Can we rely on adolescents to self-assess puberty stage? A systematic review and meta-analysis

Susan C. Campisi, Josée D. Marchand, Fahad Javaid Siddiqui, Muhammad Islam, Zulfiqar A. Bhutta, Mark R. Palmert

Research output: Contribution to journalReview articlepeer-review

27 Citations (Scopus)


Context: Clinicians, researchers, and global health advocates often include pubertal development in outcomes. However, assessments of pubertal stage can be challenging because of the sensitive nature and feasibility of clinical examinations, especially in larger settings. Objective: To determine the accuracy of self-assessed Tanner staging when compared with physically assessed Tanner stages by a clinician. Data Sources: MEDLINE, PubMed, Embase, Web of Science, Scopus, the Cochrane Library, CINAHL. Study Selection: Studies were included if they reported 5 × 5 tables of self-assessment compared to clinician-assessment for the 5-stage Tanner scale. Data Extraction: We extracted data to generate complete 5 × 5 tables for each study, including any subgroup eligible for the analysis, such as overweight/obese youth. Data Synthesis: After screening, 22 studies representing 21,801 participants met our inclusion criteria for the meta-analysis. Overall agreement was moderate or substantial between the 2 assessments, with breast stage 1, female pubic hair 1, male pubic hair 1, and male pubic hair 5 having the highest agreement. When stages were collapsed into pre- (Tanner stage 1), in (stages 2,3), and completing (stages 4,5) puberty, levels of agreement improved, especially for pre- and completing pubertal development. Most included studies comprised Caucasian youth. More studies are needed which include a broader range of geographic and socioeconomic settings, as well as a greater diversity of racial/ethnic groups. Conclusions: Self-assessment of puberty is most accurate when identifying Tanner stage 1, Tanner stage 5 and when development is categorized into prepuberty, in, and completing puberty phases. Use of self-assessment data should be structured accordingly. Protocol Registration: PROSPERO # CRD42018100205.

Original languageEnglish
Pages (from-to)2846-2856
Number of pages11
JournalJournal of Clinical Endocrinology and Metabolism
Issue number8
Publication statusPublished - 1 Aug 2020


  • meta-analysis
  • puberty assessment
  • systematic review


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