Growth hormone treatment for short stature: a review of psychosocial assumptions and empirical evidence.

The advent of the unlimited availability of recombinant human growth hormone (rhGH) ushered in a new era of clinical management options and decisions for children with short stature, in particular, for those without GH deficiency. Ethical questions about treating non-GH-deficient short-statured children with rhGH quickly arose. After over two decades and after several additional indications for rhGH use in children were approved, many issues remain relevant today, e.g., under what circumstances should rhGH be used; is rhGH a treatment for psychosocial problems; and do benefits outweigh risks? Ideally, findings from large placebo-controlled randomized clinical trials would inform clinical management decisions; however, their conduct has proved infeasible thus far. Still, mounting research evidence has addressed many aspects of the controversies in this area of elective care. Clinicians are encouraged to systematically explore alternative, evidence-based options to rhGH treatment with parents and patients as a remedy for any perceived liabilities of SS, either in the present or future.