Is a 12-year and 10-month-old patient with elevated estradiol (E2) levels, normal testosterone levels, slightly elevated Follicle-Stimulating Hormone (FSH) levels, and low Luteinizing Hormone (LH) levels, likely a female in puberty, and when can menarche be expected?

From the Guidelines

This patient is likely a biological female in early puberty, given the hormone levels and age. The estradiol level of 50 pg/mL, FSH of 4.19 mIU/mL, and LH of 1.24 mIU/mL are consistent with early pubertal development in females, as indicated by the activation of the hypothalamic-pituitary-gonadal axis 1. The testosterone level of 20 ng/dL is also within the normal range for pubertal females.

Key Points:

• The patient's hormone levels suggest early-to-mid puberty, with estradiol levels indicating the onset of puberty.
• The FSH and LH levels are consistent with the early activation of the hypothalamic-pituitary-gonadal axis, typical in female puberty 1.
• Menarche (first menstrual period) typically occurs about 2-2.5 years after the onset of breast development (thelarche), which is the first sign of puberty in females. Given the patient's age of 12 years and 10 months, the first period could be expected within the next 6-12 months, though this varies considerably between individuals, with the average age of menarche in the United States being approximately 12.5 years, and a normal range extending from 10 to 15 years. Regular monitoring of pubertal progression through physical examination and continued hormone level assessment would provide a more precise estimate for this specific patient.

From the Research

Hormone Levels

• The patient's estradiol level is 50, testosterone level is 20, FSH is 4.19, and LH is 1.24.
• According to 2, the normal reference range for FSH in males is 7.9-20.0, and for LH is 4.9-86.5, but these ranges may vary across laboratories.
• The patient's FSH and LH levels are within the lower end of the normal range for males, but it's essential to consider that these ranges may not be directly applicable to a 12-year-old female.

Puberty and Menstruation

• The patient's hormone levels suggest that they may be in the early stages of puberty, as indicated by the presence of estradiol and testosterone.
• However, the patient's FSH and LH levels are relatively low, which may indicate that they are not yet fully pubertal.
• According to 3, FSH concentrations are typically higher in girls than in boys during puberty, which may suggest that the patient is female.
• As for when the patient's period is expected to start, it's difficult to predict with certainty, but typically, menstruation begins 1-2 years after the onset of breast development and pubic hair growth.
• More research is needed to determine the exact timing of puberty and menstruation in this patient, considering their unique hormone levels and individual development.

Limitations and Considerations

• The provided studies primarily focus on adult populations or specific conditions, which may not be directly applicable to a 12-year-old female.
• Hormone levels and reference ranges can vary significantly across different laboratories and populations, making it challenging to interpret the patient's results.
• Further evaluation and consultation with a healthcare professional are necessary to determine the patient's pubertal status and predict when their period may start.