Context. Pediatric management of patients with Turner syndrome focuses on height, frequently resulting in a delay of pubertal induction. The influence of pubertal management on psychosocial adjustment and sex life has not been evaluated in Turner syndrome patients.

Objective. To identify the determinants of self-esteem, social adjustment and initiation of sex life in patients with Turner syndrome, particularly those related to pubertal management.

Design. Prospective evaluation, the StaTur study.

Setting. Population-based registry of growth hormone-treated patients.

Participants. 566 young adult women with Turner syndrome, aged 22.6 ± 2.6 yr, range 18.3/31.2.

Main outcome measures. Coopersmith's Self-Esteem Inventory (SEI), Social Adjustment Scale Self-Report (SAS-SR), questions on sexual experience and extensive data on pediatric management.

Results. Low self-esteem was associated with otological involvement and limited sexual experience. Low social adjustment was associated with lower paternal socioeconomic class and an absence of sexual experience. Late age at first kiss or date was associated with cardiac involvement and a lack of spontaneous pubertal development. Age at first sexual intercourse was related to age at puberty and to paternal socioeconomic class. Delayed induction of puberty had a long lasting effect on sex life. Height and height gain due to growth hormone treatment had no effect on outcomes.

Conclusion. Puberty should be induced at a physiologically appropriate age in patients with Turner syndrome, to optimize self-esteem, social adjustment and initiation of the patient's sex life. Therapeutic interventions altering normal pubertal development in other groups of patients should be reconsidered in light of these findings.