Can I get taller with HGH?

By Veronica Bonilla Gurzeler

Smart, beautiful and big - this is how parents want their children to be. If the genes don't play along, the size can be helped. But is that harmless?

Let's be completely honest: How would you react if you knew that your son would not be taller than 1.60 meters and that your daughter might not exceed the limit of short stature of 1.50 meters? "Size is a fetish in our society," says child endocrinologist Prof. Urs Eiholzer and suspects that many more parents would probably ask for the prescription pad if growth hormones were as cheap as Ritalin.

Pediatricians weigh and measure children at precisely specified intervals and enter their progress in growth curves. It can be seen at a glance whether a child is currently one of the youngest, is playing in the middle of the field or wants to go big. If it is on the lowest percentile curve - i.e. if it belongs to the lowest three percent - or if it suddenly falls below this mark, pediatricians nowadays suggest a detailed examination by a specialist. Because: In some cases, a herb has grown against small body size caused by illness - or an active ingredient has been found: the growth hormone somatropin. Children can become 10 to 20 centimeters taller with it - provided the indication is really correct.

Parents small, child small

Leandro (8) sits at the dining room table and shows the visitor how he injects himself the medication every evening after brushing his teeth - independently, without batting an eyelid. He skillfully inserts the hair-fine needle into the injection pen, which is similar in size and shape to a ballpoint pen. Now he turns the other end of the pen until the correct dosage is set, pushes his pants down, places the pen on his thigh - yesterday it was the left, today it is the right - and click! The growth hormone is catapulted into its adipose tissue. "It doesn't hurt, I don't even feel it," says Leandro and his green-blue eyes shine believably. Far more important for the boy is that he grows. And in a hurry! Last year it rose exactly 11.4 centimeters, roughly twice as much as healthy boys of the same age; Leandro is catching up. "Suddenly he always needs new shoes," says his mother Bettina Zehnder happily.

Leandro was an inconspicuous 50 centimeters long when he was born. Until his third birthday he grew along the lowest percentile curve, from then on he slipped below it. "He was always small compared to his peers," says Bettina Zehnder, "his siblings are growing much faster." The mother was not worried, after all, at 1.64 meters, she is not a giant herself; Leandro's father, who died four years ago, was 1.74 meters tall and a few centimeters shorter than the average Swiss man. In the 7-year examination in the summer of a year ago, Leandro was just 1.12 meters - two centimeters smaller than the smallest three percent of the boys. On the advice of the pediatrician, Leandro was examined at the Pediatric Endocrinological Center Zurich (PEZZ); the PEZZ deals with the research, diagnosis and treatment of childhood growth disorders and hormone disorders. Leandro's hand was x-rayed and the bone age determined. It was thus possible to determine whether the boy is a so-called late developer or not, whether he will reach puberty later than his peers and thus grow longer and possibly overtake his older children on the home straight. Because waxing is primarily a hormonal matter, thyroid, adrenal, and growth hormone levels were also examined. Lo and behold: Leandro's bones showed a delayed ripening. He also suffered from a combined disorder of the pituitary gland, which leads to an underactive thyroid - which is now also being treated with medication - and at the same time to a growth hormone deficiency. Doctors suspect that the traumatic brain injury, which Leandro suffered in a car accident at the end of 2010, also played a role.

Cost: 20,000 francs

If a child grows too slowly, diagnosis is not easy. “There is only a cause for the short stature in around 10-15 percent,” says Urs Eiholzer, head of the PEZZ. According to Prof. Primus-E. Mullis, Head of Children's Endocrinology at Inselspital Bern, is the reason for a growth hormone deficiency in 13.5 percent of cases, and other hormonal causes are responsible in 25-30 percent. One has to rule out whether kidney dysfunction or celiac disease, i.e. gluten intolerance, inhibits growth. Hormone therapy is only prescribed - and paid for by the IV - if the growth hormone does not rise sufficiently in two simulation tests and the bone maturation is also typical for a growth hormone deficiency. Or if it occurs after cancer treatment. Children with the special chromosome Turner Syndrome, who are only 1.45 meters tall on average, are also allowed to receive hormone treatment.

Since 2004 there has been another indication called SGA (Short for Gestational Age). SGA children are newborns who are underweight or too small compared to their age. If you do not make up the size gap in the first two to four years of life, you can be treated with growth hormones; The health insurance has paid for the treatment since 2008. There are around 2300 newborn SGA children in Switzerland every year. In the specialist journal “Paediatrica”, Prof. Urs Zumsteg from the University Hospital in Basel describes how numerous studies have been carried out since the launch of the synthetic growth hormone in the mid-1980s to prove that the drug can positively influence the final length. Obviously with success: Long-term treatment for SGA children was approved in the USA as early as 2001.

Last but not least, this is good news for the pharmaceutical companies. Because the treatment is expensive. Depending on the dose, the expenditure amounts to CHF 10,000 to 20,000 and more - year after year, until the end of the increase in length between the ages of 15 and 18 years. However, due to competition, the therapy will have to become cheaper in the future. “The market dictates the price,” says Primus-E. Mullis.

Reduce suffering

We live in a time of opportunity. Optimization of all areas of life is almost mandatory today if you want to stay ahead. Thanks to growth hormone, the following applies: if you are small, you don't necessarily have to stay that way. Paradox: an average European adult is 1.75 to 1.78 meters tall, an average European 1.65 to 1.67 meters. "The ideal of beauty is significantly higher," says Eiholzer. Even if most of the claims cannot be verified, there are numerous myths about the length: taller people earn more, have to fight less to get noticed, are more successful - if not in their professional life, then certainly with the opposite sex. "30 years ago, size was mainly an issue for boys," said Eiholzer. He notes that the popularity of programs like Germany's Next Top Model leads to girls wanting higher too. "Parents who want growth hormones for their children only reflect on the social situation," says Eiholzer. Its task is not to change society, but to reduce suffering. Both the Bernese and the Zurich pediatric endocrinologist, however, refuse to prescribe growth hormones medically without any indication, although in the highest dosage two to three, possibly five centimeters more final height could be achieved, depending on the age at the start of therapy. “That doesn't justify the multi-year, expensive therapy,” says Mullis, “besides that, we're just producing new little ones. A 'never ending story'. "

However, the hormone not only increases height, it is also a popular doping agent. It builds muscle and breaks down fat, improves speed, increases the ability to regenerate. The detection in the blood is very complex, special analyzes are necessary. It took more than 12 years to develop the doping test, which was first used at the Olympic Games in summer 2012. Leandro not only notices how trouser legs and sweater sleeves get shorter quickly. The boy has a six-pack that is second to none. And bursting with energy. “I would like to play football all day,” he says. It's not just the muscles that are in good shape. "Growth hormone should also have a positive effect on brain development in toddler age," says Mullis. A scientific study is currently investigating to what extent cognitive performance increases under growth hormones in the age group 2-4 years.

So a real miracle cure, this growth elixir! But does it also have side effects? The experts first give the all-clear: “The side effects depend on the dose. Fortunately, the doses described in studies with long-term side effects were never given in Switzerland, »says Mullis. Occasionally, there will be some headache at the beginning, so the drug is reduced but not stopped. The hip bone rarely slips off. A predisposition to diabetes is also possible; this disappears after treatment is discontinued. According to the current state of knowledge, cancer is not increasing. Hardly any other hormone is as well documented as growth hormone. Nevertheless: "With drugs, long-term side effects are always an issue," says Eiholzer. And Mullis adds: "You don't know what if the children are 60 or 70 years old." Therefore: The treatment belongs in the hands of a children's endocrinologist, a lifelong follow-up is indicated. Mullis is conducting a corresponding follow-up study with Swiss scientists.

Despite everything - it was quickly clear to Bettina Zehnder that she would consent to the treatment. “If you find out that your son will probably only be 1.55 meters tall, but there is therapy that will make him taller, you really have no choice. I didn't want to take the risk of hearing from Leandro at some point that I had withheld treatment from him. "

Is my child growing normally?

  • The baby's length and weight at birth are usually an expression of whether it was doing very well or not so well in the womb during pregnancy; a small baby does not necessarily become a small adult. In the first three months of life, children grow an average of 3.5 centimeters per month, after that a little more slowly. They have until around their fourth birthday to adapt to their genetic pattern. Until then, “lane changes” in the percentile curve are generally only a sign of this adjustment and not an indication of a disruption. From the age of four, growth should follow the inherited percentile channel through the onset of puberty.
  • The genetic predispositions of the parents are decisive for the final height: small couples are more likely to have smaller children and vice versa. The target size can be roughly calculated using a simple formula: height of father plus height of mother divided by two. Deduct 6 cm for girls, add 6 cm for boys. A deviation of 8.5 cm is possible.
  • The prognosis of the final size is complex. Few doctors have enough experience to determine the age of the bone and the adult size from a hand x-ray with sufficient certainty. Depending on the method used, there is a difference in size of several centimeters.