Puberty happens because of hormones produced by the ovaries. The main hormone produced by the ovaries is called oestrogen which is released into the blood. Ovaries, in turn, are controlled by hormones from the pituitary gland called gonadotrophins (Luteinizing Hormone, LH for short, and Follicle Stimulating Hormone, FSH for short) which travel in the blood to the ovaries.
So normally your LH and FSH go up and your ovaries start to make oestrogen then you start puberty. Eventually a few years after starting puberty you have some bleeding from your uterus which is the start of your periods. Oestrogen also has other jobs like keeping your bones healthy. Women keep producing oestrogen (and having periods) until they are around 50 years of age.
Not going into puberty or not having periods is something that mostly but not always happens in TS therefore there is a focus on making sure you go through puberty normally and have regular periods. Most of you will be started on or are already taking medication containing oestrogen.
Why will I most likely have a problem going through puberty?
In TS your ovaries often don’t work properly and it is your ovaries that make oestrogen and it is oestrogen that takes you through puberty and gives you periods.
How will I know if my ovaries don’t work properly?
If your ovaries are not working properly the first thing you will notice will be not going into puberty, the first sign is starting to develop breasts which usually happens by the age of 13. Girls go into puberty at different times so you may notice that other girls at school are developing even from the age of 8. If you manage to start puberty the first thing you might notice is not starting periods which usually happens by the age of 15 or your periods may start then stop.
The doctors can also do some blood tests and check your gonadotrophins (Luteinizing hormone, LH for short, and follicle stimulating hormone, FSH for short), if these are higher than they should be it means that your ovaries are not working properly. They would usually check this around the age of 12.
What will help me go through puberty?
It is easy to give you the oestrogen back that your ovaries are not making to help you go through puberty, it often comes as a small tablet that has to be taken every day or maybe a patch. The doctors try and do exactly what the body would do and start at low doses and increase them very gradually over several years until you are mostly through puberty.
At some point when you are on a higher dose of oestrogen they will add in progesterone (another hormone also normally made by the ovaries) or start you on a tablet that has both oestrogen and progesterone in it. This will give you periods. The tablet with both might either be the oral contraceptive pill and hormone replacement therapy, sometimes you may be offered a patch.
Try and find ways to make it easy for you to remember. Your doctor will check the dose is right for you by seeing how you are progressing through puberty and whether you are having periods and how you feel (so tell them). Later on they may check with a scan that your uterus or womb has grown or that your bones are healthy.