Women With Turner Syndrome Are Both Estrogen and Androgen Deficient: The Impact of Hormone Replacement Therapy

J Clin Endocrinol Metab. 2022 Jun 16;107(7):1983-1993. doi: 10.1210/clinem/dgac167.


Context: Women with Turner syndrome (TS) suffer from hypergonadotropic hypogonadism, causing a deficit in gonadal hormone secretion. As a consequence, these women are treated with estrogen from the age of 12 years, and later in combination with progesterone. However, androgens have been given less attention.

Objective: To assess sex hormone levels in women with TS, both those treated and those nontreated with hormone replacement therapy (HRT), and investigate the impact of HRT on sex hormone levels.

Methods: At Aarhus University Hospital, 99 women with TS were followed 3 times from August 2003 to February 2010. Seventeen were lost during follow-up. Control group 1 consisted of 68 healthy age-matched control women seen once during this period. Control group 2 consisted of 28 young, eumenorrheic women sampled 9 times throughout the same menstrual cycle. Serum concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH), 17β-estradiol, estrone sulfate, DHEAS, testosterone, free androgen index, androstenedione, 17-OH progesterone, and sex hormone-binding globulin (SHBG) were analyzed.

Results: All androgens, 17-OH progesterone, and sex hormone-binding globulin (SHBG) were 30% to 50% lower in TS compared with controls (P < 0.01). FSH, LH, and estrone sulfate were more than doubled in women with TS compared with controls (P < 0.02). Using principal component analysis, we describe a positive correlation between women with TS receiving HRT, elevated levels of SHBG, and decreased levels of androgens.

Conclusion: The sex hormone profile in TS reveals a picture of androgen deficiency, aggravated further by HRT. Conventional HRT does not normalize estradiol levels in TS.

Trial registration: ClinicalTrials.gov NCT01678274.

Keywords: Turner syndrome; androgen; estrogen; sex hormones.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Androgens* / deficiency
  • Estradiol
  • Estrogens* / deficiency
  • Female
  • Follicle Stimulating Hormone
  • Gonadal Steroid Hormones / therapeutic use
  • Hormone Replacement Therapy*
  • Humans
  • Luteinizing Hormone
  • Progesterone / therapeutic use
  • Sex Hormone-Binding Globulin / analysis
  • Testosterone
  • Turner Syndrome* / drug therapy


  • Androgens
  • Estrogens
  • Gonadal Steroid Hormones
  • Sex Hormone-Binding Globulin
  • Testosterone
  • Progesterone
  • Estradiol
  • Luteinizing Hormone
  • Follicle Stimulating Hormone

Associated data

  • ClinicalTrials.gov/NCT01678274