During adolescence, the human body undergoes various physical, physiological and immunological changes triggered and mediated by hormones, of which the most significant in females is 17-β-oestradiol (an oestrogen) and, in males, is testosterone. Oestradiol usually begins to act around the age of 10 and testosterone some months later. There is evidence that these steroids act directly not only on the primary and secondary sexual characteristics but also have an effect on the development and regulation of the immune system, including an increased risk in developing pubescent and post-pubescent autoimmunity. There is also some evidence that cell surface receptors on B cells and macrophages may detect sex hormones in the system.

What is the primary trigger for immunological changes in teens?