Body Image Dissatisfaction and Hormonal Therapy Effects in Indonesian Females with Turner Syndrome

  • Dinda Tiara Firdaus Graduate School of Biomedical Science, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
  • Annastasia Ediati Faculty of Psychology, Universitas Diponegoro, Semarang, Indonesia
  • Achmad Zulfa Juniarto Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
DOI: https://doi.org/10.56338/mppki.v9i3.8970
Keywords: Turner Syndrome, Sex Chromosome Disorders, Body Image, Body Dissatisfaction, Hormone Replacement Therapy

Abstract

Introduction: Turner Syndrome (TS) is a genetic disorder that impairs the development of secondary sexual characteristics and may negatively affect body image. Hormonal therapy is administered to stimulate puberty, but its impact on body image remains inconclusive. Data from Indonesia is still limited. This study aims to analyze the differences in body image assessment between females with and without TS, and to evaluate the relationship between the duration of hormonal therapy and body image perception in females with TS.

Methods: A cross-sectional case-control study was conducted at CEBIOR, Faculty of Medicine, Diponegoro University. Twenty-eight females with TS, aged 14-31 years, participated. Body image was assessed using a validated questionnaire, and secondary sexual characteristics were evaluated using the Tanner stage. Data were analyzed using the Mann-Whitney U test and Spearman's correlation.

Results: The mean Tanner stage was increased from 3.6 ± 1.1 to 6.2 ± 2.7 after hormonal therapy. No significant difference in overall body image dissatisfaction was found between females with TS and controls (MdnTS = 74.5 [34–120]; MdnC = 68.0 [31–109]; p = 0.512). However, females with TS showed significantly higher dissatisfaction scores in the sexual domain (MdnTS = 11 [4–20]; MdnC = 7.5 [4–16]; p = 0.013) and in height–weight perception (MdnTS = 7 [3–10]; MdnC = 6 [2–8]; p = 0.014). No significant correlation was found between therapy duration and body image scores, although a weak negative trend was observed for height–weight perception (r = –0.373; p = 0.051).

Conclusion: Hormonal therapy increased Tanner stage but did not reduce overall body image dissatisfaction. Females with TS reported greater dissatisfaction in specific domains. These findings suggest that psychosocial interventions are crucial for enhancing body image and overall well-being in this population.

References

Hutaff-Lee C, Bennett E, Howell S, Tartaglia N. Clinical developmental, neuropsychological, and social–emotional features of Turner syndrome. Am J Med Genet C Semin Med Genet. 2019;181:126–34. Available from: https://doi.org/10.1002/ajmg.c.31687

Department/SMF of Pediatric Health Sciences, Faculty of Medicine, Airlangga University, Dr. Soetomo Hospital, Surabaya. Pendekatan praktis perawakan pendek pada anak. 1st ed. Surabaya: Fakultas Kedokteran Universitas Airlangga; 2019.

Shankar Kikkeri N, Nagalli S. Turner Syndrome In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554621/

Winarni TI, Ep Mundhofir F, Faradz MH. The role of SHOX gene in short stature of Turner syndrome and its variant. Media Med Indones. 2010;44(2):57–61. Available from: https://ejournal.undip.ac.id/index.php/mmi/article/view/21834

Gravholt CH, Andersen NH, Christin-Maitre S, Davis SM, Duijnhouwer A, Gawlik A, et al. Clinical practice guidelines for the care of girls and women with Turner syndrome: Proceedings from the 2023 Aarhus International Turner Syndrome Meeting. Eur J Endocrinol. 2024;190(Suppl 1):G53–151.

van de Grift TC, Cohen-Kettenis PT, de Vries ALC, Kreukels BPC. Body image and self-esteem in disorders of sex development: A European multicenter study. Health Psychol. 2018;37(4):334–43. Available from: https://doi.org/10.1037/hea0000600

Granero-Molina J, Román RA, del Mar Jiménez-Lasserrotte M, Ruiz-Fernández MD, Ventura-Miranda MI, Granero-Heredia G, et al. “I’m still a woman”: A qualitative study on sexuality in heterosexual women with Turner syndrome. J Clin Nurs. 2023;32(17–18):6634–47. Available from: https://doi.org/10.1111/jocn.16715

Bornioli A, Lewis-Smith H, Slater A, Bray I. Body dissatisfaction predicts onset of depression among adolescent females and males: A prospective study. J Epidemiol Community Health. 2021;75(4):343–8. Available from: https://doi.org/10.1136/jech-2019-213033

Gupta M, Zubiar F, Gupta N. Turner syndrome and the risks of clinical depression in adolescence. Cureus. 2021;13(11):e19204. Available from: https://doi.org/10.7759/cureus.19204

Rengga OL, Soetjiningsih CH. Body image ditinjau dari jenis kelamin pada masa dewasa awal. Philanthropy J Psychol. 2022;6(1):1–12. Available from: https://doi.org/10.26623/philanthropy.v6i1.4851

Carel JC, Elie C, Ecosse E, Tauber M, Léger J, Cabrol S, et al. Self-esteem and social adjustment in young women with Turner syndrome: Influence of pubertal management and sexuality. J Clin Endocrinol Metab. 2006;91(8):2972–9. Available from: https://doi.org/10.1210/jc.2005-2652

Lagrou K, Froidecoeur C, Verlinde F, Craen M, De Schepper J, François I, et al. Psychosocial functioning, self-perception, and body image in GH- and estrogen-treated young adult women with Turner syndrome. Horm Res Paediatr. 2006;66(6):277–84. Available from: https://doi.org/10.1159/000095547

Vijayakanthi N, Marcus DJ, Fritz SP, Xiang Y, Fadoju D. Body image, self-perception, and satisfaction among girls with Turner syndrome. J Clin Endocrinol Metab. 2022;107(4):E1382–9. Available from: https://doi.org/10.1210/clinem/dgab889

Viuff MH, Berglund A, Juul S, Andersen NH, Stochholm K, Gravholt CH. Sex hormone replacement therapy in Turner syndrome: Impact on morbidity and mortality. J Clin Endocrinol Metab. 2020;105(2):e825–35. Available from: https://doi.org/10.1210/clinem/dgz039

Cragg SJ, Lafreniere KD. Effects of Turner syndrome on women’s self-esteem and body image. J Dev Phys Disabil. 2010;22:433–45. Available from: https://doi.org/10.1007/s10882-009-9178-0

Novina N, Sumapraja K, Gunardi H, Pulungan AB. Association between karyotype, puberty stage, and reproductive organ volume in Turner syndrome. J South Asian Feder Obst Gynae. 2023;15(3):326–31. Available from: https://doi.org/10.5005/jp-journals-10006-225 3

Editorial Team. The latest Indonesian average is 2025, and the comparison with other countries. VOI. 2025 Nov 11 [cited 2025 Nov 25]. Available from: https://voi.id/en/info-sehat/532049

Mittal M, Gupta P, Kalra S, Bantwal G, Garg MK. Short stature: Understanding the stature of ethnicity in height determination. Indian J Endocrinol Metab. 2022;26(3):123-9. Available from: https://doi.org/130.10.4103/ijem.ijem_197_21

Yusof AA Bin, Chii MLS, Yusoff NIM, Kama RNIFRM, Raj JR, Ghani NAA, et al. Quality of life and body image disturbances in Turner syndrome patients in Malaysia: A cross-sectional study. BMC Womens Health. 2023;23:373. Available from: https://doi.org/10.1186/s12905-023-02745-x

Irzyniec T, Je? W, Lepska K, Maciejewska-Paszek I, Frelich J. Childhood growth hormone treatment in women with Turner syndrome: Benefits and adverse effects. Sci Rep. 2019;9:1–8. Available from: https://doi.org/10.1038/s41598-019-52332-0

Ediati A. Disorders of sex development in Indonesia: The course of psychological development in late-identified patients. [PhD dissertation]. Rotterdam: Erasmus University; 2014. Available from: http://hdl.handle.net/1765/50331

Balzer BWR, Garden FL, Amatoury M, Luscombe GM, Paxton K, Hawke CI, et al. Self-rated Tanner stage and subjective measures of puberty correlate with longitudinal hormone changes. J Pediatr Endocrinol Metab. 2019;32(6):569–76. Available from: https://doi.org/10.1515/jpem-2019-0017

Klein KO, Rosenfield RL, Santen RJ, Gawlik AM, Backeljauw PF, Gravholt CH, et al. Estrogen replacement in Turner syndrome: Literature review and practical considerations. J Clin Endocrinol Metab. 2018;103(5):1790–803. Available from: https://doi.org/10.1210/jc.2017-02183

Kardelen AD, ?ükür M, Özturan EK, Öztürk AP, Poyrazo?lu ?, Ba? F, et al. Body proportions in Turner syndrome on GH treatment. Turk J Med Sci. 2023;53:518–25. Available from: https://doi.org/10.55730/1300-0144.5612

Krantz E, Landin-Wilhelmsen K, Trimpou P, Bryman I, Wide U. Health-related quality of life in Turner syndrome and the influence of GH therapy: A 20-year follow-up. J Clin Endocrinol Metab. 2019;104(11):5073–83. Available from: https://doi.org/10.1210/jc.2019-00340

B?aszczyk E, Shulhai AM, Gieburowska J, Bara?ski K, Gawlik AM. Components of metabolic syndrome in girls with Turner syndrome receiving long-term GH: A prospective study. Front Endocrinol. 2023;14:1216464. Available from: https://doi.org/10.3389/fendo.2023.1216464

Tarantino C, Vincenzi L, Angelini F, Tomaselli A, Carlomagno F, Rosato E, et al. Karyotype, hormones, sexuality, and body image perception in individuals with Turner syndrome. J Endocrinol Invest. 2025;48:1225–36. Available from: https://doi.org/10.1007/s40618-024-02521-0

Budiati AC. Aktualisasi diri perempuan dalam sistem budaya jawa: persepsi perempuan terhadap nilai-nilai budaya Jawa dalam mengaktualisasikan diri. Pamator [Internet]. 2010;3(1):52–59. [cited 2025 Nov 28]. Available from: https://ejournal.uin-suska.ac.id/index.php/marwah/article/view/28712

Rahmi SW. Images of Javanese women in patriarchal culture represented by Aisyah (a character in Umar Kayam’s Para Priyayi). In: Proceedings International Joint Conference on Science and Technology (IJCST); 2017. p. 112–8. [cited 2025 Nov 28]. Available from: https://ojs.pnb.ac.id/index.php/proceedings/article/view/958

Gravholt CH. Turner syndrome, sexology, quality of life, depression, anxiety and medicinal treatment—untangling the intricacies. [Master’s thesis]. Aalborg: Aalborg University; 2018 .

Published
2026-03-03
How to Cite
Firdaus, D. T., Ediati, A., & Juniarto, A. Z. (2026). Body Image Dissatisfaction and Hormonal Therapy Effects in Indonesian Females with Turner Syndrome . Media Publikasi Promosi Kesehatan Indonesia (MPPKI), 9(3), 594-606. https://doi.org/10.56338/mppki.v9i3.8970
Issue
Vol. 9 No. 3 (2026): March 2026
Section
Article

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