Estrogen Treatment of the Young: Summary and Recommendations

Abstract

Pediatricians and, perhaps to a greater extent, gynecologists and general practitioners are treating girls with estrogens for three main clinical indications: (1) because their height prediction suggests that they will be too tall at maturity for social acceptability; (2) as replacement therapy for functional agonadism, e.g., Turner's syndrome; and (3) for contraception and menstrual irregularities. Current Use of Estrogen Treatment of Young Girls In the case of healthy tall girls, estrogen is administered in large pharmacologic doses for a period of several years. The dose, age at treatment, type of estrogen, and duration of therapy have varied among the reported series. This practice is controversial. A survey of pediatric endocrinologists suggests that this practice is more common in Europe than in the United States. The anticipated height reduction appears to correlate directly with the dose and inversely with the stage of adolescent development and age of the subject. In general, the height reduction is not great, averaging about 4 cm. However, the accuracy of height prediction in uncertain. Growth predictions for children as tall as those treated have not been made in large numbers of untreated girls and validated by following up the girls to maturity. These data would be necessary to know more precisely the extent of height reduction. Little is known of the psychosocial benefit derived from treatment, and comparison has not been made with girls who have not been treated. Since this therapy is instituted for psychosocial reasons, it would seem urgent that studies be done to evaluate the psychological benefit of treatment vs no treatment.