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

Peter C. Hindmarsh

Disclosures

Clin Endocrinol. 2009;71(1):7-10. 

In This Article

Conclusions and Areas of Uncertainty

The physiology of puberty needs to be taken into consideration in the induction of puberty. Puberty is a relatively slow process and the replacement therapy in the induction process 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.

There remain a number of areas of uncertainty. Despite the widespread use of pubertal induction programmes, there are very few carefully constructed randomized control studies that can inform the clinician on aspects of efficacy and safety. In particular, there are no superiority studies to advance the case for one particular therapeutic modality over another in terms of clinical outcome and biochemical changes. Dosing schedules for the induction process are reasonably well defined, but those required for long-term bone health are not. Studies assessing 'trade-offs' between growth and uterine development and bone mineralization and cardiovascular risk factors are needed.

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.

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