Agreement between self-reported and physician-assessed tanner stages in adolescents: a cross-sectional study

Introduction Physician-assessed Tanner staging remains the clinical standard for puberty evaluation, but privacy and feasibility concerns have increased the interest in self-assessment, whose validity in clinical settings remains uncertain. This study aimed to analyze the agreement between self-reported and physician-assessed Tanner stages in adolescents attending a tertiary Adolescent Medicine Unit, and the influence of sex and anthropometrics on self-classification accuracy. Methods This cross-sectional agreement study included 98 adolescents (45.9% girls; aged 13.9 ± 2.0 years) who self-assessed their Tanner stage using sex-specific illustrations, with physician-assessment as the reference standard. Agreement was assessed using exact agreement, within-one-stage agreement, and quadratic-weighted Cohen's kappa, for individual stages and for pre-, mid-, and late-pubertal phases. Associations between age, sex, weight, and height and underestimation, accurate classification, and overestimation were examined using multivariable logistic regression. Results Exact agreement was 37.8% (95% CI 28.8 to 47.6%), increasing to 80.6% within one stage (weighted κ =0.55). Agreement was lowest at stage V (19.4%), and pubertal-phase categorization yielded fair agreement (60.2%, κ =0.32). Overall, 54.1% of participants underestimated, and 8.2% (all boys) overestimated their stage. Girls had higher odds of underestimation (OR = 4.70), although this association was attenuated after adjustment for physician-assessed stage. Greater weight was associated with higher odds of accurate self-classification (OR = 1.36 per 10 kg). Conclusion Self-reported Tanner staging showed limited agreement with physician assessment, even across broad pubertal phases, suggesting it should not replace clinical evaluation. Pubertal stage, sex, and body weight may influence pubertal self-perception and should be considered when interpreting self-reported pubertal status.