Changes in secondary sex characteristics include every change that is not directly related to sexual reproduction. In males, these changes involve appearance of pubic, facial, and body hair, deepening of the voice, roughening of the skin around the upper arms and thighs, and increased development of the sweat glands. In females, secondary sex changes involve elevation of the breasts, widening of the hips, development of pubic and underarm hair, widening of the areolae, and elevation of the nipples. The changes in secondary sex characteristics that take place during puberty are often referred to in terms of five Tanner stages, named after the British pediatrician who devised the categorization system.