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Hormone Levels During Normal Puberty in Cisgender Girls

By Aly W. | First published April 29, 2020 | Last modified August 6, 2021

Preface

This is a collection of published data on hormone levels throughout normal puberty in cisgender girls. Levels of estrogens (estradiol and estrone), progesterone, and androgens are included. Data are limited to those determined with mass spectrometry-based analytic techniques wherever available.

Estrogen Levels

Esoterix/LabCorp (2020)

Esoterix/LabCorp. (2020). Endocrinology Expected Values and S.I. Unit Conversion Tables. [PDF]:

Table: Estradiol and estrone levels in cisgender girls and women (HPLC–MS/MS):

  Estradiol Estrone 
Life stageAge (years)Mean (pg/mL)Range (pg/mL)Mean (pg/mL)Range (pg/mL)
Tanner stage 1<9.28.05.0–20134.0–29
Tanner stage 29.2–13.71610–242110–33
Tanner stage 310.0–14.4257.0–603015–43
Tanner stage 410.7–15.64721–853616–77
Tanner stage 511.8–18.611034–1706129–105
Adult follicular>18.0?30–100?30–100
Adult luteal>18.0?70–300?90–160

Figure: Mean (± ref. range) estradiol and estrone levels in normal female puberty (HPLC–MS/MS):

Frederiksen et al. (2020)

Frederiksen, H., Johannsen, T. H., Andersen, S. E., Albrethsen, J., Landersoe, S. K., Petersen, J. H., … & Main, K. M. (2020). Sex-specific estrogen levels and reference intervals from infancy to late adulthood determined by LC-MS/MS. The Journal of Clinical Endocrinology & Metabolism, 105(3), 754–768. [DOI:10.1210/clinem/dgz196]

The graphs below were created from analysis of this study by Sam S.

Figure: Mean (± SD) estradiol and estrone levels in normal female puberty (LC–MS/MS):

Figure: Median (± SD) estradiol and estrone levels in normal female puberty (LC–MS/MS):

The lower estradiol and estrone levels in TS5 relative to TS4 are likely due to sampling error.

Kushnir et al. (2008)

Kushnir, M. M., Rockwood, A. L., Bergquist, J., Varshavsky, M., Roberts, W. L., Yue, B., … & Meikle, A. W. (2008). High-sensitivity tandem mass spectrometry assay for serum estrone and estradiol. American Journal of Clinical Pathology, 129(4), 530–539. [DOI:10.1309/LC03BHQ5XJPJYEKG]

Table: Estradiol and estrone levels in cisgender girls and women (LC–MS/MS):

 EstradiolEstrone
Life stage or age (years)Ref. range (pg/mL)Ref. range (pg/mL)
Tanner stage 1<55<26
Tanner stage 22–1331–39
Tanner stage 312–2778–117
Tanner stage 4/52–2594–109
Before menarche1–84<41
After menarche3–2644–113
7–9 years<35<25
10–12 years<87<42
13–15 years9–2488–105
16–17 years2–2664–133
Postmenopausal (41–63 years)2–213–32

Figure: Median estradiol and estrone levels around puberty in cisgender girls (LC–MS/MS):

It should be noted that this study has been criticized (Ankarberg-Lindgren & Norjavaara, 2009a; Ankarberg-Lindgren & Norjavaara, 2009b).

Janfaza et al. (2006)

Janfaza, M., Sherman, T. I., Larmore, K. A., Brown-Dawson, J., & Klein, K. O. (2006). Estradiol levels and secretory dynamics in normal girls and boys as determined by an ultrasensitive bioassay: a 10 year experience. Journal of Pediatric Endocrinology and Metabolism19(7), 901–910. [DOI:10.1515/JPEM.2006.19.7.901]:

Table: Estradiol levels in 375 cisgender girls (RCBA—ultrasensitive recombinant cell bioassay):

Pubertal stagenMean age (years)Mean estradiol (pg/mL)Estradiol range (pg/mL)
11478.7 ± 1.71.6 ± 2.6<0.02–18
26811.1 ± 1.16.9 ± 1.1<0.02–40
35511.9 ± 1.123 ± 33<0.02–147
46813.4 ± 1.427 ± 380.10–270
53715.0 ± 1.648 ± 650.49–306

Madsen et al. (2020)

Madsen, A., Bruserud, I. S., Bertelsen, B. E., Roelants, M., Oehme, N. H. B., Viste, K., … & Sagen, J. V. (2020). Hormone references for ultrasound breast staging and endocrine profiling to detect female onset of puberty. The Journal of Clinical Endocrinology & Metabolism, 105(12), dgaa679. [DOI:10.1210/clinem/dgaa679]:

Table: Estradiol and estrone levels in cisgender girls (LC–MS/MS):

Estradiol (pg/mL)Estrone (pg/mL)
Tanner stagenMedianRange (2.5–97.5%)MedianRange (2.5–97.5%)
B12601.30.24–103.81.2–10
B2696.51.6–569.23.5–32
B363–66251.2–77213.2–52
B473–78487.1–2193211–108
B576–814113–2683615–129

Other Studies

  • Courant, F., Aksglaede, L., Antignac, J. P., Monteau, F., Sorensen, K., Andersson, A. M., … & Bizec, B. L. (2010). Assessment of circulating sex steroid levels in prepubertal and pubertal boys and girls by a novel ultrasensitive gas chromatography-tandem mass spectrometry method. The Journal of Clinical Endocrinology & Metabolism, 95(1), 82–92. [DOI:10.1210/jc.2009-1140]
  • Biro, F. M., Pinney, S. M., Huang, B., Baker, E. R., Walt Chandler, D., & Dorn, L. D. (2014). Hormone changes in peripubertal girls. The Journal of Clinical Endocrinology & Metabolism, 99(10), 3829–3835. [DOI:10.1210/jc.2013-4528]
  • Ankarberg-Lindgren, C., Dahlgren, J., & Andersson, M. X. (2018). High-sensitivity quantification of serum androstenedione, testosterone, dihydrotestosterone, estrone and estradiol by gas chromatography–tandem mass spectrometry with sex-and puberty-specific reference intervals. The Journal of Steroid Biochemistry and Molecular Biology, 183, 116–124. [DOI:10.1016/j.jsbmb.2018.06.005]
    • Has estrone sulfate levels in the different Tanner breast stages.
  • Bae, Y. J., Zeidler, R., Baber, R., Vogel, M., Wirkner, K., Loeffler, M., … & Kratzsch, J. (2019). Reference intervals of nine steroid hormones over the life-span analyzed by LC-MS/MS: Effect of age, gender, puberty, and oral contraceptives. The Journal of Steroid Biochemistry and Molecular Biology, 193, 105409. [DOI:10.1016/j.jsbmb.2019.105409]

Progesterone Levels

Esoterix/LabCorp (2020)

Esoterix/LabCorp. (2020). Endocrinology Expected Values and S.I. Unit Conversion Tables. [PDF] [Alt] [Alt]:

Table: Progesterone levels in cisgender girls and women (HPLC–MS/MS):

Life stage / age (years)Range (ng/mL)
<10 years≤0.26
11 years≤2.6
12 years≤8.6
13 years≤6.9
14 years≤12.0
15 years≤10.8
16 years≤12.9
Adult early follicular (days 1–6)≤0.17
Adult late follicular (days 7–12)≤1.4
Adult mid-cycle (days 13–15)≤15.6
Adult luteal (days 16–28)*≤25.6
Postmenopausal≤0.10
Pregnancy first trimester6.3–45.5
Pregnancy second trimester15.4–52.1
Pregnancy third trimester25.0–99.9
  • Note: Luteal progesterone peaked from 3.5 to 37.5 ng/dL ranging on cycle days 17 to 23.

Progesterone levels in males: ≤0.15 ng/mL (age 1–16 years) and ≤0.11 ng/mL (adult).

Quest Diagnostics (2007)

Fisher, D. A., Quest Diagnostics, Nichols Institute (2007). The Quest Diagnostics Manual: Endocrinology: Test Selection and Interpretation, 4th Edition. [PDF] [Alt PDF] [Alt]:

Table: Progesterone levels in cisgender girls and women (LC–MS/MS):

Life stage / ageRange (ng/mL)
5–9 years≤0.6
10–13 years≤10.2
14–17 years≤11.9
Adult early follicular≤0.6
Adult late follicular≤14.5
Adult mid-cycle≤16.1
Adult luteal≤31.4
Postmenopausal≤0.2

Progesterone levels in males: ≤1.2 ng/mL (age 5–17 years) and ≤0.3 ng/mL (adult).

Wu (2006)

Wu, A. H. B. (2006). Tietz Clinical Guide to Laboratory Tests, 4th Edition. St Louis: WB Saunders Company. [PDF] [Alt]:

Table: Progesterone levels in cisgender girls and women (RIA):

Life stageRange (ng/dL)
Tanner stage 1≤0.33
Tanner stage 2≤0.55
Tanner stage 3≤4.5
Tanner stage 4≤13.0
Tanner stage 5≤9.5
Adult follicular0.15–0.70
Adult luteal2.0–25.0
Adult postmenopausal≤0.40
Pregnancy first trimester10.3–44.0
Pregnancy second trimester19.5–82.5
Pregnancy third trimester65.0–229.0

Progesterone levels in males: <0.10–1.1 ng/mL (age 1–10 years + puberty) and 0.13–0.97 ng/mL (adult).

Note that RIA gives less accurate and often overestimated values relative to MS-based techniques.

Other Studies

  • Ceglarek, U., Werner, M., Kortz, L., Körner, A., Kiess, W., Thiery, J., & Kratzsch, J. (2010). Preclinical challenges in steroid analysis of human samples. The Journal of Steroid Biochemistry and Molecular Biology, 121(3–5), 505–512. [DOI:10.1016/j.jsbmb.2010.03.039]

Androgen Levels

Esoterix/LabCorp (2020)

Esoterix/LabCorp. (2020). Endocrinology Expected Values and S.I. Unit Conversion Tables. [PDF]:

Table: Total testosterone levels in cisgender girls and women (HPLC–MS/MS):

Life stageAge (years)Mean (ng/dL)Range (ng/dL)
Tanner stage 1<9.24.9<2.5–10
Tanner stage 29.2–13.7187–28
Tanner stage 310.0–14.42515–35
Tanner stage 410.7–15.62213–32
Tanner stage 511.8–18.62820–38
Adult premenopausal>18.0?10–55
Adult postmenopausal⪆50 years?7–40

Table: Dihydrotesterone (DHT) levels in cisgender girls and women (HPLC–MS/MS):

Life stageAge (years)Mean (ng/dL)Range (ng/dL)
Tanner stage 1<9.2?<3
Tanner stage 29.2–13.785–12
Tanner stage 310.0–14.4127–19
Tanner stage 410.7–15.674–13
Tanner stage 511.8–18.693–18
Adult>18.0?4–22

Table: Androstenedione levels in cisgender girls and women (HPLC–MS/MS):

Life stageAge (years)Mean (ng/dL)Range (ng/dL)
Tanner stage 1<9.2<10<10–17
Tanner stage 29.2–13.73310–72
Tanner stage 310.0–14.49750–170
Tanner stage 410.7–15.610547–208
Tanner stage 511.8–18.613750–224
Adult premenopausal18–40 years?28–230
Adult postmenopausal⪆50 years?<10–93

Table: Dehydroepiandrosterone sulfate (DHEA-S) levels in cisgender girls/women (HPLC–MS/MS):

Life stageAge (years)Mean (ng/dL)Range (ng/dL)
Tanner stage 1<9.24019–144
Tanner stage 29.2–13.77234–129
Tanner stage 310.0–14.48832–226
Tanner stage 410.7–15.612058–260
Tanner stage 511.8–18.614844–248
Adult premenopausal18–50 years?17–372
Adult postmenopausal⪆50 years?<215

ARUP Laboratories (undated)

ARUP Laboratories. Testosterone, Free and Total (Includes Sex Hormone Binding Globulin), Females or Children. [URL] [Alt]:

Table: Total and free testosterone levels in cisgender girls and women (LC–MS/MS):

Life stage / ageTotal: Range (ng/dL)Free: Range (pg/mL)
Tanner stage 12–17 ng/dL<2.2
Tanner stage 25–40 ng/dL0.4–4.5
Tanner stage 310–63 ng/dL1.3–7.5
Tanner stage 411–62 ng/dL1.1–15.5
Tanner stage 511–62 ng/dL0.8–9.2
1–6 years<30 ng/dL<0.6
7–9 years1–11 ng/dL0.6–1.8
10–11 years3–32 ng/dL0.1–3.5
12–13 years6–50 ng/dL0.9–6.8
14–15 years6–52 ng/dL1.2–7.5
16–17 years9–58 ng/dL1.2–9.9
18–30 years9–55 ng/dL0.8–7.4
31–40 years9–55 ng/dL1.3–9.2
41–51 years9–55 ng/dL1.1–5.8
Postmenopausal5–32 ng/dL0.6–3.8

Other Studies

  • Kushnir, M. M., Rockwood, A. L., Roberts, W. L., Pattison, E. G., Bunker, A. M., Fitzgerald, R. L., & Meikle, A. W. (2006). Performance characteristics of a novel tandem mass spectrometry assay for serum testosterone. Clinical Chemistry, 52(1), 120–128. [DOI:10.1373/clinchem.2005.052167]
  • Kushnir, M. M., Blamires, T., Rockwood, A. L., Roberts, W. L., Yue, B., Erdogan, E., Bunker, A. M., & Meikle, A. W. (2010). LC-MS/MS assay for androstenedione, dehydroepiandrosterone and testosterone with pediatric and adult reference intervals. Clinical Chemistry, 56(7), 1138–1147. [DOI:10.1373/clinchem.2010.143222]