Exogenous Pubertal Induction by Oral versus Transdermal Estrogen Therapy

Diversity of Pubertal Development in Cartilage-Hair Hypoplasia; Two Illustrative Cases

“…In both patients, pubertal induction was started with transdermal estrogen therapy which allows smaller dose changes and is especially useful in short stature and lowweight adolescents. 8 An analysis of health-related quality of life found significantly more problems in patients with chondrodysplasias than in healthy controls, amongst them lower sexual activity. 9 In a previous series of short statured woman, the overall use of contraception was 42,6 %, almost 50% of whom had tried several contraception methods.…”

Challenges in the diagnosis and management of disorders of sex development

“…In females, oral treatment can be initiated with ethinyl estradiol 5 mcg daily, or conjugated equine estrogens 0.3 mg every other day. Transdermal estrogen therapy, especially with matrix formulation patches, which permit doses as low as 6.25 mcg daily, is also very advantageous in pubertal induction, and has the added advantage of higher bioavailability and lower liver toxicity, compared to oral estrogen therapy (Kenigsberg et al, 2013). In the presence of a uterus, when the adult dose of estrogen is reached, or when withdrawal bleeding begins, a progestational agent should be added, to minimize the risk of endometrial cancer from unopposed estrogen action.…”

Effective use of transdermal drug delivery in children

“…Further, the treatment has to be delayed with respect to the age of spontaneous puberty to avoid a negative impact on the patient's final height, often resulting in some psychological sequelae [147]. Key advantages of the transdermal approach is avoidance of pre-systemic first-pass effects and the availability of matrix patches, which can be cut into smaller systems to pieces allow puberty induction to be started earlier using very low doses [147][148][149]. A clinical study in 15 girls with hyper-or hypo gonadotropic hypogonadism were treated with transdermal estradiol (Evorel® 25µg.day -1 ) [147].…”

“…A 2011 investigation on 128 (13.5±0.5 y) girls with Turner syndrome revealed a significant increase in the use of transdermal oestrogen over the preceding 4 years reflecting, presumably, the view that the patches provide a more physiologic and favourable mode of oestrogen replacement [150]. The literature through 2013 comparing oral versus transdermal exogenous pubertal induction has been reviewed, and dose equivalences between the two therapeutic approaches has been pondered [148]. Although transdermal therapy seems promising, there is clearly a need for large-scale, multicenter studies to properly validate the positive results from the limited (in terms of patient numbers) assessments performed to date.…”