New Clarity on a Little‑Understood Stage of Childhood Development

Adrenarche—an early, puzzling transition between childhood and adolescence—has long been clouded by inconsistent terminology across pediatrics, endocrinology, and puberty research. A new call for precision aims to change that in a paper by Lauren Houghton, PhD, assistant professor of Epidemiology at Columbia University Mailman School of Public Health in JAMA Pediatrics.

“Precision in how we use terms like adrenarche, gonadarche, pubarche, and puberty is essential,” said Houghton. “By aligning language with underlying physiology, we can advance both research and pediatric care.”

There is a developmental shift that begins earlier than most realize, according to Houghton. Adrenarche marks the rise of adrenal androgen production along the hypothalamus–pituitary–adrenal (HPA) axis. These hormonal changes typically occur between ages 6-8 years. Pubarche is the growth of pubic hair and does not typically occur by age 8. 

“We routinely define adrenarche by detectable rises in DHEAS while, almost in the same breath, linking it to pubic or axillary hair and stating that it ‘typically’ begins between ages 6 and 8,” said Houghton. “But when I first realized that pubic hair development at age 6 would actually be considered strikingly early in clinical practice, the contradiction became impossible to ignore. If most 6-year-olds were presenting with pubic hair, parents, pediatricians, and the media would be sounding alarms about precocious puberty. 

For decades, adrenarche and pubarche have been used interchangeably—even though they describe different biological processes. New analysis underscores that:

• Adrenarche is a hormonal event.
• Pubarche is a physical milestone—the first appearance of pubic hair.
• Gonadarche is a separate hormonal activation of the reproductive system.

Puberty is the broader transition encompassing all of the above.

“Conflating these terms has led to confusion in clinical assessments, research design, and the interpretation of early developmental changes. Clear definitions can improve diagnostic accuracy and help settle ongoing scientific debates about how these processes relate,” notes Houghton.

While some argue that evidence is still emerging, current physiology confirms that adrenarche and pubarche are not the same process. Distinguishing them allows researchers to better understand early development and may ultimately reshape how clinicians assess pubertal timing.

“By adopting consistent terminology, the field can move toward clearer diagnostic criteria, more accurate research, and a deeper understanding of how children transition into adolescence,” said Houghton.

Read the paper “Adrenarche is not Pubarche: time to stop conflating terms“.

The authors declare no conflict of interest.