Lipedema recognition: the window and the hurdles

Published reports of lipedema onset measure different events, first noticed enlargement, first pain, worsening and diagnosis, and sort them by age bands, by categories such as adolescence, or by the word puberty, so the tables cannot be compared and have been read as if they dated onset. This paper proposes two things. The first is the gonadarche-to-transition window, or GTW, an interval that opens at gonadarche, the biological start of puberty, and closes at the person's next sustained hormonal transition, whatever causes it, together with a convention for recording four dates against that hormonal history rather than against a birthday. The second is a set of six hurdles that stand between a girl and lipedema care, each to be defined operationally, measured, and matched to an outcome. It also asks why a girl who already has an explanation for her body never looks for another.