This study used a combination of research methods. Some women participated in focus groups.  Most participants completed postal questionnaires and telephone interviews about themselves and their health.  Two further studies have been undertaken with women involved in the Tall Girls Study.

One study explored how women remembered and believed they were affected by their adolescent experiences of being assessed or treated for tall stature. The aim of the research was to develop an understanding of the possible antecedents to the high prevalence of depression in adulthood found among women in the Tall Girls Study. This study is now complete and the results challenge certain dominant assumptions held about femininity and tallness at the time girls were treated. The findings suggest that for some women, the problematising and medicalising of tall stature during adolescence was stigmatizing. Feelings of shame and humiliation commonly resulted in poor self-esteem and body-image. These feelings and states are known antecedents for major depression.

The second new study has examined whether hormone treatment for tall stature had lasting effects on breast tissue. The number of participants in this cohort was too small to obtain reliable estimates of breast cancer risk associated with treatment, however, mammographic density, a well established risk factor for breast cancer, could be examined. While it is known that mammographic density can be affected by hormones such as estrogen in the short-term, for example by HRT, it is not known whether hormone levels in adolescence have any lasting effects on the breast. For this study, women aged 40 years and over were asked to complete a short telephone interview and to have a breast x-ray (mammogram), or to give us permission to access a mammogram they had had in the past. Findings from the study have been submitted for publication and will be available in due course. Visit Menzies Research Institute

Data collection for the main follow-up has been completed and some of the findings have been published. Other analyses are still underway. The study collected data from 396 women who had been treated with hormones to reduce their adult height, and 448 women who had been medically assessed because of their tall stature but were untreated.

In relation to infertility, treated women reported more difficulties becoming pregnant, they were more likely to have seen a doctor for fertility problems, and to have had infertility treatment. Treated women were slightly less likely to have ever been pregnant. Among women who conceived, the time taken to become pregnant tended to be longer in those who had been treated for tall stature.

Overall, the vast majority of untreated women (99%) were satisfied with the decision not to be treated no matter how tall they became. Fewer treated women were satisfied with the decision to be treated (58%). Dissatisfaction with treatment was associated with not having an active say in the decision making process; having negative experiences of assessment or treatment; and having unwanted side-effects of treatment.

A comparison of mental health outcomes in treated and untreated tall women showed that the two groups were similar in their history of depression. Compared with the general population of women of the same age, however, study participants were more likely to have experienced depression. Women with a history of depression were more likely to have sought medical attention for tall stature because of difficulties they were having in adolescence and were more likely to have had negative experiences of assessment or treatment procedures for tall stature.

Oestrogen treatment was shown to be effective, albeit modestly, in reducing the height of tall girls, after adjusting for error in the height prediction. Using a model based on 107 pairs of treated and untreated girls, the mean difference between the final height and estimated mature height was –1·4 cm (SE 0·29) in the treated group and 1·1 cm (SE 0·23) in the untreated group, giving an unadjusted treatment effect of –2·5 cm (95% CI –3·2 to 1·8). The treatment effect was greatest in those commencing treatment at an early bone age and was significant if initiated before a bone age of 15 years. On average, oestrogen treatment resulted in an adult height that was less than predicted. Although treatment was more effective in the least mature girls, the mean height difference was relatively modest for most treated girls.

Venn A, Bruinsma F, Werther G, Pyett P, Baird D, Jones P, Rayner J, Lumley J. Oestrogen treatment to reduce the adult height of tall girls: long term effects on fertility. Lancet 2004; 364: 1513-1518

Summary

Background: Treatment with oestrogen to reduce the adult height of tall girls has been available since the 1950s. This retrospective cohort study examined the long-term effects on fertility.
Methods: Eligible subjects were identified from the records of Australian paediatric endocrinologists who assessed tall girls from 1959 to 1993, and from self-referrals. Subjects included girls who received oestrogen treatment (diethylstilboestrol or ethinyl estradiol) (treated group) and those who were assessed but not treated (untreated group). Information on reproductive history was sought by telephone interview.
Findings: 1,432 eligible subjects were identified and 1,243 (87%) were traced. Of these, 780 (63%) completed interviews: 651 were identified from endocrinologists' records, 129 self-referred. Treated (n=371) and untreated (n=409) women were similar in socio-economic and other characteristics. After adjusting for age, treated women were more likely to have ever tried for 12 months or more to become pregnant without success (RR=1, 80, 95% CI 1, 40-2, 30); more likely to have seen a doctor because they were having difficulty becoming pregnant (RR=1.80, 95% CI 1.39-2.32) and to have ever taken fertility drugs (RR=2.05, 95% CI 1.39-3.04). Using the time taken to conceive a first pregnancy, the treated group was 40% less likely to conceive in any given menstrual cycle of unprotected intercourse (age-adjusted fecundability ratio: 0.59, 95% CI 0.46-0.76). These associations persisted when self-referred women were excluded.
Interpretation: High-dose oestrogen treatment in adolescence appears to reduce female fertility in later life. This finding has implications for current treatment practices and for our understanding of reproductive biology.

Pyett P, Rayner J, Venn A, Bruinsma F, Werther G, Lumley J. Using hormone treatment to reduce the adult height of tall girls: are women satisfied with the decision in later years? Social Science in Medicine 2005; 61: 1629-39

Summary

Treatment with synthetic oestrogens to reduce adult height has been available for tall girls since the 1950s. Treatment aims to reduce psychosocial problems associated with tall stature that might occur in adolescence or adulthood, but little is known about the long-term outcomes.
This retrospective cohort study identified 1,248 eligible women from the medical records of Australian paediatricians who assessed or treated tall girls between 1959 and 1993, and 184 women from self-referrals. They included girls who received oestrogen treatment (diethylstilbestrol or ethinyl estradiol) in adolescence (treated group) and those who had been assessed but did not receive treatment (untreated group). A total of 1243 (86.8%) women were traced and invited to participate in the study, and 67.9% of these women (396 treated and 448 untreated) agreed. In a postal questionnaire women were asked to comment on a range of issues including how they felt about their current height, the assessment and treatment procedures, and the decision whether or not to have treatment.
While untreated women were almost unanimously glad they were not treated (99.1%), no matter how tall they became, 42.1% of the treated women expressed dissatisfaction with the decision that was made. There was no clear association between satisfaction with treatment and women's final height. However, dissatisfaction was related to whether or not the girls had an active say in the decision-making; to negative experiences of the assessment or treatment procedures; to side effects experienced during the treatment period; and to later side effects women believed were associated with the treatment. Qualitative analysis of comments made by treated women helps explain their dissatisfaction with the decision to have treatment.

Bruinsma F, Venn A, Patton G, Rayner J, Pyett P, Werther G, Jones P, Lumley J. Concern about physical appearance during adolescence and depression in later life. Journal of Affective Disorders, 2006; 91: 145-52
Summary
Objective: This retrospective cohort study aimed to examine the long-term psychosocial outcomes for women assessed or treated during adolescence for tall stature.
Method: Women assessed or treated for tall stature identified from the records of Australian paediatricians were eligible to participate. Psychosocial outcomes were measured using the depression, mania and eating disorders modules of the Composite International Diagnostic Interview (CIDI), the SF-36, and an index of social support.
Results: There was no significant difference between treated and untreated women in the prevalence of 12 month or lifetime major depression, eating disorders, scores on the SF-36 mental health summary scale, or the index of social support. However, compared with the findings of population-based studies, the prevalence of major depression in both treated and untreated tall girls was high (12 month prevalence untreated 10.5%, treated 10.5%; lifetime prevalence untreated 29.3%, treated 30.5%). Factors significantly associated with lifetime major depression in this study were self-reported difficulties during adolescence being the reason for seeking a medical assessment of height (OR 2.25, 95% CI 1.4-3.6) and a negative experience of the assessment or treatment procedures (OR 2.04, 95% CI 1.4-3.0).
Conclusion: Long-term follow-up of a large cohort of tall girls showed that psychological outcomes among both treated and untreated women were poor and that the intended psychosocial benefit of treatment may not have been realized. The findings highlight the importance of attending to the mental health of adolescents presenting for management of conditions where self-concept and body image are a primary focus.

Jordan HL, Bruinsma FJ, Thomson RJ, Amir, LH, Werther GA, Venn AJ. Adolescent exposure to high-dose estrogen and subsequent effects on lactation. Reproductive Toxicology, 2007; 24:397–402

Summary

Treatment with high-dose estrogens has been used to reduce the adult height of tall girls for many years. Short-term side effects on the breast have been reported but there have been no studies to investigate whether there are long-term effects on lactation.
This retrospective cohort study of 371 treated and 409 untreated women asked about breastfeeding history. After adjusting for maternal age at first live-birth, treated women (4.4%) were no more likely than untreated women (4.1%) to not commence breastfeeding (RR 1.13, 95% CI 0.50–2.52). After adjusting for age, there was no significant difference in the average duration of breastfeeding between treated median 41.1 weeks) and untreated women (median 43.3 weeks) (p = 0.77) for all live-births. Treated women were not significantly more likely to report physiological reasons for stopping breastfeeding than untreated women.
Women treated with high-dose estrogens during adolescence appeared to be no different to untreated women in their ability to lactate.

Venn A, Hosmer T, Hosmer D, Bruinsma F, Jones P, Lumley J, Pyett P, Rayner J, Werther G. Oestrogen treatment for tall stature in girls: estimating the effect on height and the error in height prediction. Clinical Endocrinology, 2008; 68:926–29
Summary
Objective: To determine the effect of oestrogen treatment on attenuating the growth of tall girls after adjusting for error in height prediction.
Design: Retrospective cohort study.
Patients: Tall girls assessed by Australian paediatric endocrinologists between 1959 and 1993. A total of 279 girls received oestrogen treatment (diethylstilboestrol or ethinyl oestradiol) and 367 girls were assessed but not treated.
Measurements: Estimated mature height (EMH) was calculated using radiographic assessment of bone age in adolescence. Final adult height was self-reported at follow-up. To control for error in the EMH predictions and their different distributions by treatment status, pairs of treated and untreated girls, matched on EMH within
1 cm, were selected for analysis. Covariate adjusted estimates of treatment effect (final height – EMH) were calculated.
Results: In the sample of 108 matched pairs, the mean difference between the final height and EMH was –1·4 cm (SE 0·29) in the treated group and 1·1 cm (SE 0·23) in the untreated group, giving an unadjusted treatment effect of –2·5 cm (95% CI –3·2 to 1·8). A regression model based on 107 pairs of treated and untreated girls contained a significant interaction between bone age at treatment initiation and treatment, which estimated an approximately 1 cm per year decrease in treatment effect. The treatment effect was greatest in those commencing treatment at an early bone age and was significant if initiated before a bone age of 15 years.
Conclusions: On average, oestrogen treatment resulted in an adult height that was less than predicted. Although treatment was more effective in the least mature girls, the mean height difference was relatively modest for most treated girls.