DiEthylStilbestrol and the temptation to tinker with a child’s height

Too tall for future happiness?

Abstract

When Laura was growing up in a small New England town, her parents and doctors worried that her predicted adult height threatened her future happiness. Laura’s tall mother had been teased and embarrassed about her own height at school. When the local paediatrician mentioned that a specialist might be able to stunt Laura’s growth and spare her the social pain of towering over boys as an adolescent and men as an adult, her family agreed. A paediatric endocrinologist affiliated with a prestigious US academic medical centre confidently prescribed the synthetic oestrogen diethylstilbestrol in doses 100 times greater than the oestrogen found in today’s high-dose oral contraceptives.

Too tall, too small? The temptation to tinker with a child’s height, The Lancet, Volume 375, No. 9713, p454–455, dx.doi.org/10.1016/S0140-6736(10)60185-7, 6 February 2010.

Too tall and too small by P-cate.

Laura obediently took the little coated pills, now commonly known as DES, for about 2 years. But they made her sick and when she reached adulthood and married, she experienced miscarriage after miscarriage that denied her what she most wanted in life—children. When doctors also diagnosed her with a condition that put her at risk of breast cancer, Laura wondered what effects the little pills might have had on her adult health. She didn’t know at the time that other tall girls also went on to have reproductive problems after taking diethylstilbestrol and other high-dose oestrogens to stunt their growth, or that there had been concerns about the drug’s potential effects on fertility and cancer even at the time her physician prescribed it. Laura didn’t know because none of the physicians she consulted as an adult had heard of the treatment she had received as a child; there had been hardly any follow-up studies of these girls once they became adults.

Meanwhile, the culture of the 1950s and 1960s, which had made limiting the height of tall girls seem like such a good idea to parents and to physicians, was changing rapidly by the mid-1970s. Girls who dutifully swallowed pills to try to remain below 5′6″ so that they could qualify for the corps de ballet or become airline stewardesses, or girls who desperately wanted to stay below 5′10″ to improve their chances of finding a husband, suddenly had many more options in life. They could join a volleyball or basketball team, become doctors and attorneys and police officers, run a business, or compete for political office. The medical advice that suggested tall girls invariably risked psychosomatic illness, or were at risk of not only spinsterhood but homosexuality, today seems quaint. No wonder women like Laura have encountered difficulty explaining this medical intervention to disbelieving obstetricians and gynaecologists.

How do medical therapies launched with the best of intentions result in tragedy? The history of treating children for height provides a compelling allegory for modern medicine, in which cures for disease evolve at an ever-quicker pace into treatments for disability, then for disadvantage, then to satisfy the desire for perfection. Over and over, the best and worst motives combined: the concern of parents and children, the desire of doctors to help and to discover, and the potential profits of industry. There have been far fewer incentives to follow up what happened to these children once they became adults.

In the case of the tall girls who received childhood or adolescent exposure to massive doses of oestrogen, none received any ongoing medical observation, despite calls by some doctors in the mid-1970s to follow them for the rest of their lives. Although diethylstilbestrol is no longer used, and the demand for stunting the growth of healthy girls has dropped in recent decades, some tall girls are still prescribed oestrogens to stunt height, especially when parents insist. ” …

Continue reading Too tall, too small? The temptation to tinker with a child’s height by Susan Cohenemail and Christine Cosgrove on The Lancet.

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