Growth hormone and estrogen therapies are among the most common treatments for individuals who have Turner Syndrome (TS). Short stature affects at least 95% of all individuals with TS and is the most consistent and readily recognizable clinical feature of TS. Additionally, only 16% of those affected have spontaneous puberty, and many have a lack of estrogen activity, which can cause issues like ovarian failure. Thus, growth hormone and estrogen therapies are introduced to support growth and development.
In this post, learn some basic information about these treatments, their benefits, and potential side effects. You can also search our website for much more information related to this topic.
Disclaimer: This article is not a substitute for medical advice. It contains general information about growth hormone and estrogen therapies. If you have any questions about what types of treatments work best for you or your loved one, visit a trusted medical professional, such as an endocrinologist.
What is Growth Hormone Therapy?
Growth hormone therapy (GHT) is an injection-based treatment that mimics the process of normal secretion of growth hormones, which typically happens nightly. A synthetic growth hormone often used for this therapy is somatropin, a protein that aids muscle and bone growth. There are many products that have this medication as the primary ingredient. This therapy is done daily, with doses being adjusted every three to six months.
Pros and Cons of GHT
The earlier GHT is started, the better the results may be. On average, adults with TS are eight inches shorter than the average female. GHT has been identified as an effective measure to increase the final adult height of those who have TS.
In addition, GHT can have other benefits, such as:
- increased strength,
- improved balance/coordination, and
- improvement in mood.
Side effects of GHT may include:
- swelling at injection site,
- increased appetite,
- hip pain, and
- knee pain.
You can learn more about GHT in our upcoming FREE webinar with pediatric endocrinologist Dr. Mary Gwyn Roper:
What is Estrogen Therapy?
Estrogen Therapy (ET) is also often prescribed to those who have TS to counteract estrogen deficiency. ET aims to minimize the effects of the deficiency and can help patients feminize.
ET uses estradiol, a steroid sex hormone. Unlike GHT, estradiol can be administered through a gel/skin patch or by taking a pill. Taking either treatment will usually not have large effects on your body’s estrogen levels. However, when taking the pill version, part of the estradiol will turn into estrone sulfate. This form of estrogen is stored in the body, not used actively.
Usually, doctors recommend that this treatment start at the beginning of puberty, starting with small doses and gradually increasing the estradiol levels as puberty progresses. Doctors recommend that ET continue until around the age of menopause.
Pros and Cons of Estrogen Therapy
Benefits of ET include:
- increased fertility;
- increased breast size and shape;
- improved cardiovascular and liver functions and other estrogen-dependent processes;
- prevention of bone deterioration; and
- potential increase in self-esteem due to feminization similar to one’s peers.
Some common side effects of ET include:
- vaginal bleeding, and
- breast tenderness/swelling.
If these side effects last longer than a few weeks, another version of ET should be considered.
How Do Growth Hormone Therapy and Estrogen Therapy Work Together?
GHT works to help the body grow. After an adolescent finishes their bone growth, this treatment usually stops. After that, ET can then start, which causes the growth plates to close. However, it can be hard to determine when the growth phase ends and puberty begins. Doctors recommend to start ET between the ages of 11 and 14; this is the average stage in which the menstrual cycle should start.
Financial Concerns about Hormone Therapy
Hormone therapy is pricey; GHT treatment alone can cost between $10,000 and $60,000 per year.
However, if you or a loved one have TS but are uninsured or unable to afford this treatment, you are eligible for compensation, since hormone therapy is considered medically necessary for those with TS.
Be sure to subscribe to the TSF blog; we will be publishing a future article outlining some financial assistance programs.
How To Help Your Child Adjust
If your child is afraid of taking GHT or ET:
- Tell them how the therapy will help them grow normally. Do this with patience, firmness, and calmness.
- Talk to your doctor or case manager if you have any questions or concerns about the therapy.
- Normalize the therapy by making it part of your child’s nighttime routine.
- If you can’t do the therapy alone, have loved ones like your friends or neighbors help you.
- Encourage your loved ones to measure their growth along with your child. That way, they will be able to see the therapy’s positive effects.
- Praise or reward your child when she stays committed to the therapy. The rewards will change as they grow.
- As your child gets older, increase their participation in the therapy. Have them choose where to inject, remind you to do the therapy, or discuss their feelings about it.
- When your child becomes a teenager, let them decide how much they want to participate in the therapy, including the injections.
- Let they child choose if they want to tell family and other loved ones about them taking the therapies.
Written by Elizabeth (Liz) Rivera, Turner Syndrome Foundation (TSF) intern and blog post writer.