“…In both sexes, circulating gonadal steroids (predominately estradiol and progesterone in girls and testosterone in boys, although both sexes experience rises in all three hormones at puberty) rise across puberty until reaching adult concentrations (Boswell, 2014; Rilling et al, 1996). In girls, the rise in circulating estradiol first manifests externally through the start of breast development (Divall and Radovick, 2008; Marshall and Tanner, 1969), which is followed 1–3 years later by first menses (menarche) (Anderson and Must, 2005; Hansen et al, 1975) and eventual ovulation and regular menstrual cyclicity within another 1–3 years (Boswell, 2014; Divall and Radovick, 2008; Legro et al, 2000). In boys, milestones are more difficult to observe; the first external indicator of puberty onset occurs with testosterone-induced increase in testicular volume along with a change in the color and texture of the scrotal skin (Marshall and Tanner, 1970; Sørensen et al, 2010).…”