Janatin Hastuti, PhD

Lab of Bio- & Paleoanthropology

Faculty of Medicine, UGM
The Tanner Stages
Developed by James Tanner (British pediatrician)
A method of determining sexual maturity.
The scale defines physical measurements of development
based on external primary and secondary sex characteristics
Boys and girls are rated on a 5 point scale.
Boys are rated for genital development, testicular, and pubic
hair growth.
Girls are rated for breast development and pubic hair growth.
 Beginning with pre-adolescent and ending at full
maturation.
Tanner rates:
1-2: 10-13 years old (early adolescent)
3-5: 14-16 years old (middle adolescent)
5: 17-20 years old (late adolescent)
Individuals pass through the Tanner stages at different
rates, depending in particular on the timing of puberty.
Some children are early bloomers and some are late
developer.
Pubic hair changes in boys
and girls (Tanner)
The Tanner Stages for pubic hair growth in females:

Stage I (Preadolescent) - There is no sexual hair.

Stage II - Sparse, long, pigmented, downy hair, which is straight or only
slightly curled, appears. These hairs are seen mainly along the labia. This
stage is difficult to quantitate on black and white photographs, particularly
when pictures are of fair-haired subjects.
Stage III - Considerably darker, coarser, and curlier sexual hair appears.
The hair has now spread sparsely over the junction of the pubes.
Stage IV - The hair distribution is adult in type but decreased in total
quantity. There is no spread to the medial surface of the thighs.
Stage V - Hair is adult in quantity and type and appears to have an inverse
triangle of the classically feminine type. There is spread to the medial
surface of the thighs but not above the base of the inverse triangle.
The Tanner Stages for pubic hair growth in males:

Stage I (Preadolescent) - There is no androgen-sensitive pubic hair.

Stage II - There is sparse development of long pigmented downy hair,
which is only slightly curled or straight. The hair is seen chiefly at the base
of penis. This stage may be difficult to evaluate on a photograph,
especially if the subject has fair hair.
Stage III - The pubic hair is considerably darker, coarser, and curlier. The
distribution is now spread over the junction of the pubes, and at this point
that hair may be recognized easily on black and white photographs.
Stage IV - The hair distribution is now adult in type but still is considerably
less that seen in adults. There is no spread to the medial surface of the
thighs.
Stage V - Hair distribution is adult in quantity and type and is described in
the inverse triangle. There can be spread to the medial surface of the
thighs.
Tanner
stages for
female
breast and
male
genitalia
development
The Tanner stages for breast development in females:

Stage I (Preadolescent) - Only the papilla is elevated above the level of the
chest wall.
Stage II - (Breast Budding) - Elevation of the breasts and papillae may occur
as small mounds along with some increased diameter of the areolae.
Stage III - The breasts and areolae continue to enlarge, although they show
no separation of contour.
Stage IV - The areolae and papillae elevate above the level of the breasts
and form secondary mounds with further development of the overall breast
tissue.
Stage V - Mature female breasts have developed. The papillae may extend
slightly above the contour of the breasts as the result of the recession of the
aerolae.
The Tanner stages for genitalia development in males:

Stage I (Preadolescent)- The testes, scrotal sac, and penis have a size and
proportion similar to those seen in early childhood.
Stage II - There is enlargement of the scrotum and testes and a change in
the texture of the scrotal skin. The scrotal skin may also be reddened, a
finding not obvious when viewed on a black and white photograph.
Stage III - Further growth of the penis has occurred, initially in length,
although with some increase in circumference. There also is increased growth
of the testes and scrotum.
Stage IV - The penis is significantly enlarged in length and circumference,
with further development of the glans penis. The testes and scrotum continue
to enlarge, and there is distinct darkening of the scrotal skin. This is difficult to
evaluate on a black-and-white photograph.
Stage V - The genitalia are adult with regard to size and shape.
Testicular volume
Tanner I -- prepubertal (testicular volume less than 1.5 ml; small penis of 3
cm or less)
Tanner II -- testicular volume between 1.6 and 6 ml; skin on scrotum thins,
reddens and enlarges; penis length unchanged
Tanner III -- testicular volume between 6 and 12 ml; scrotum enlarges
further; penis begins to lengthen to about 6 cm
Tanner IV -- testicular volume between 12 and 20 ml; scrotum enlarges
further and darkens; penis increases in length to 10cm and circumference
Tanner V -- testicular volume greater than 20 ml; adult scrotum and penis of
15 cm in length

Prader orchidometer (testicular size)

Female Tanner Stage
I. Stage: Tanner 1 (Prepubertal)
Height increases at basal rate: 5-6 cm/year
Breast
Papilla elevation only
Pubic Hair
Villus hair only
No coarse, pigmented hair

II. Stage: Tanner 2

Height increases at accelerated rate: 7-8 cm/year
Breast
Breast buds palpable and areolae enlarge
Age 10.9 years (8.9-12.9 years)
Pubic Hair
Minimal coarse, pigmented hair mainly on labia
Age 11.2 years (9.0-13.4 years)
Modifications based on increasingly earlier Puberty
White: Stage 2 changes may appear one year earlier
Black: Stage 2 changes may appear two years earlier
III. Stage: Tanner 3
Height increases at peak rate: 8 cm/year (age 12.5)
Breast
Elevation of Breast contour; areolae enlarge
Age 11.9 years (9.9-13.9 years)
Pubic Hair
Dark, coarse, curly hair spreads over mons pubis
Age 11.9 years (9.6-14.1 years)
Other changes
Axillary hair develops (13.1 years)
Acne Vulgaris develops (13.2 years)

IV. Stage: Tanner 4

Height increases at 7 cm/year
Breast
Areolae forms secondary mound on the Breast
Age: 12.9 years (10.5-15.3 years)
Pubic Hair
Hair of adult quality
No spread to junction of medial thigh with perineum
Age: 12.6 years (10.4-14.8 years)
V. Stage: Tanner 5

No further height increases after age 16 years

Breast
Adult Breast contour
Areola recesses to general contour of Breast
Pubic hair
Adult distribution of hair
Pubic hair spreads to medial thigh
Pubic hair does not extend up linea alba
Exam: Other Milestones

Adrenarche: Age 6 to 8 years

Menarche: Age 12.7 years (10.8-14.5 years)
Delayed >1 year if low body fat (e.g. athlete)

Exam: Growth in Girls

Peak height velocity: 11.5 years (9.7-13.3 years)

Basal growth occurs up until Tanner Stage 2
Basal Growth rate: 5.0 to 6.0 cm per year
Pubertal Growth
Girls who mature average time: 8.3 (6.1-10.4) cm/yr
Girls who mature early: 9.0 (7.0-11.0) cm/yr
Girls who mature late: 7.5 (5.4-9.6) cm/yr
Female
Tanner stage
Male Tanner Stage
I. Stage: Tanner 1 (Prepubertal)
Height increases at basal rate: 5-6 cm/year
Testes
Smaller than 4 ml or long axis <2.5 cm
Pubic Hair
No coarse, pigmented hair
Penis Stage: No growth

II. Stage: Tanner 2

Height increases at basal rate: 5-6 cm/year
Testes
Size 4 ml or long axis 2.5 to 3.2 cm
Age 11.5 years (age 9.5 to 13.5 years)
Pubic Hair
Minimal coarse, pigmented hair at base of penis
Age 12.0 years (age 9.9 to 14.0 years)
Penis Stage
Earliest increased length and width
Age 11.5 years (age 10.5-14.5 years)
III. Stage: Tanner 3

Height increases at accelerated rate: 7-8 cm/year

Testes
Size 12 ml or long axis 3.6 cm
Age 14.0 years (11.5-16.5 years)
Pubic Hair
Coarse, dark curly hair spread over the pubis
Age 13.1 years (11.2-15.0 years)
Penis Stage
Increased length and width
Age 12.4 years (10.1-14.6 years)
Other Changes
Gynecomastia may occur (age 13.2 years)
Voice breaks (age 13.5 years)
Muscle mass increases
IV. Stage: Tanner 4

Height increases at peak rate: 10 cm/year (age 13.8)

Pubic Hair
Hair of adult quality
Not spread to junction of medial thigh with perineum
Age 13.9 years (12.0-15.8 years)
Penis
Continued growth in length and width
Age 13.2 years (11.2-15.3 years)
Testes
Length 4.1 to 4.5 cm
Other Changes
Axillary hair (age 14.0 years)
Voice changes (age 14.1 years)
Acne Vulgaris (age 14.3 years)
V. Stage: Tanner 5

No further height increases after age 17 years

Pubic Hair
Adult pubic hair distribution (15.3 years)
Pubic hair spreads to medial thigh
No hair spread to linea alba
Penis
Mature genital size by 16.5 years
Testes
Length >4.5 cm
Secondary sexual characteristics
Facial hair present on sides
Mature male physique
Gynecomastia disappears
Male Tanner stage
Exam: Testicle Size (typical ranges)

Birth to 6 months
Size: 1.5 cm long and 1.0 cm wide
Child <6 years
Size 2 cm long and 1.2 cm wide
Adult:
Size 4-5 cm long and 3.0 cm wide and 3.0 cm deep
(AP)
Testicle length <3.5 cm is considered small for an
adult
Exam: Growth in Boys

Peak height velocity: Age 13.5 (11.7-15.3 years)

Basal growth occurs up until Tanner Stage 3
Basal Growth rate: 5.0 to 6.0 cm per year
Pubertal Growth
Boys who mature average time: 9.5 (7.1-11.9) cm/yr
Boys who mature early: 10.3 (7.9-12.5) cm/yr
Boys who mature late: 8.5 (6.3-10.7) cm/yr
Application and Misuse

Help to determine a childs physical maturation as opposed to

his chronological age.
Was designed for estimating development or physiologic age
for medical, educational, and sports purposes --- identifying
early and late maturers.
Not designed for estimating chronologic age.
Sexual maturity and chronological age do not necessarily
match up.
 Feingold, D. Pediatric Endocrinology In Atlas
of Pediatric Physical Diagnosis, Second
Edition, Philadelphia. W.B. Saunders, 1992,
9.16-19
Tanner (1966) Growth at Adolescence,
Appleton.
Tanner (1985) J Pediatr 107(3):317
Tanner Score. Retrieved November 2013 from
http://www.unc.ed