How do you initiate oestrogen therapy in a girl who has not undergone puberty?

Summary The physiology of puberty needs to be taken into consideration in the induction of puberty. Puberty is a relatively slow process and replacement therapy should mimic this. Long‐term maintenance requires careful monitoring and long‐term assessment of risk‐benefit. This has not been appreciably defined in the adolescent population. Options for fertility need careful consideration and may depend on the adequacy of pubertal induction in terms of uterine development. A number of regimens are available for pubertal induction but the lack of comparisons makes it difficult to advocate for a particular regimen. There remain a number of areas of uncertainty, and future studies need to consider these issues and whether there are cardiovascular risk factor advantages to certain preparations. The long‐term risks of breast and gynaecological malignancy remain uncertain. Long‐term cohort studies are required to address these issues.