Tanner staging

Investigation Protocol

Tanner stage	Breasts	Pubic hair	Growth	Other
Stage 1	Prepubertal - elevation of papilla only.	Prepubertal villus hair only.	Basal level - 5 cm to 6 cm per year.	Adrenarche Ovaries grow and enlarge.
Stage 2	Breast bud appears under an enlarged areola (mean age 11.2 years).	Sparse hair along labia (mean age 11.9 years).	Accelerated growth - about 7 cm to 8 cm per year.	Clitoral enlargement with labial pigmentation Uterine enlargement..
Stage 3	Breast tissue grows beyond areola but without contour separation (mean age 12.4 years).	Hair coarser and pigmented - spreads across pubes (mean age 12.7 years).	Peak velocity - about 8 cm per year (mean age 12.5 years).	Axillary hair (mean age 13.2 years). Acne (mean age 13.2 years).
Stage 4	Projection of areola - papilla forms a secondary mound (mean age 13.1 years).	Adult pattern but without spread to medial thigh (mean age 13.4 years).	Deceleration- less than 7 cm per year.	Menarche (mean age 13.3 years). Regular periods (mean age 13.9 years).
Stage 5	Adult breast contour with projection of papilla only (mean age 14.5 years).	Adult with spread to medial thigh but not up linea alba (mean age 14.6 years).	Cessation of growth at around 16 years.	Adult genitalia.

Tanner stage	Genitalia	Pubic hair	Growth	Other
Stage 1	Prepubertal - testes less than 2.5 cm.	Villus hair only.	Basal rate - 5 cm to 6 cm per year.	Adrenarche.
Stage 2	Thinning and reddening of scrotal skin (mean age 11.9 years). Testes 2.5 cm to 3.2 cm.	Sparse growth base of penis (mean age 12.3 years).	Basal rate as above.	Reduction in total body fat.
Stage 3	Growth of penis (mean age 13.2 years). Testes 3.3 cm to 4 cm.	Thicker hair - spreads to mons pubis (mean age 13.9 years).	Accelerated growth - 7 cm to 8 cm per year.	Gynaecomastia (mean age 13.2 years). Voice break (mean age 13.5 years). Increase in muscle mass.
Stage 4	Growth of penis and glans with darkening of scrotum (mean age 14.3 years). Testes 4.1 cm to 4.5 cm.	Adult but no spread to medial thigh (mean age 14.7 years).	Peak velocity about 10 cm per year (mean age 13.8 years).	Axillary hair (mean age 14 years). Voice change (mean age 14.1 years). Acne (mean age 14.3 years).
Stage 5	Adult genitalia (mean age 15.1 years). Testes greater than 4.5 cm.	Adult with spread to medial thigh but not linea alba (mean age 15.3 years).	Deceleration and cessation (about 17 years).	Facial hair (mean age 14.9 years). Muscle mass increases further and beyond Stage 5.