Many people have pointed to the conspicuous absence of an mention of Ashley’s mastectomy in Diekema and Fost’s (2006) article on growth attenuation. There is another conspicuous absence that has not received the same attention. The authors provide no data about Ashley’s weight. This absence is troublesome since the author’s justify the procedures by indicating that Ashley was getting much larger and the primary concern was that she would become to heavy to be cared for by her family. However, they provide information about Ashley’s height before and during treatment but nothing about her weight.
How heavy was Ashley? Did her treatment succeed in attenuating her weight?
Fortunately, her parents have been a lot more forthcoming by providing height and weight charts for Ashley. As seen in her height chart, her growth slowed and dropped steadily in weight percentile for age during treatment.
Ashley was treated for two years. So this chart starts at the beginning of her treatment and includes her two years of treatment and includes date after treatment was discontinued. During two years of treatment, she dropped from well above the 75 percentile to below the 50th and after about two more years she has dropped below the 25 percentile. Without any data on her weight, we might expect that her weight would also start well above the 75 percentile and drop below the 25 percentile. Her weight chart, however, shows a much different pattern:
First, it should be noted that Ashley was not heavy for her age when her treatment began. She weighed about 22 kilograms and was well below average weight for girls her age. Next it should be noted that immediately after estrogen was started, she gained weight substantially, not a surprising finding since a frequent side effect of estrogen treatment is weight gain (although Gunther and Diekema assure readers that there were no side effects). Near the end of her treatment her weight gain begins to slow, so that after two years of treatment, her weight is back just above the 25 percentile for her age, pretty much exactly where it would have been expected to be without treatment. Only two full years after treatment is discontinued is there any indication of attenuation of weight gain. At that point she weighs about 2.5 kilograms less than would be expected if she remained at the same weight-for-age percentile as four years earlier before starting treatment. Much of this modest difference can be attributed to the surgical removal of her breasts and uterus.
Of course, the failure of this treatment to clearly produce significant weight attenuation, the primary rationale provided for using the treatment, is not the primary reason for objecting to this treatment. There are, in my opinion, many more important reasons.