A nurse is developing a health program for the parents of school-age boys. Which of the following information about pubescent changes should the nurse include in the program?

A. Puberty might be considered delayed if there are no scrotal changes by the age of 11 years, as testicular enlargement is one of the earliest signs of puberty in boys. B. Growth spurts typically occur early in puberty, not towards the end. C. Changes in voice occur later in puberty, not at the beginning. D. Gynecomastia (breast tissue development) commonly occurs during early puberty rather than late puberty and is usually temporary.