Although adolescent males have as many health issues and concerns as adolescent females, they are much less likely to be seen in a clinical setting. This is related to both individual factors and the health care system itself, which is not always encouraging and set up to provide comprehensive male health care. Working with adolescent boys involves gaining the knowledge and skills to address concerns such as puberty and sexuality, substance use, violence, risk-taking behaviors, and mental health issues. The ability to engage the young male patient is critical, and the professional must be comfortable initiating conversations about a wide array of topics with the teen boy, who may be reluctant to discuss his concerns. It is important to take every opportunity with adolescent boys to talk about issues beyond the presenting complaint and let them know about confidential care. The physician can educate teens about the importance of regular checkups and that they are welcome to contact the physician if they are experiencing any concerns about their health or well-being. Parents of preadolescent and adolescent boys should be educated on the value of regular health maintenance visits for their sons beginning in their early teen years.

Pubertal development follows a fairly consistent and predictable sequence of events, although the onset and duration vary depending on genetics, nutrition, health status, and psychological factors. It is important to understand this process to be able to answer concerns about growth and puberty. For males, there are notable events during this sequence:

• Puberty begins (SMR II) with testicular enlargement (gonadarche) to a volume greater than or equal to 4 mL (a length greater than or equal to 2.5 cm).
• Penis size increases (first in length and then in diameter), followed by pubic hair growth (pubarche).
• First ejaculation (spermarche) occurs around SMR III, usually approximately one year after the onset of SMR II.
• During SMR III to SMR IV, growth velocity increases, the voice starts to change, and gynecomastia occurs.
• Peak height velocity (5.8 cm/year to 13.1 cm/year) usually correlates with SMR IV.
• Facial and axillary hair growth follows.
• Normal testicular volume in the fully developed male is between 15 mL and 25 mL (4 cm to 6 cm in length) and is achieved in SMR V.

Adolescents can experience many concerns or worries about growth and puberty. They rarely consult a physician, and during a medical visit for other conditions, they do not always feel comfortable bringing up these issues. It is important that healthcare professionals ask boys questions about growth and pubertal development starting in the early teen years or even in the prepubertal years. One way to introduce these topics is to ask the teen whether he has any concerns about topics such as athletic performance, strength, or endurance. These topics can naturally lead to questions about how the young man is feeling about his changing body. Opening up discussions around these topics serves many purposes – it lets the young teen know that doctors are interested and are available to talk about these topics;