in fact have serious consequences for those affected. Early puberty has been linked to a higher risk for depression, eating disorders, substance abuse and antisocial behavior, for example.

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Early puberty may also be caused by a more serious condition, such as a central nervous problem, or an ovary, adrenal, pituitary or brain tumor, so these conditions need to be ruled out as causative factors before hormone treatment is considered.

“From 9 to like 15, you’re going through this process, but the stress of the pandemic sped up that physiological process. Meanwhile, socially and emotionally, they’re still children.”

Other suspects include elevated electromagnetic field (EMF) exposure, an unhealthy diet, low physical activity, increased obesity, elevated exposure to endocrine-disrupting chemicals in the home and poor sleep — all of which were exacerbated during the lockdowns as children were cooped up indoors and had to study remotely.

Separately, none of these are sufficient to explain the sudden explosion of early puberty, but taken together, they might trigger changes in central nervous mediators and an increase in catecholamines to set off the pubertal process.

Curiously, at the same time as precocious puberty was skyrocketing, researchers at Penn Medicine published preclinical trial results suggesting anti-androgen drugs could disrupt the ACE2 and TMPRSS2 receptors that SARS-CoV-2 uses to gain entry into the cell.

The study, which was funded by the National Institutes of Health and a U.S. Department of Defense award, was published March 19, 2021.

“The findings provide more insight into the molecular mechanisms of the virus but also support the use of anti-androgen therapies to treat COVID-19 infections, which are currently being investigated in clinical trials and have produced promising results. They also support data showing increased mortality and severity of disease among men compared to women, who have much lower levels of androgen.

“We provide the first evidence that not only TMPRSS2, which is known to be regulated by androgen, but ACE2 can also be directly regulated by this hormone,’ said senior author Irfan A. Asangani, PhD, an assistant professor of Cancer Biology in the Perelman School of Medicine at the University of Pennsylvania.

“We also show that the SARS-CoV-2 spike relies on these two receptors to impale and enter cells, and that they can be blocked with existing drugs. That’s important because if you stop viral entry, you reduce the viral load and disease progression.’”

Other research has found ACE2 receptors are present on nearly all testicular cells. This raises the question of whether male fertility and/or gonad function might be adversely affected by SARS-CoV-2 infection.