Endocrine Abstracts

Background: Pubertal induction with transdermal or oral estradiol (E2) is essential in the care of girls with Turner syndrome (TS), but long-term data comparing both regimens are limited. Additionally, current practice patterns and factors influencing the choice of regimen remain underexplored. A better understanding of these factors can optimize counseling and support shared decision-making.

Methods: Trends in estrogen use for pubertal induction were analyzed using data from the Dutch National Registry of Growth Hormone Treatment, a nationwide quality registry established in 1998. All girls with TS initiating E2 therapy were included. Additionally, two surveys were conducted among girls with TS aged 11–18 years and pediatric endocrinologists in the Netherlands, assessing decision-making on route of administration, reasons for regimen choice, and treatment experiences.

Results: A total of 526 girls with TS met the inclusion criteria in the Registry (transdermal: n = 52, oral: n = 474). After the introduction of transdermal E2 in Dutch guidelines in 2011, 84% of patients initiated oral estrogen. Median age at puberty induction decreased from 13.0 (IQR 12.4–14.7) years before 2011, to 12.3 (IQR 11.9–13.6) years from 2011 onwards.Fifty patients completed the survey (transdermal: n = 15, oral: n = 35). Among girls receiving transdermal E2, 40% reported that the route of administration was determined by their clinician. In contrast, 40% of girls treated with oral E2 made this choice themselves/with parents, primarily because of ease of use. In 22% of respondents, regimen choice was not explicitly discussed. Of 34 responding clinicians, those with >5 years of experience (n = 14) more often preferred transdermal E2 because of perceived effectiveness and safety, whereas those with >5 years of experience (n = 20) more often favored oral E2 because of ease of use and personal experience. Overall, clinicians reported a need for more evidence on effectiveness and safety, as well as practical guidelines and educational materials.

Conclusions: Our data show that transdermal E2 remains much less frequently used than oral regimens for pubertal induction in girls with TS, with an apparent generational difference in preference among clinicians. These findings can inform development of information and decision-support tools that incorporate stakeholder perspectives to improve shared decision-making.