A generation ago, many doctors prescribed estrogen
to suppress the growth of girls destined to be over 6 feet
tall. Far fewer do so today, says a survey published Tuesday.
But an advocacy group condemned any continuation
of growth-suppression therapy, and petitioned the government
to place a warning label on all estrogen products, branding
its use potentially dangerous.
"My gripe is that nobody knows if it's
safe or not," said Dr. Neal Barnard of the Physicians
Committee for Responsible Medicine. Yet "kids have been
treated since the 1950s. Why has there been no monitoring?"
asked Barnard, a well-known estrogen critic.
Girls' increasing production of estrogen during
puberty causes the skeleton to mature so that growth eventually
stops. Giving them estrogen pills can speed up that bone maturation
and suppress growth somewhat, by up to 2 inches.
It first was tried in 1956; by 1978, one survey
suggested half of pediatric endocrinologists offered it to
girls expected to be taller than 6-foot-1 as adults.
Typically, a very tall mother brought her daughter
to a hormone specialist, saying she didn't want the child
to face the social or psychological issues that she recalled
because of height, said Dr. Joseph Sanfilippo of the University
of Pittsburgh.
But being tall is not a disease, he noted.
Over time, social values changed - supermodels often are over
6 feet tall. Consequently, "it's been years since I've
had this request," Sanfilippo said.
Barnard surveyed 715 members of the nation's
largest group of pediatric endocrinologists. Of the 411 doctors
who responded, 22 percent had prescribed growth-suppressing
estrogen for between one and five tall girls within five years.
That's a very small number of patients, said
Dr. Janet Silverstein of the American Academy of Pediatrics.
But Barnard called it too high. His advocacy
group filed a petition asking the Food and Drug Administration
to place warning labels on all estrogen products, telling
doctors and parents that the hormone has never been approved
for such use and could be dangerous.
He cited a handful of women who think their
adolescent estrogen therapy caused later cancer or fertility
problems.
Barnard opposes estrogen therapy in general.
His Physicians Committee for Responsible Medicine, best known
for pushing vegetarian diets, opposes much use of animals
in science. One major estrogen brand is derived from horse
urine.
Although growth-suppressant patients in particular
haven't been studied, "there is no evidence, to my knowledge,
of early estrogen exposure and long-term consequences,"
said Sanfilippo, who edits the Journal of Pediatric and Adolescent
Gynecology that printed Barnard's survey.
In fact, young girls seem to suffer no harm
when given birth control pills for other reasons, such as
irregular bleeding, that contain similar estrogen amounts,
he said.
The FDA said it was concerned that girls could
be exposed to untested treatments and will review the petition
carefully, but "there is no reason ... to consider this
an imminent danger."