Bone age is a common index utilized in pediatric radiology and endocrinology departments worldwide to define skeletal maturity for medical and non-medical purposes [Fig.1]. It is the age expressed in years that corresponds to the level of maturation of bones. Hand and wrist X-rays are the most used images. Bone age may be affected by several factors, including gender, nutrition, metabolic, genetic, and social factors, and either acute or chronic pathologies, especially hormone alteration [Fig.2]. Advanced bone age is common when a child has had prolonged elevation of sex steroid levels, as in precocious puberty or congenital adrenal hyperplasia. The bone age is often marginally advanced with premature adrenarche when a child is overweight from a young age or when a child has lipodystrophy. We sought to determine gender-based causes of increased bone age.