April 13, 2026-- Higher levels of key steroid hormones—combined with elevated stress and body mass index (BMI)—are associated with earlier onset of puberty in girls, according to a new study at Columbia University Mailman School of Public Health. Many studies describe declining trends in the age at puberty, but until now few studies have examined how stress and BMI interact with a girl's hormonal biology. This paper is among the first to integrate these three factors using a comprehensive steroid metabolome approach. The findings are published in The Journal of Clinical Endocrinology & Metabolism.
Elevated prepuberty urinary levels of glucocorticoids, androgens, and progesterone were strongly linked to accelerated breast development (thelarche). Girls with high glucocorticoid levels alongside high BMI and stress entered puberty an average of seven months earlier than peers with lower levels.
"While stress and BMI have long been recognized as independent predictors of puberty, few studies have examined how they interact with a girl's hormones," said Lauren Houghton , PhD, assistant professor of Epidemiology at Columbia Mailman School, and first author. "Our findings challenge conventional research that has largely focused on estrogen and body size, highlighting instead the role of stress and androgens – typically thought of as male hormones-- in shaping pubescent development."
The strongest associations were observed for progesterone, androgens, and glucocorticoids, indicating that multiple hormonal pathways—not just estrogen—play a critical role in the timing of puberty.
For example:
-Higher glucocorticoid, androgen, and progesterone metabolites were associated with earlier onset of puberty,
-Elevated androgens and progesterone were also linked to a longer duration of puberty,
-Estrogen metabolites were associated with delayed onset, not acceleration,
-The effects of hormones on puberty timing were significantly modified by BMI and stress levels.
Notably, the associations were consistent regardless of family history of breast cancer.
"Our objective was to identify the full set of hormonal patterns linked to accelerated puberty and test whether BMI and stress modify this relationship," said Houghton, who is also assistant professor at the Herbert Irving Comprehensive Cancer Center at Columbia. "We predicted that girls with elevated BMI and stress would experience the earliest onset—and that the stress response shifts during this key time for girls."
The researchers drew on data from the LEGACY Girls Study, a cohort of 1,040 girls ages 6 to 13 recruited across the U.S. States and Canada. Participants were followed every six months with clinical assessments, questionnaires, and biospecimen collection.
The analysis included 327 girls who were at the pre-puberty stage at baseline and provided urine samples at least one year before the onset of puberty. Houghton and colleagues measured a comprehensive panel of steroid metabolites using first-morning urine samples and tracked puberty development using validated clinical scales.
Mothers of the girls completed an Internalizing Composite Scale, which includes subscales for anxiety, depression, and other at-risk status. They also provided information on girls' family history of all cancers as well as on pregnancy and infancy, including birth weight and their child's race and ethnicity. Trained research staff measured height and weight twice every 6 months.
"Unlike prior research, this study simultaneously examined hormonal patterns, BMI, and psychosocial stress—captured through standardized behavioral assessments—within the same cohort," said senior author Mary Beth Terry , PhD, professor of Epidemiology at Columbia Mailman School, and the Herbert Irving Cancer Center, and Silent Spring Institute. "Interestingly, we also learned that the associations were consistent regardless of family history of breast cancer."
The findings may help explain the ongoing trend toward earlier puberty and point to actionable prevention strategies, observed the authors.
"Stress-reducing interventions and healthy lifestyle changes may help delay early puberty and improve long-term health outcomes," said Houghton. 'Because early puberty is linked to increased breast cancer risk later in life, the results have important implications for both pediatric care and public health."
Co-authors are Eva Siegel, Ying Wei, and Regina M Santella, Columbia Mailman School of Public Health; Stefan A Wudy and Michaela F Hartmann, Center of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany; Frank Stanczyk, Keck School of Medicine, University of Southern California; Julia A Knight, Sinai Health, Lunenfeld-Tanenbaum Research Institute, Toronto and Dalla Lana School of Public Health, University of Toronto; Irene L Andrulis, Sinai Health, Lunenfeld-Tanenbaum Research Institute, Toronto and University of Toronto; Angela R Bradbury and Lisa Schwartz, Perelman School of Medicine, University of Pennsylvania; Saundra S Buys, University of Utah Health Sciences Center, Huntsman Cancer Institute, Salt Lake City; Mary B Daly, Fox Chase Cancer Center, Philadelphia; Esther M John, Stanford Cancer Institute, Stanford University School of Medicine; Wendy K Chung, Columbia University Medical Center and Herbert Irving Comprehensive Cancer Center, and Boston Children's Hospital and Harvard Medical School; and Russell D Romeo, 18Department of Neuroscience and Behavior, Barnard College.
The research was funded by the National Cancer Institute, grants 5K07CA21816603 to L.C.H., 5R01CA15986804 5R01CA138819 5R01CA138638, and 5R01CA138844; the Breast Cancer Research Foundation, and the Columbia University Biomarkers Core P30CA013696 and P30ES009089.
The authors declare no conflict of interest.
Columbia University Mailman School of Public Health
