Hormone Replacement Therapy in Adolescent Girls
Hormone Replacement Therapy is often
needed to treat hypogonadism in girls.
Hypogonadism happens when your body is
not making enough sex hormones. This can
happen if the pituitary gland, hypothalamus,
or ovary doesn’t work, or is missing.
What organs in my body are involved in
The ovaries are organs that make eggs and
the sex hormones estrogen and progesterone.
Estrogen helps breasts develop. Along
with progesterone, it also helps to start and
maintain monthly periods. It also helps girls
The hypothalamus and pituitary gland are
parts of your brain. The hypothalamus
releases gonadotropin releasing hormone
GnRH, which tells the pituitary gland to
send luteinizing hormone LH and follicle
stimulating hormone FSH to the ovaries.
The ovaries then make estrogen and
The adrenal glands release androgens,
which are hormones needed for pubic and
armpit hair growth and body odor. If your
adrenal glands are working you may have
hair growth and body odor even if you have
What are the causes of hypogonadism?
ξ Primary Hypogonadism: Doctors
use these words when the ovaries are
not working. This happens with
conditions like Turner Syndrome,
gonadal dysgenesis, and
galactosemia. This can also happen
if the ovaries are damaged by
treatments for cancers like radiation
treatment, or if the immune system
isn’t working as it should.
ξ Secondary Hypogonadism:
Doctors use these words when there
is a problem with the hypothalamus
or pituitary gland. This can happen
if these parts of the brain did not
form as they should have before you
were born, or formed, but do not
work as they should. This can also
happen if the brain is damaged by
treatment for cancers like removal of
a tumor or radiation treatment.
How will your doctor know if you are in
Doctors look for the normal signs of puberty
to decide if your ovaries are working as they
should. Puberty is the process that changes
a girl into a woman. The normal age for the
start of puberty in girls is between 8 and 14
years old. The signs caused by estrogen
ξ Breast changes
ξ Increase in growth rate
ξ Advances in bone age
If these signs do not happen as expected,
your doctor may then wonder if you have
We can tell your bone age through a simple
X-ray of your hand and wrist. By looking at
this X-ray, your doctor can tell how mature
your bones are and your potential growth. If
your bone age is significantly delayed (less
than your age) and you have not started
puberty, your doctor may begin to think
Your doctor will use blood tests to see how
your ovaries, hypothalamus and pituitary
gland are working. The main things your
doctor checks are:
Often the first test your doctor does is a
single blood test to check the levels of these
hormones in your blood. If the levels of
FSH and LH are very high while the
estrogen level is low, this tells your doctor
that your ovaries are not making estrogen as
well as they should. If the LH, FSH, and
estradiol levels are low, then your doctor
may want to do a second longer test. For the
longer test, you will first get a small
injection of luteinizing hormone releasing
hormone (LHRH) followed by blood tests
after that and maybe even the next day. A
small needle or catheter may be left in the
vein to collect the blood. If in that time you
don’t start making FSH and LH, this tells
your doctor that your pituitary gland or
hypothalamus is not working.
Sometimes, the cause of hypogonadism is
genetic. Your doctor may look for genetic
causes by doing a blood test to look at the
chromosomes. Your chromosomes have all
the important messages to tell the cells in
your body how to develop. Chromosomes
have messages that make your eyes a certain
color, make all the organs including the
ovaries develop, and control many other
things about how you developed before you
If problems are found in your hypothalamus
or pituitary gland, the doctor may ask you to
have an MRI or a CT scan done. Both of
these tests take a picture of your brain to
better look at the pituitary gland where LH
and FSH are made.
Why does hypogonadism need to be
The purpose of treatment is to replace the
hormones that your body is not making
enough of. This helps your body to:
ξ Start and maintain puberty
ξ Finish growing
ξ Have strong bones and prevent
ξ Prevent uterine cancer and heart
ξ Have sexual function such as sexual
thoughts, feelings, and responses
How is hypogonadism treated?
This is treated by taking hormones to try to
copy what happens in normal puberty. As
you get older, you take hormones to copy
the way adult ovaries work.
You will probably start treatment when your
bone age is 10 to 12 years old, but you may
be older. Once you and your doctor decide
that you should begin treatment, you will
receive a very small amount of estrogen
daily either by a pill or a patch on your skin.
You may stay on this dose for the first 6-12
months. This dose is so low that often little
or no signs of puberty are seen.
Your doctor will watch for signs of changes
in your body and your bone age to decide
when to increase your dose. You may see
changes in your breasts and an increase in
the rate of your growth. Some girls may
also see pubic hair, armpit hair, and acne. It
may be different for each person. Ask your
doctor if you have any concerns.
After about 1-2 years of estrogen treatment,
progesterone is added. This helps to start
monthly periods and keep them cycling.
There are two ways to take these hormones.
The first is by daily pills. These are made as
two separate pills, or as a combined pill. It is
the same type of pill called a “birth control
The second way is a patch which is worn on
your hip or buttock, and releases estrogen
and sometimes progesterone through your
skin. Skin patches are a good option for
girls with galactosemia because the patches
do not contain lactose.
It is important to take your medicine as
prescribed. To help you remember, you
may want to use a calendar or a day of the
week pillbox. If you are having trouble, ask
your nurse or doctor for help.
How long will I need treatment?
Even after you complete puberty, you need
to take hormones to maintain strong bones,
prevent uterine cancer, and reduce the risk
of heart disease. Treatment tries to copy the
hormone patterns of the normal menstrual
Are there any side effects?
As with any drugs, there are side effects to
taking hormones. Some nausea, breast
soreness, and unexpected bleeding can
occur. For girls with Turner Syndrome, the
hands and feet may be more swollen.
Hormone replacement in girls with
hypogonadism is not the same as that in
postmenopausal women. The treatment for
hypogonadism provides hormones at a time
when they should be present in the body. As
a result, there are fewer and less serious side
However, you should stop taking your
hormones and call your doctor if you have
problems breathing or severe pain in one
Are there other concerns I should know
Estrogen does two things in with growth.
First, it gives a boost to your growth rate,
making you grow faster. It also helps to
eventually close the growth plates in your
bones, and shortens the time you have to
grow. Higher dose estrogen treatment may
be delayed to give you more time to grow
before your growth plates close. Talk with
your doctor or nurse about the best time to
start treatment. Your feelings are important
in this decision.
There are many causes of hypogonadism.
Each cause has different effects on fertility.
You may need to talk with your doctors as
you get older. They can talk with you about
your options, as they are different for each
With treatment, you should be able to have
normal sexual function. If you decide to
become sexually active, be sure to talk about
the use of condoms with your doctor or
nurse to protect yourself against pregnancy
and sexually transmitted diseases.
The breast size you develop depends much
more on your genetics than on the dose of
estrogen you take. Your doctor will decide
on the dose of estrogen that is best for you.
Changing this dose will not change the
amount of final breast growth you get.
While there is no cure for hypogonadism,
taking hormones can help you to grow and
develop. Be sure to ask your doctors or
nurses about the best treatment options for
Guidelines for Girls and Women with Turner Syndrome, 2007. Journal of Clinical Endocrinology and Metabolism.
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