In the current study, we addressed our previous shortcomings and evaluated a cohort of 159 genetically confirmed female FD patients from six Fabry centers (five German centers, one Swiss center) with well-characterized clinical phenotypes at three time points to assess the implementation of current FD guidelines for treatment initiation with agalsidase-alfa or agalsidase-beta (Supplemental Table 1), the clinical impact of ERT in affected females and the disease course in untreated females over time. This evidence concerns the gene GLA and Fabry disease.