My Little Brother on Drugs

Studies show that half of short kids report being teased and three-quarters say they’re treated younger than their age—but keep in mind that this is an awkward age to begin with. Starting at about age 10, grade-wide height discrepancies tend to widen dramatically, which just adds fuel to the broader stew of middle school insecurities most of us shudder to recall. This is the age at which families often become conscious of and concerned about growth issues—because discrepancies are suddenly so visually apparent.


When I was in fifth grade, the boys would chase me down the hall on their knees playing “catch the midget,” and one of the tougher girls would taunt me: “You’re so small I need a microscope to see you.” But before feeling sorry for me, consider my classmate Kelly (Editor’s note: Name has been changed), who was 5 feet 10, a full 2 feet taller than I was—a virtual fifth-grade giant. (Given social norms, it’s appropriate to compare the experience of being a short boy to that of being a tall girl.) Kelly was tortured so badly throughout adolescence that at 18 she became bulimic. When her weight dropped to 115 pounds, she was hospitalized. “I thought it would make me smaller and more attractive,” she recalled in a recent phone conversation. “It almost killed me.”

Being a tall girl is so psychologically traumatic, in fact, that in the 1950s, doctors began giving tall girls estrogen as a growth suppressant. In high doses, the hormone stimulates cartilage maturation without causing an increase in height, which means the girls stop growing earlier. In Kelly’s case, treatment was discussed, but doctors were confident, based on her bone development, that she wouldn’t grow much taller than 6 feet. Good call: Today Kelly is only an inch taller than she was in fifth grade. And although no formal long-term studies have been done, tall girls treated with estrogen have reported increased incidences of miscarriage, endometriosis, infertility and ovarian cysts. Yet a survey taken last year reported that one-third of pediatric endocrinologists have offered the treatment at least once in the past five years.


Learning about the side effects of estrogen therapy only increased my apprehension about treating Alex with hGH. Armed with a small forest of research, I drove up to Yale†New Haven Children’s Hospital to unload my worries on Dr. Myron Genel, Alex’s pediatric endocrinologist.


With his white hair and white lab coat, Genel looks the prototypical old-school doctor, the kind you imagine making house calls with his little black medical kit. I take a sip of my coffee. “This won’t stunt my growth, will it?” I joke. “Too late to worry about that,” he replies.


I reach into my bag and pull out binders of research: diagrams of the growth process, historical time lines, and a folder labeled “risks,” which is packed with studies. “How concerned should my family be about the risks?” I ask.


I wait for reassurance—or, in any case, for a defense of Alex’s treatment. But Genel surprises me.


“We honestly don’t know the long-term side effects, and I think that’s a reason for real concern,” he says. “We’re using a hormone that promotes growth, and there are things whose growth we don’t want to promote. IGF-1, for example, has been shown to play a role in the development of malignancies in tissue culture.”

This I knew. Multiple studies of human serum specimens have shown that elevated levels of IGF-1 identify people at higher risk for developing breast, prostate and colon cancer, and tumor specimens, most studies show, have more IGF-1 receptors than normal adjacent cells. Although it’s not yet known whether an abundance of IGF-1 actually causes malignancies or is merely associated with some other risk factor, it is a reason for concern because growth hormone is what stimulates the liver and tissues to produce IGF-1.


But Genel explains that he’ll test Alex’s IGF levels every three months to make sure they’re in what’s considered the normal range. “In theory, if we keep his growth factors at an acceptable level, he’s not at risk,” he says.


I scan my list of questions, typed up in order of progressing intensity, and zoom to the bottom. “Given the risks, what makes Alex a good candidate?”