11
Table 8. Protocol Induction of Puberty
Induction of female puberty with oral 17β-estradiol, increasing the dose every 6 mo:
• 5 μg/kg/d
• 10 μg/kg/d
• 15 μg/kg/d
• 20 μg/kg/d
• Adult dose = 2–6 mg/d
In postpubertal transgender female adolescents, the dose of 17β-estradiol can be
increased more rapidly:
• 1 mg/d for 6 mo
• 2 mg/d
Induction of female puberty with transdermal 17β-estradiol, increasing the dose
every 6 mo (new patch is placed every 3.5 d):
• 6.25–12.5 μg/24 h (cut 25-μg patch into quarters, then halves)
• 25 μg/24 h
• 37.5 μg/24 h
• Adult dose = 50–200 μg/24 h
For alternatives once at adult dose, see Table 11
Adjust maintenance dose to mimic physiological estradiol levels (see Table 15)
Induction of male puberty with testosterone esters, increasing the dose every 6 mo
(IM or SC):
• 25 mg/m
2
/2 wk (or alternatively: half this dose weekly or double the dose every 4 wk)
• 50 mg/m
2
/2 wk
• 75 mg/m
2
/2 wk
• 100 mg/m
2
/2 wk
• Adult dose = 100–200 mg/2 wk
In postpubertal transgender male adolescents the dose of testosterone esters can
be increased more rapidly:
• 75 mg/2 wk for 6 mo
• 125 mg/2 wk
For alternatives once at adult dose, see Table 11
Adjust maintenance dose to mimic physiological testosterone levels (see Table 14).
Abbreviations : IM, intramuscular; SC, subcutaneous
Adapted from Hembree WC et al. J Clin Endocrinol Metab. 2009;94(9):3132–3154.
