There is considerable controversy over the earliest age at which it is clinically, morally, and legally safe to use GnRH analogues, and for how long. The sixth edition of the World Professional Association for Transgender Health 's Standards of Care permit it from Tanner stage 2 but do not allow the addition of hormones until age 16, which could be five or more years later. Sex steroids have important functions in addition to their role in puberty, and some skeletal changes (such as increased height) that may be considered masculine are not hindered by GnRH analogues.
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Abstract In order to examine whether the anabolic steroid oxandrolone has any long-term effect on height in Turner syndrome, the short- and long-term effects were studied in a group of 35 individuals with the syndrome. At commencement of treatment, age range was –16 years (mean ); oxandrolone dosage was - mg/kg per day (mean mg/kg per day) and continued for 12 months-6 years (mean 33 months), ending at 12– years (mean years). Height velocity increased significantly on therapy from ± to ± cm/year at 6 and 12 months, and maintained at ± cm/year by two years (all P <). Girls who were younger and whose bone age was delayed grew faster ( P <). Oxandrolone dose correlated with height velocity at 12 ( r = , P <) and 18 months ( r = , P <). Both height standard deviation score (SDS) and estimated mature height (EMH) increased significantly by the end of treatment (- ± , and to ± , and ± cm to ± cm respectively (both P <). in 23 patients who had completed growth at a mean age of ± years, final height was ± cm. This was not significantly different from EMH of ± cm at the end of therapy, and based on a pre-treatment EMH of ± cm, represented a mean height gain of 5 cm. Furthermore, based on height SDS for Turner syndrome at age 18 of ± , compared with pre-treatment height SDS of - ± , there was an increased SDS by the end of therapy of , equivalent to 4–5 cm. Side effects of oxandrolone were minor and infrequent, limited to increased muscularity and some degree of voice deepening. It is concluded that in Turner syndrome use of the anabolic steroid oxandrolone: (i) increases height velocity for up to 2 years of treatment; (ii) increases final height by 4–5 cm, based on both bone age EMH prediction and use of height standard deviation scores; (iii) is associated with reliable prediction of final height at end of therapy using Greulich-Pyle/ayley-Pinneau methods. Oxandrolone is an effective, economic, safe and well-tolerated promoter of growth in Turner syndrome.