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Commentary: Is Growth Hormone the Best Treatment for Short Stature in Healthy Peripubertal Boys?: Insights From the Field of Economics

Kaplowitz, Paul B. MD, PhD

doi: 10.1097/TEN.0b013e3180dc90fd
CME Review Article #22

The management of short stature in healthy boys between the ages of 11 and 14 is controversial. Many clinicians use testosterone injections or oral anabolic steroids to provide an immediate acceleration of growth, with the understanding that this will likely have no effect, either positive or negative, on adult stature. Others prefer to use growth hormone, despite its high cost and the uncertainty that it will result in a significant increase in adult stature when started close to the onset of puberty. The assumption in using growth hormone is that any increase in adult stature is worthwhile, in part because of the well-known relationship between adult height and wages. A recently published study in the economics literature is reviewed, which carefully analyzed the effects of adult height in white males on earnings and as it related to height at ages 7, 11, 16, and 33. The only height which was independently associated with adult earnings was height at age 16. This study suggests that the economic advantage of tall stature is related more to teen height than adult height and that late-maturing boys, who are significantly shorter at age 16 than in adulthood, are at a disadvantage in the labor market. Evidence is presented that increased participation in sports and other social activities accounted for the economic effect of greater teen height. The implications of this study in terms of different strategies for managing short stature in peripubertal boys are discussed, and it is suggested that androgen therapy may be more advantageous than growth hormone in such patients.

Professor of Pediatrics, Department of Endocrinology, Children's National Medical Center, George Washington University School of Medicine and the Health Sciences, Washington, DC.

Dr. Kaplowitz has disclosed that he has no significant relationships with or financial interests in any commercial company that pertains to this educational activity.

The author has disclosed that the use of letrozole (Femara) has not been approved by the U.S. Food and Drug Administration for use in the treatment of short stature in peripubertal boys. Please consult product labeling for the approved use of this drug or device.

Lippincott Continuing Medical Education Institute, Inc. has identified and resolved all faculty conflicts of interest regarding this educational activity.

Reprints: Paul B. Kaplowitz, MD, PhD, 111 Michigan Ave, NW Washington, DC 20010. E-mail:

Chief Editor's Note: This article is the 22nd of 36 that will be published in 2007 for which a total of up to 36 AMA PRA Category 1 Credits™ can be earned. Instructions for how credits can be earned precede the CME Examination at the back of this issue.

© 2007 Lippincott Williams & Wilkins, Inc.