Adjusting Hormone Replacement Therapy for Turner Syndrome

Estradiol Target Levels and Dosing

For women with Turner syndrome requiring hormone replacement therapy, transdermal 17β-estradiol should be the first-line treatment option, with doses ranging from 50-100 μg/day, as recommended by the Endocrine Society 1, 2
The dose of estradiol should be adjusted based on serum levels, with the goal of achieving adequate feminization and physiological benefits, according to the Endocrine Society 3

Transdermal administration is preferred as it mimics physiological serum estradiol concentrations, provides a better safety profile than oral formulations, avoids hepatic first-pass effect, minimizes impact on hemostatic factors, and has more beneficial effects on lipid profiles and inflammation markers, as stated by the American College of Obstetricians and Gynecologists 4
When transdermal administration is contraindicated or refused, oral 17β-estradiol at doses of 1-2 mg daily can be used as a second choice, as recommended by the Endocrine Society 5

Preferred progestin options for women with an intact uterus include micronized progesterone (200 mg daily for 12-14 days every 28 days) as first choice, medroxyprogesterone acetate (10 mg daily for 12-14 days per month) as an alternative, and dydrogesterone (10 mg for 12-14 days per month) as another option, according to the American College of Obstetricians and Gynecologists 2, 3
Progestins with anti-androgenic effects should be avoided as they may worsen hypoandrogenism, as recommended by the Endocrine Society 2

Women with Turner syndrome typically require hormone replacement therapy until the average age of natural menopause (45-55 years), as stated by the American College of Obstetricians and Gynecologists 5

Bone mineral density should be assessed in patients with hypogonadism, as recommended by the National Osteoporosis Foundation 6