How do You initiate Oestrogen Therapy in a Girl Who has Not Undergone Puberty?

Peter C. Hindmarsh


Clin Endocrinol. 2009;71(1):7-10. 

In This Article

Abstract and Introduction


The physiology of puberty needs to be taken into consideration in the induction of puberty. Puberty is a relatively slow process and replacement therapy should mimic this. Long-term maintenance requires careful monitoring and long-term assessment of risk-benefit. This has not been appreciably defined in the adolescent population. Options for fertility need careful consideration and may depend on the adequacy of pubertal induction in terms of uterine development. A number of regimens are available for pubertal induction but the lack of comparisons makes it difficult to advocate for a particular regimen. There remain a number of areas of uncertainty, and future studies need to consider these issues and whether there are cardiovascular risk factor advantages to certain preparations. The long-term risks of breast and gynaecological malignancy remain uncertain. Long-term cohort studies are required to address these issues.


The development of secondary sexual characteristics represents an important point in the transition of the child into adulthood confirming the ability of the individual to undertake reproduction. The process of puberty passes through a series of well-defined stages[1] and is a manifestation of changes taking place in the hypothalamo–pituitary–gonadal axis in both sexes and to a greater extent in females the hypothalamo–pituitary–adrenal axis.[2] Gonadal failure may be either primary or secondary, and the aetiology will determine to what extent full reproductive capability can be restored. In addition because puberty contributes 25–30 cm to final height in males and 20–25 cm for females consideration needs to be given in cases of secondary gonadal failure to potential interactions with other hypothalamo–pituitary hormones such as GH. This review considers the use of oestrogens for pubertal induction in situations of primary and secondary gonadal failure. It is recognized that other approaches to secondary gonadal failure could be adopted.[3]


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