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Estrogen's history as a growth limiter

January 15, 2007|Susan Brink | Times Staff Writer

Using growth hormone to make short kids taller isn't the first time medicine has sought to manipulate the height of healthy children.

Estrogen treatment to halt female growth -- recently in the news because of a report about a Seattle family using medical interventions to stop the growth of their severely disabled daughter -- was used for decades beginning in the 1950s to slow the growth of healthy girls.

The recent controversial report centers on a girl known publicly only as Ashley and as the "pillow angel" -- her parents' name for her. The 9-year-old, treated at Seattle Children's Hospital, has been given estrogen therapy with the expectation that treatment will halt her growth at about 4 feet, 5 inches. Her parents say they made the decision to stop her growth so that the child, who cannot sit up, feed herself or speak, can remain at home with them through adulthood. They feared that if she grew taller and bigger they could no longer manage her care.

But at the midpoint of the 20th century, with nary a whimper of protest, girls with no medical problems were taken to doctors' offices seeking a pharmaceutical solution to the problem of getting too tall.

Back then, girls who appeared on a path to reaching 5 feet 10 inches or more -- a height their parents feared would render them unmarriageable -- were sometimes treated with high doses of estrogen. That was when homemaker and mother were the most popular and available career choices for women, and FBI Director J. Edgar Hoover was urging young women to marry early and have children "to fight the twin enemies of freedom -- crime and Communism."

The hormone is responsible for hastening the fusion of growth plates of long bones during puberty, which is why the onset of menstruation signals a significant slow-down in growth in girls. Doses of estrogen could hurry that process along.

"There are some parallels with today's growth hormone technology," says Joyce Lee, a professor of pediatric endocrinology at the University of Michigan. She wrote a historical overview of estrogen treatment for tall girls in the October 2006 issue of Archives of Pediatric and Adolescent Medicine.

"Now we can use technology to augment height in boys," she says. "Estrogen was thought to reduce height by 1 to 2 inches. Growth hormone is thought to increase height by 1 to 2 inches."

In slow-growing children, the medical term is idiopathic short stature. In rapidly growing children, the term is constitutional tall stature. The underlying and unproven rationale for treatment in both cases is that altering the natural growth pattern will improve quality of life.

Few doctors followed the hormone-treated girls into adulthood, but one 2005 study in the journal Social Science and Medicine identified 396 Australian women who between 1959 and 1993 had been treated with estrogen to reduce their final adult height. They were compared with 448 women who, as girls, had been offered treatment but decided against it.

In questionnaires given up to 40 years later, almost all the untreated women, 99.1%, said they were glad they weren't treated, no matter how tall they became, while 42.1% of the treated women expressed dissatisfaction with the treatment decision.

Some of the treated women who said they were dissatisfied with their treatment had long-standing and unanswered questions about the health consequences of the hormone therapy. Of the 396 treated women, 67 had problems getting pregnant and wondered if the problems were caused by treatment during their teen years. Worse, one of the estrogens commonly used in treatment was diethylstilbestrol, or DES, linked in 1971 to vaginal and cervical cancer in the daughters of women who took the drug to prevent miscarriages.

Girls are rarely treated to slow their growth anymore. "It's still done for ballerinas in the United Kingdom, but there's no published data," Lee says.

Perhaps it's fallen out of favor because the women's movement has made it OK for females to be powerful. And Title IX, the law requiring schools to provide equal athletic opportunities for girls, has made it OK for a lady to sweat. Corporate executives and athletes, male or female, can be tall.

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