Stage 1 (Induction of breast development): Initial breast development is induced using low doses of estrogen for 6 to 12 months. The breast induction phase can also be done up to 12 to 24 months depending on age, height, and bone age. For example, combined estrogens (Pemeril) 0.3 mg or estradiol valerate (Tegretol) 0.5 mg or estradiol skin patches 5, 10 and 25 mg. Phase II (Establishment of normal menstruation and normal bone mineralization): Promotion of ovarian development and induction of menstruation. Use conjugated estrogen (Pemetrix) 0.625 mg or estradiol valerate (Tegretol) 1 mg or estradiol skin patch 50 mg. Note: The timing of estrogen dose adjustment needs to be determined by bone age, expected height and the patient’s need for rapid breast development. It is recommended that progestin should be added briefly for the initial 5 days per month at 2 to 3 months of Phase II estrogen dosing; after 6 months of full breast development, progestin use can be increased to 10 days and eventually 12 to 14 days to best protect the endometrium. Stage 3 (long-term maintenance of normal estrogen levels): Daily estrogen: 0.625 mg of combined estrogen (Bemisil) or 1 mg of estradiol valerate (Tegretol) or 50-100 mg of estradiol skin patch daily, plus progestin for 12-14 days per month, or estrogen and progestin sequential hormones (e.g. Bemisil, Finmarton, estrogen and progestin skin patch or oral contraceptives). Note: Adolescent patients, especially those with estrogen deficiency, should receive 1300mg of calcium and a minimum of 400iu VitD (daily multivitamin) daily from diet or supplements.