The effects of estrogen induction therapy on pubertal presentations in turner syndrome patients

Pubertal induction in Turner syndrome without gonadal function: A possibility of earlier, lower-dose estrogen therapy

“…The initial dosage at age 9 years is roughly 1/100th of the adult dosage. Not only the transdermal E2 regimen but also the oral EE2 and CE regimens are shown, because transdermal E2 patch is still unavailable in some regions ( 15 , 16 ). There are two protocols using transdermal E2 patch for patients aged 9 years or older, either of which can be used depending upon patients’ psychological age, height, BA, BMD, and the consent of the patients and their guardians ( Table 7 ).…”

“…Progestin must be used in addition to estrogen when breakthrough bleeding occurs or after 2-3 years of pubertal induction with estrogen (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)65). However, recent two guidelines emphasized that progestin should be added after confirming uterine size and endometrial thickness on ultrasonography (5,7).…”

“…In practice, many types of E2 patch are available in different parts of the worlds, as listed by Klein et al (3). In addition, other types of estrogen, such as oral E2, synthetic ethinyl estradiol (EE2), and conjugated estrogen (CE) produced from horse urine, are also used worldwide (15)(16)(17)(18)(19) in Table 2). The list in Table 2 is not exhaustive, but shows the methods used for inducing puberty in five institutions, regions, or countries after the release of the Cincinnati Meeting (2).…”

“…The initial dosage at age 9 years is roughly 1/100th of the adult dosage. Not only the transdermal E2 regimen but also the oral EE2 and CE regimens are shown, because transdermal E2 patch is still unavailable in some regions (15,16). There are two protocols using transdermal E2…”