Editing Turner syndrome (section)

====Puberty====
[[File:Histological sections of ovarian cortex from patients with TS.png|thumb|upright=1.3|[[Histopathology]] of ovarian tissue in mosaic (A and B) and full (C) Turner syndrome]]
Puberty is delayed or absent in Turner syndrome. A 2019 literature review found that 13% of women with a 45,X0 karyotype could expect to experience spontaneous [[thelarche]] (breast development), while 9% would undergo spontaneous [[menarche]] (beginning of menstruation). These numbers were higher in women with mosaic Turner's; 63% with 45,X0/46,XX karyotypes experienced spontaneous thelarche and 39% spontaneous menarche, while 88% with 45,X0/47,XXX (the presence of a [[trisomy X]] cell line) experienced spontaneous thelarche and 66% spontaneous menarche. Unexpectedly, women with Y-chromosome cells also had increased rates of thelarche and menarche compared to the 45,X baseline, at 41% and 19%. However, few women with trisomy X or Y-chromosome cell lines were covered in the review, impeding extrapolation from these results.<ref name="hrp">{{cite journal | vauthors = Dabrowski E, Jensen R, Johnson EK, Habiby RL, Brickman WJ, Finlayson C | title = Turner Syndrome Systematic Review: Spontaneous Thelarche and Menarche Stratified by Karyotype | journal = Hormone Research in Paediatrics | volume = 92 | issue = 3 | pages = 143–149 | date = 2019 | pmid = 31918426 | doi = 10.1159/000502902 | s2cid = 210131881 | doi-access = free }}</ref> 6% of women with Turner syndrome have regular menstrual cycles; the rest experience primary or secondary [[amenorrhea]] or other menstrual dysfunction.<ref name="Klein et al Estrogen Replacement in Turner Syndrome">{{cite book |doi=10.1007/978-3-030-34150-3_5 |chapter=Estrogen Replacement in Turner Syndrome |title=Turner Syndrome |date=2020 |last1=Klein |first1=Karen O. |last2=Rosenfield |first2=Robert L. |last3=Santen |first3=Richard J. |last4=Gawlik |first4=Aneta M. |last5=Backeljauw |first5=Philippe |last6=Gravholt |first6=Claus H. |last7=Sas |first7=Theo C. J. |last8=Mauras |first8=Nelly |pages=93–122 |isbn=978-3-030-34148-0 }}</ref>{{rp|84}}

In girls with Turner syndrome who do not experience spontaneous puberty, [[exogenous]] estrogen is used to induce and maintain feminization. Estrogen replacement is recommended to begin at around age 11–12, although some parents prefer to delay the induction of puberty in girls with lower social and emotional preparedness. The dose of estrogen in induced puberty begins at 10% of adult estrogen levels and is steadily increased at six-month intervals, with a full adult dose attained two to three years after the beginning of treatment. Estrogen replacement may interfere with growth hormone therapy, due to the closing effects of estrogen on growth plates; individuals must weigh up their preferences for taller height versus greater feminization.<ref name="Klein et al Estrogen Replacement in Turner Syndrome" />{{rp|97–103}}