A three-year-old girl was triggered to enter precocious puberty following exposure to her trans-identified father’s “gender affirming” topical estrogen gel. The toddler was seen by pediatric endocrinologists after experiencing breast development and vaginal discharge over a time frame of six months.
The father, a male who identifies as a “woman,” told clinicians that he was having daily skin-to-skin contact with the toddler girl, despite his daily application of estradiol gel 3.75mg to his chest, abdomen, shoulders, and thighs. He had previously been using an estradiol spray on his forearms only.
A case study, first published in the European Society for Pediatric Endocrinology in 2023, describes the toddler’s exposure to her father’s synthetic hormones as “inadvertent.”
According to the study, a “physical examination of the girl revealed a Tanner stage III for breast and Tanner stage I for pubic hair development. Height was 108.1 cm (+3,2 SD), weight 19.7 kg (+0,54 SD) and bone age advanced to 6.9 years (Greulich and Pyle). Pelvic ultrasound demonstrated increased size for age of both uterus and endometrium corresponding to Tanner stage III-IV.”
The Tanner stages refer to a puberty classification system that ranges from I, pre-pubertal, to V, which represents the final adult stage.
At Tanner III, a girl’s breasts are described as having “breast tissue palpable outside of the areola, [with] no areolar development.” Precocious puberty is defined as the onset of any Tanner stage II secondary sex characteristics prior to age 8 in girls, or 9 in boys.
Reviewing the case, developmental biologist Emma Hilton noted on X that the toddler girl was “just about ready for a training bra. Normal for a 10-to-12-year-old.” She also noted that the toddler’s “uterus development was approaching Tanner stage 4. That’s period territory.”
Basically, a male slathering himself in estrogen gel has, via skin-skin contact, induced early puberty in his 3-year-old daughter.
— Emma Hilton (@FondOfBeetles) July 18, 2025
🚩The daughter had Tanner stage 3 breasts. Just about ready for a training bra. Normal for a 10-to-12-year-old.
🚩She was 108cm/3'7'' height.… https://t.co/8ZV2JEFFvF pic.twitter.com/Ftia1fKJjh
From the case study, it appears that the girl’s condition was reversed when the exposure to her father’s medication stopped.
“The hormone therapy of the father was changed from a gel to a transdermal patch, and the girl experienced regression of breast development, normalization of growth velocity, pelvic ultrasound and GnRH stimulation test,” reads the case study.
Hilton, again posting to X, said that it may not be so simple: “And another note: his daughter’s precocious puberty ‘receded’ after exposure to estrogen was stopped. The assumption is that all is now ‘reset.’- I’d advocate caution there,” she wrote.
In another post, she told an X user that she is unsure if the girl will go on to experience a “normal” or “second” puberty, or if she will remain taller for her age. “I’m not sure there can be answer to that. It’s possibly unprecedented,” posted Hilton.
The case study concludes that the father must not have known the risks of exogenous estradiol exposure to his 3-year-old girl.
“Transgender persons should be thoroughly informed of the risk of transmission of transdermal hormones and be advised to wash hands, use gloves and avoid skin contact shortly after hormone application. Patients with children must be warned of the risk and Gender Clinics should consider the possibility of prescribing alternative routes of administration such as tablets or patches in high-risk patients.”
No follow up to the case study has been published since.
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