It requires an intact hypothalamic–pituitary–gonadal (HPG) axis and is heralded by the reemergence of gonadotropin-releasing hormone (GnRH) secretion from its relative quiescence during childhood.

Stressors can activate three different cascades: the HPA axis, the SAS and the HPG axis. Stress can also increase levels of GnIH, which has an inhibitory effect on the HPG axis.