AFAICT, spermarche occurs at variable Tanner stages, but often not prior to Tanner stage 3; menarche is typically at Tanner stage 4. I keep trying to not throw myself back into this because there is absolutely nothing for me to gain here, but it is what it is.
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Thanks. Changing my mind towards "the guidelines permit transition early enough that the tradeoff with fertility is in fact quite absolute; few transitions actually occur that early but that does not seem to be because guidelines discourage it". WIll email study authors re >=T2.
Curious why you think few transitions happen that early? Presumably not because of this study? I'm finding a number of clinical refs that argue for intervention as close to Tanner 2 as possible & having a hard time finding arguments in favor of delay. Fertility rarely discussed.
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The average age in the study was 15, which is part of why the T3 or later interpretation seems so likely to me. I think that even if the guidelines say ASAP, in practice wheels grind slowly, and as you observed many clinics do wait for T3.
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(There's a general phenomenon in medicine where actual practitioners who've seen lots of patients are often behaving quite sensibly, especially if they cannot be sued for delaying, which afaik they cannot, even if the officially written rules would not be sensible as written.)
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