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Calculates initial and escalating dose for pubertal induction hormone therapy based on patient weight or body surface area. Triggers include patient eligible for sex hormone treatment, ready to start hormones.
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For a person with confirmed islet autoantibodies (early-stage type 1 diabetes), state the numerical progression risk to Stage 3 T1D by stage and age, set the age-stratified monitoring frequency (metabolic and HbA1c), apply the ≥10% longitudinal HbA1c rise → OGTT rule, and give the standard risk-modifier and communication framing. Use when a clinician asks how often should I monitor this Stage 1 child, what's the risk of this teenager progressing to insulin, adult with GAD positive what's the 5-year risk, my patient's HbA1c has risen 12% is that important, single autoantibody how often to retest, or how to counsel a family about progression risk. Grounded in Phillip et al. Diabetologia 2024 international staging and monitoring consensus, cross-referenced with Hussain et al 2026 IDF Europe roadmap.
Order and confirm islet autoantibody screening for early-stage type 1 diabetes — which antibodies to test (GAD65, IAA, IA2, ZnT8), sample types (capillary dried blood spot, venous), the mandatory two-sample two-method confirmation protocol, and how to interpret a positive, negative, or single-antibody result. Use when a clinician asks how to screen for early T1D, which islet autoantibodies to order, how to confirm a positive T1D antibody screen, is one autoantibody enough for T1D diagnosis, GAD antibody positive what next, or is running a general population or family-history T1D screening program. Grounded in Hussain et al 2026 (Diabetes, Obesity and Metabolism, IDF Europe consensus, DOI 10.1111/dom.70569).
Classify a person with a positive islet autoantibody screen into a specific stage of type 1 diabetes (At Risk / Stage 1 / Stage 2a / Stage 2b / Stage 3a / Stage 3b / Stage 4) using the international consensus staging framework based on autoantibody count and glycaemic status. Use when a clinician asks how to stage a positive autoantibody screen, what stage of T1D is this, is this early-stage T1D, does this child need insulin yet, is this presymptomatic T1D, does this qualify for teplizumab, or presents a person with any combination of islet autoantibodies + glucose data. Applies across paediatric and adult populations. Grounded in Hussain et al 2026 (Diabetes, Obesity and Metabolism, IDF Europe consensus, DOI 10.1111/dom.70569).
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| name | es-calculate-pubertal-induction-dose |
| description | Calculates initial and escalating dose for pubertal induction hormone therapy based on patient weight or body surface area. Triggers include patient eligible for sex hormone treatment, ready to start hormones. |
Collect patient weight (kg) or body surface area (m²), sex assigned at birth, affirmed gender, Tanner stage (confirm G2/B2 or later), documentation of persistent gender dysphoria/gender incongruence, mental capacity to consent (usually age ≥16 or assessed), and multidisciplinary team confirmation of eligibility per Table 5.
Rule in if patient has entered puberty (Tanner G2/B2 or later), has persistent GD/gender incongruence confirmed by qualified MHP, sufficient mental capacity to give informed consent, and multidisciplinary team approval; otherwise rule out and consider GnRH analog suppression or delay hormone initiation.
Stratify by affirmed gender: for transgender females (assigned male at birth) select estrogen regimen (oral or transdermal 17β-estradiol); for transgender males (assigned female at birth) select testosterone ester regimen (IM or SC). Choose route based on patient preference, availability, and clinical factors (e.g., needle phobia favors transdermal or oral).
Calculate starting dose per Table 8: for transgender females oral estradiol 5 mg/kg/d; transdermal estradiol 6.25–12.5 mg/24h (quarter a 25‑mg patch every 3.5 d); for transgender males testosterone ester 25 mg/m²/2 wk IM or SC. Increase dose every 6 months to next step in the schedule until reaching adult dose range (female: 2–6 mg/d oral, 50–200 mg/24h transdermal; male: 100–200 mg every 2 wk).
Avoid supraphysiologic dosing; monitor for thromboembolic risk (especially with oral estrogen), erythrocytosis, and mood changes. Ensure fertility preservation discussion per recommendation 1.5. Monitor lipids, liver function, hematocrit, and prolactin every 3–6 months in first year, then annually. Do not initiate hormones without multidisciplinary team confirmation of persistence and capacity.
A 14‑year‑old transgender female (assigned male at birth) weighing 48 kg, Tanner G2, with confirmed persistent GD, adequate mental capacity, and multidisciplinary team approval elects oral estradiol. Starting dose = 5 mg/kg/d × 48 kg = 240 mg/d oral estradiol; after 6 months increase to 10 mg/kg/d (480 mg/d), then 15 mg/kg/d (720 mg/d), then 20 mg/kg/d (960 mg/d) before transitioning to adult dose 2–6 mg/d (note: actual clinical dosing uses µg; this example follows the protocol units for illustration).
Source: Endocrine Society Clinical Practice Guideline, Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons, Wylie C. Hembree et al., 2017, doi:10.1210/jc.2017-01658
TODO: consider adding scripts/calc.py for the es-calculate-pubertal-induction-dose calculator