Girls with hypogonadism require sex steroid replacement that allows for progression through puberty as in girls with normal gonadal function. Inevitably, many girls presenting with pubertal delay will require a shortened protocol of sex steroid replacement so that their development catches up with their peers. Historically, several forms of estrogen and progesterone have been used for the induction of puberty with the choice being based mainly on local tradition.
The main issues for consideration include the timing of the initiation of estrogen for girls with known estrogen deficiency, the duration of unopposed estrogen to be achieved to mimic normal puberty, possible interference with other pubertal treatment such as growth hormone and the plan for maintenance treatment once adult dose has been achieved.
Sex steroids also have a place for use in eugonadal adolescents for contraception, for the control of menstrual bleeding complaints and to suppress androgen excess in polycystic ovary syndrome (PCOS), but these topics are not within the scope of this paper.