Steroid Treatment of Tall Girls - Literature review Example

Steroid Treatment of Tall Girls Introduction The use of steroids to reduce the height of tall girls has been in use since 1950s. It has been started to be used in Europe, USA and Australia. It is recently, that the problem of the becoming tall has been recognized by the pediatricians and endocrinologists. But the controversy, as to whether an attempt should be made to control their growth by the estrogen therapy, still remains. The actual definition of tall is arbitrary. The problem faced by tall girls may vary in nature and they may create various issues for them. The tall girls may face problems in various ways like not being able to make friends with those of the same age group. Sometimes it may so happen that they may feel embarrassed to be so tall and thus become psychologically depressed. They feel unusual from their peers and are subject to cutting comments about their height. As a result of this the girl may tend to adopt the defense mechanisms like the kyphotic postures, seclude themselves from social activities, and have a tensed, depressed and irritable personality. Difficulties may also be faced in buying clothes and especially footwear for them as they need them in an unusual size. This may even have its effect on one’s pocket. Their size becomes unusual as there are a little bunch of girls who are atypically tall like them. There are many girls in this category who find it embarrassing for them to be taller than boys and this fact also disturbs them constantly thinking about the fact that they will not be finding a suitable match for them. Some very prosperous job prospects like that of being a ballet dancer or being an airhostess totally close for them due to the unusual tall stature. There are many girls who feel comfortable for their tall stature and are happy about that fact. They should not be advised to take any kind of medical treatment for reducing their heights. But there are also such girls who along with their parents are very much concerned about the unusual height. In such a situation it becomes essential to discuss their problems and try to resolve it either only by psychological treatment or by medical treatment if they are not at all convinced by the discussions. For the treatment of reducing the height of the girls, there are certain criteria to be fulfilled: there should be available a reasonably accurate measure of the mature height, the treatment would considerably reduce the height of the girl from that if it was left untreated, and it should be taken care of that the long and short side effects are very minimal or negligible. The treatment of tall stature is basically a psychological ground. When seen from a strict medical view point, treatment is not at all required and is unnecessary. Therefore it is very much true that the validity and necessity of the treatment is totally questionable. Although the psychosocial factors constitute the main reason for treatment, yet extensive psychological investigations were never done either before or during the height reductive therapy. There has been much discussions made over the years in regard to the reduction of height by the use of supra physiological doses of sex hormones, not only because of the problems in assessing the real efficacy of growth reduction but also because of the probability of the redundant side effects. For this very reason, special attention has been focused on the lipid metabolism, haemostatis, and the functioning of the hypothalamic gonadal axis. Till now there have been reports of side effects only during or shortly after its discontinuation. Most of these side effects are either very mild or reversible. Regarding girls, the general proof of complete reversibility of hypothalamic gonadal suppression has been reported in quite a number of single cases. Table Studies Characteristics Results Conclusion W.J De Wall and others To evaluate the possible long term side effects of the high doses of sex steroids in the management of the constitutionally tall stature with special reference to the hypothalamic- gonadal function. Interview of 180 tall adult women and 64 tall adult men who had received the supra physiological doses of sex hormones during puberty was done in a standardized manner at a mean follow up of 10 years after the accomplishment of the treatment. 94 untreated tall adult women and 61 untreated tall adult men served as controls. Most of the subjects were satisfied by their decision regarding hormone treatment.77% of women and 78%of men reported certain kind of mild side effects during the treatment.3% of women stopped the treatment because of adverse effects. The frequencies of reported side effects were higher in women during treatment with high doses of oestrogens than during the oral contraceptive use, indicating towards the dose dependent relationship. Malignancy was not reported. Information of about 127 pregnancies was found and revealed no distinct differences in outcome and details between the previously treated men and women and controls. There is no evidence after a mean follow up, that pharmacological doses of sex hormones have a long-term side effect on the reproductive function. Stenvert L.S. Drop and others In 1956, estrogen was introduced by Goldzeiheras a treatment of excessive growth of adolescent girls. The investigators mainly of USA treated the excessively tall girls with conjugated estrogens. Others in Western Europe used ethinyl estradiol in varying doses usually with the combination of progestogen 710 days each month in order to induce menstruation There has been a consideration since long that pubertal growth is an androgen dependant process. But there are various clinical and experimental evidences which show that estrogen may be responsible primarily for the accelerated growth during puberty. Girls show growth spurt during estrogen treatment. Similarly girls with central or pseudo- precocious puberty with clearly elevated estrogen levels have shown increased height velocity and a premature epithelial closure. The acute infusion of gonadal steroids in peripubertal children has shown the complexity of the relationship between the gonadal steroids and growth hormone. There is also the presence of evidence to show high dose dependency. It has been found that high doses of estrogen result in decreased velocity. The tratment of constitutionally tall stature is basically based on psychological grounds. The constitutionally tall children referred should be in their late prepubertal period in order to have proper pretreatment evaluation of the bone maturation and growth. Restricting treatment to such girls whose tall stature would not allow them to take up professional courses like that of pilot and ballet dancer. Treatment should be initiated at an early bone age. Finally treatment should be continued till the complete closure of the epiphyses has been radio logically established. Alison Venn and others Treatment with oestrogen to reduce the adult height of tall girls has been studied to assess the long term effects of the treatment on fertility. Eligible girls were chosen from the Australian pediatric endocrinologists’ records and also from self referrals. The study included those girls who were treated with oestrogen and also those who were only assessed and not treated. The information about the reproductive history was sought via telephone. Out of the 1432 identified individuals only 1243 could be traced. That summed up to 87%. 780 (63%) were interviewed. 371 treated and the 409 untreated women were found to be similar in their socioeconomic status and other characteristics. Treated women, after adjustment of age, were more likely to have tried to become pregnant without success, for more than 12 months. They were more likely to have visited the doctor for their problem of not conceiving and also more likely to have taken fertility drugs. The analysis of the time to 1st pregnancy showed that the treated group was 40%less likely to conceive in any given menstrual cycle with unprotected intercourse. When the self referred women were excluded, these associations persisted. In adolescence, the high dose oestrogen treatment reduces the female fertility in the later life. This treatment is valid for the current treatment practices and also for the understanding of the biology of reproduction. H. Norman B. Whettenhall and others 450 girls were concerned about their tall stature. 168 of them were treated with stilbestrol which is the estrogen therapy. 87 of them were followed after treatment and they provided data for the study. 81 girls were excluded from the study. 40 of them were still being treated, 30 of them did not follow long enough be assured that they had stopped growing, 8 girls lived very far off , so they could not be followed, and 3 girls abandoned the treatment before its completion. There were no long side effects. The skeletal growth assessment was made at the onset of the therapy but they were not repeated until the growth in the stature had ceased. Therefore it is difficult to provide with the evidence of more rapid advancement in the skeletal age in the treatment’s first year. Side effects seen were very few. Like irregular of menstrual cycle, pigmentation of the breast areolas, nausea at the beginning of the therapy, obesity developed in some girls as their growth reduced. One of the girls had developed par ovarian cyst, one, cyst adenoma of the ovary and one, superficial venous thrombosis of the calf. Estrogen can significantly reduce the rate of growth of almost all tall girls, but treatment must be carried out great care and supervision, keeping in minds the possible side effects. Discussion of the table The above table shows that the various studies conducted on the use of estrogen or oestrogen have proved to be successful and it also shows that there have been very less side effects found in this treatment. Although there have been various kinds of side effects shown during the treatment or just after its completion yet there has not been any kind of long term side effect shown by this treatment. But contrary to this fact the study done by Alison Venn and others shows that, in adolescence, the high dose oestrogen treatment reduces the female fertility in the later life. This treatment is valid for the current treatment practices and also for the understanding of the biology of reproduction. Although more of the studies have been done only on females, Stenvert L.S. Drop and others have also conducted studies on men. But it has been observed that all the studies put emphasis in resolving the problem first by psychological discussions. And all the studies conclude with the fact that oestrogen reduces the probable height of the tall girls if treated at the early prepubertal stage when the bone maturation and growth can be studied properly. Discussions of problems and potential biases, considered by the authors The authors have emphasized on the point that the treatment should be started at the early prepubertal stage so that the growth and bone maturation can be studied properly. If not done so then there could be problems for the girls in their later life. Moreover though treatment has been recommended for the reduction of growth rate and thereby controlling the tall stature of the girls yet it has been given the name of a psychological problem, every attempt is made to see to the fact that discussions are done in order to reduce the anxiety of the patient and also the parents who are very much worried about the tall stature of their girls. Other problems which the authors speak of are those of the side effects which though are very few in numbers yet there is a possibility of the side effects being taking aggressive nature. The problems and potential biases that authors may not have considered There may be the presence of certain problems which the authors may not have considered. They should be taken care of during the treatment. It has been found that many girls come for the treatment just because of their tall stature. They think that they would not get a proper match for them if they grow unusually tall. But it has also been found that there are also boys who turn up for such treatments. Therefore the girls while being advised should be made known of this fact so that there is less number of girls who would be interested in such treatments. This treatment is a kind of opposition given to the natural growth of a person, so this is something like going against nature. Therefore there can be very adverse effects found which might not be visible to the naked eyes of the human beings. Conclusion The treatment of inducing steroids in tall girls is of course proving helpful to those girls who are socially disrespected by their peers and they are even able to take up various kinds of good professional careers. The estrogen treatment considerably reduces the height of a girl who undergoes the treatment at a proper age and with due care considerably than that which she would have reached if she would not have undergone such a treatment. But lastly it would be advisable for all those who undergo such treatments to be very careful about the possible side effects of the treatment. Read More