Want a naturally tall guy? Don't try U.S., Asia

Boys in the United States and Asia face more pressure to achieve "normal" height than boys elsewhere in the world, researchers from the Children's Hospital of Philadelphia found in a new study.

The study, released in April, found that male children are twice as likely as girls to be treated with recombinant human growth hormones in the U.S. and Asian countries, especially Japan.

Yet boys are only slightly favored to receive treatment in Europe, New Zealand and Australia. And in the rest of the world, boys and girls receive the hormone equally.

Adda Grimberg, a pediatric endocrinologist at CHOP and the lead author of the April study, is trying to figure out "how much of it is pediatrician-based and how much of it is family-based."

"In real life," she noted, "the two often feed off each other."

Terri Lipman, a pediatric nurse practitioner at CHOP unaffiliated with the study, noted that "a crucial distinction must be made between when growth hormone is necessary versus when it is aesthetic."

In her experience, she said, it is "not infrequent" that parents of a boy with normal short stature will request such treatment for their child.

"Parents view short men as being at a distinct disadvantage in our society, and that happens to be true," she said.

Lipman added that she "wasn't surprised at all" with the study's results.

"I've known as a nurse practitioner for many years that there's a gender disparity in children who are referred for evaluation for growth disorders" by their physician, she said.

Even back in 1985, when rhGH became available, studies of U.S. children revealed that boys received the hormone twice as often as girls.

As this trend persisted, an obvious explanation was presented: perhaps growth disorders that require hormone treatment simply occur twice as often in boys as in girls.

But if that's the case, said Grimberg, "it should be true everywhere."

Most children who receive rhGH are just naturally deficient in the hormone, Lipman said, while a minority have "idiopathic short stature" - unexplained abnormal growth in children with a healthy amount of growth hormone.

Growth hormone is notoriously difficult to measure in humans, according to Grimberg, because it is emitted in pulses at certain stages of sleep.

To measure levels of the hormone, then, clinicians must rely on a set of tests - including stimulating the pituitary gland to secrete growth hormone - which can yield false and borderline results.

The Federal Drug Administration approved the use of growth hormone to treat idiopathic short stature in kids whom an "endocrinologist feels may benefit from growth hormone therapy but whose defect the tests can't capture," Grimberg said.

That subjective space, the clinical judgment call, might be another place where a social bias for male height sneaks in.

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