Tall Girls : The Social Shaping of a Medical Therapy

Diethylstilbestrol given to healthy teenage girls to manipulate height

Abstract

During the latter half of the 20th century, estrogen therapy was administered to prevent otherwise healthy girls with tall stature from becoming tall adults by inhibiting further linear growth. We explore how decisions to treat tall girls with estrogen were influenced by both scientific knowledge and sociologic norms. Estrogen therapy represented the logical application of scientific knowledge regarding the role of estrogen for closure of the growth plates, but it also reflected prevailing societal and political beliefs about what it meant to be a tall girl. We discuss the rise and fall in popularity of this therapy and suggest that insight into the present-day treatment of short stature can be gained by comparing the use of estrogen therapy for tall girls with the use of growth hormone therapy for short boys. We suggest that this case study illustrates how scientific knowledge is always created and applied within a particular social context.

Tall Girls : The Social Shaping of a Medical Therapy, Archives of pediatrics and adolescent medicine, NCBI PubMed, PMID: 17018462, October 2006.

The therapeutic use of sex steroids dates back to the late 19th century, when medical practitioners such as midwives used ovarian extracts to treat a variety of female disorders. For example, the filtered juice of guinea pigs’ ovaries was used for women with hysteria, debility, and abnormal menstruation. Thus, even prior to the discovery of specific substances derived from the ovaries, practitioners attempted to harness their therapeutic potential.

Changes in scientific understanding led to the concept of hormones, substances that were produced in a particular organ but acted throughout the body in a complex web of interactions. By the 1930s, scientists had identified specific hormones produced by the ovaries and testes.3 The pharmaceutical industry soon began manufacturing ovarian and testicular preparations, and physicians began exploring a wide range of therapeutic applications.

One such application in the pediatric arena was the use of sex steroids for influencing growth. By the 1940s, physicians began to understand hormonal influences on the growth plate through important clinical observations. First, they observed that children with early exposure to sex hormones due to precocious puberty had premature epiphyseal closure and developed short stature as adults. Physicians also found that children with pituitary disease who lacked sex hormones had open epiphyses with a prolonged period of growth. Based on these clinical observations, it was postulated that gonadal steroids were responsible for closing the epiphyses.

Children at risk for tall stature due to acromegaly thus became the first recipients of estrogen and testosterone therapy for prevention of excess growth during the 1940s. Clinical trials revealed that estrogen preparations, in contrast to testosterone preparations, were particularly successful for preventing tall stature in children with acromegaly. As a consequence, physicians naturally considered whether the same treatment could be applied in other settings. Girls with constitutional tall stature represented a potential group of patients for whom hormone therapy might prevent further growth, an outcome that some considered desirable.

In 1946, a brief abstract was published about the clinical experience of estrogen treatment in tall girls who were “becoming alarmed and unhappy about the extremes to which their exuberant, albeit normal growth was carrying them.” A decade later, Goldzieher published the first formal clinical study of the use of estrogen therapy for the treatment of constitutional tall stature in girls. Goldzieher cast his research in terms of the application of new scientific advances; he claimed that estrogen treatment of girls destined to be tall as adults was a logical next step following the estrogen treatment of children with acromegaly and hence represented “no novelty.” In his initial case series, 14 girls aged 9 to 16 years were treated with oral forms (2 mg daily of stilbestrol or 2.5-5.0 mg daily of premarin) or injected forms (1.6 mg of estradiol monobenzoate every 5 days) of estrogen for anywhere from 3 months to 5 years. Criteria for treatment included a current height of 168 cm (66 in) with open epiphyses or a current height less than 168 cm (66 in) but with a predicted height 10 cm (4 in) above the average. In his article, Goldzieher concluded that growth was successfully arrested based on his observation that the majority of girls had growth of no more than 5 cm (2 in) from the start of therapy.

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