Estrogen Use in Children and Adolescents: A Survey

Abstract

Members of the Lawson Wilkins Pediatric Endocrine Society (LWPES) and the European Society of Pediatric Endocrinology (ESPE) were mailed a questionnaire to survey their views and practices with respect to the use of estrogens in children and adolescents. The purpose of this survey was to ascertain the prevalence of estrogen therapy in children and adolescents, as well as the estrogen preparation used, dose, benefits, and observed complications. Seventy-four of 213 LWPES members or groups and 29 of 106 ESPE members or groups returned the survey. The lack of rapid retrieval systems in many clinics and the necessity for return of the survey data within a ten-week period precluded many respondents from the exhaustive, careful chart reviews necessary to answer many of the questions posed. Accordingly, data generated in this survey must be interpreted in this light. Estrogens are used primarily in children and adolescents for (1) the treatment of tall stature, (2) replacement therapy in hypogonadal adolescents, and (3) as a component of contraceptive pills given to sexually active teenagers. ESTROGEN TREATMENT OF TALL GIRLS The treatment of "excessively" tall adolescent girls with pharmacologic doses of estrogen, in an attempt to decrease mature height, has been a subject of controversy since its inception by Goldzieher1 in 1956; 50% of the LWPES and 17% of the ESPE respondents indicated that they never treat "tall" girls with pharmacologic doses of estrogen, basing their decision primarily on the fact that the long-term side effects of such doses of estrogens are unknown. In addition, the risk-benefit ratio and the fact that tall stature is not a disease were other important reasons for not treating these girls.