Sex steroid replacement in young males and females
Once induction of puberty has been completed the options for sex steroid hormone replacement change to take in to account long term health outcomes and the issues of transition from pediatric to adult care. With regard to the late stages of development, some thought has to be given to the fact that bone mass continues to increase to reach a peak at about the age of 25. It may not be until the age of 18 that meaningful bone density results can be obtained. For those who are slow to reach peak bone mass there might be a benefit to running generous dosing levels for some years.
For many young adults, compliance with treatment can be a problem with some passing through a time of rejection of medical care. The health care team should be alert to the problems of transition and the high rate of drop out from clinic for young adults. With regard to sex steroid replacement, regimes can be adjusted to find one that is most acceptable for the individual. Involving the patient in the process of choice with education may require extending clinic time and a good relationship with nursing staff.
As young adults hypogonadal patients will take stock of their success or otherwise of pubertal development and many express concern about some aspect of physical development or self-confidence in relationships. If these points are not volunteered then skills in eliciting a frank exploration of these psychological issues will often be required. Males in particular may feel that their hypogonadism makes the common sexual insecurities of this age group much more profound.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.