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 delayed if scrotal changes have not occurred by the age of 11 years: Scrotal changes, such as thinning, reddening, and enlargement, are among the first signs of puberty in boys. If these changes have not started by age 11, it may indicate delayed puberty, warranting further assessment. B. Changes in the voice signal the beginning of puberty: Voice changes usually occur later in puberty, after the onset of testicular and scrotal development. They are a secondary sexual characteristic, not an initial sign. C. Growth spurts in height occur toward the end of midpuberty: Growth spurts typically happen during early to midpuberty, not toward the end. Height velocity peaks around Tanner stages 3 to 4, before puberty concludes. D. Gynecomastia commonly occurs during late puberty: Gynecomastia tends to occur during early to midpuberty due to hormonal fluctuations and usually resolves spontaneously. It is less common to develop or persist into late puberty.