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October 25, 2006

Tall girls, short boys: Using hormone therapy to shape children’s height to social norms

U-M researcher provides insight into the use of hormone therapy to alter height during the past 50 years

ANN ARBOR, MI – In the 1950s and 1960s, tall girls were coming up short in life. Viewed as unfeminine and less attractive to marriage suitors than shorter girls, many otherwise healthy tall girls were given estrogen treatment to stunt their growth.
 
Joyce Lee, MD, PhDWhile estrogen therapy today for tall girls is rare, its use to conform a child’s height to fit social norms may provide valuable insight into the present-day use of growth hormone treatment for healthy boys of short stature.

In a historical review in the current issue of the Archives of Pediatric and Adolescent Medicine, lead author and University of Michigan Health System Pediatric Endocrinologist Joyce Lee, M.D, MPH, explores the use of estrogen treatment during the past 50 years to illustrate how scientific knowledge continues to be created and applied to fit within prevailing societal and political beliefs.

At its onset in the 1940s, estrogen therapy use to reduce height was limited to children at risk for tall stature due to acromegaly, a hormonal disorder that results when the pituitary gland produces excess growth hormone. Not too long after that, though, scientists began to wonder if the same therapy would prevent healthy, tall girls from becoming tall adults.

Why shouldn’t healthy tall girls be allowed to grow into tall adults? According to Lee, in the 1950s parents grew increasingly concerned with the social implications of their daughters being too tall, and worried they would have difficulty finding clothes that fit and even future employment as a flight attendant or ballet dancer.

The most commonly cited reason in scientific literature for reducing the height of tall girls, however, was social attractiveness.

“Since tall girls usually become tall women, the biggest concern seemed to be that tall women would have a hard time fitting in, being comfortable in social situations, and, most importantly, finding a man to marry,” says Lee, a member of the Child Health Evaluation Research (CHEAR) Unit in the Division of General Pediatrics at U-M C.S. Mott Children’s Hospital.

Through the 1960s and 1970s, researchers began to take a closer look at the effects of estrogen therapy on a female’s growth, as well as her overall health. They noted positive effects of the therapy such as height reduction, and improvements in self-esteem and school performance. Treatment, however, had its downside. Many patients reported having nausea, headaches and weight gain, and there were more serious complications such as mild hypertension, benign breast disease and ovarian cysts.

Medical debate about its risk and effectiveness, combined with changing social culture in the 1970s and 1980s, slowed the use of estrogen therapy for tall girls. In a 1977 survey of the Lawson Wilkins Pediatric Endocrine Society, 50 percent of respondents treated tall girls with estrogen therapy. In 1999, a survey of the same endocrine society revealed that only 23 percent of the respondents treated tall girls in the past five years, and only 1 percent had treated more than five cases with estrogen therapy.

By 2003, growth hormone was approved by the U.S. Food and Drug Administration for treatment of short, but otherwise healthy children with idiopathic short stature. Although estrogen for tall stature and growth hormone for short stature are both used for altering height in children, Lee says there is one notable difference between the use of the two therapies: gender.

“While the treatment of tall stature with estrogen therapy was almost exclusively focused on girls, growth hormone treatment of healthy, short children occurs in twice as many boys as girls,” notes Lee.  “Growth hormone treatment of short boys could be considered the 21st century counterpart to estrogen treatment of tall girls, as society still expects that tall women should not date or marry short men.”

Lee says estrogen treatment, too, holds important implication for future use and study of growth hormone therapy to modify children’s height. “We need to realize that scientific advances are always applied within a specific social context, and those societal norms and beliefs can greatly impact the work of practicing clinicians.”

Along with Lee, Joel D. Howell, M.D., Ph.D., with the U-M departments of Internal Medicine in the Health System, History in the College of Literature, Science & Arts, and Health Management and Policy in the School of Public Health, co-authored the study.

The study was funded by a National Institutes of Health Pediatric Health Services Research Grant.     

Reference: Archives of Pediatric and Adolescent Medicine, October 2006, Vol. 160.

Written by Krista Hopson 

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