On the basis of her family history and normal clinical examination, Jenipher Niyonziza at only fourteen is considered to be exceptionally tall standing at 1.5 metres. The average height of a girl of her age is 1.2 metres. Her predicted adult height is 1.88 metres.

Considering both the scientific and the social aspects of this issue, Niyonziza faces various potential problems which include feeling different, being subject to hurtful comments and eventual withdrawal from social activities.

And as her mother Betty Mbabazi confesses she will definitely get difficulties in finding appropriate clothes and a future marriage partner.

"Not many men these days like very tall or fat women. The trend has changed to the smaller build,” Mbabazi said referring to her daughter.

However the risk of remaining unmarried seems no to bother Niyonziza, as she is usually not worried about her size and may even be proud because she is often considered to be older than she actually is.

Predicting future psychological well-being is extremely difficult, whereas predicting adult height is less difficult and that is why most people including her parents are advocating for treatment to guard against the expected ‘abnormal’ tallness.

The principal aim of this treatment is of course to prevent anticipated psycho-social problems caused by extreme tallness in adulthood.

Societies have probably become more tolerant to tallness, shortness and other extremes of normal variation. But how short or tall is too much particularly for a woman?

"Oestrogen treatment for girls, to prevent psychosocial problems due to extreme tallness, has been available for decades but uncertainty about its position prevails,” says Doctor Edgar Kalimba, a practitioner at King Faisal Hospital, Kigali.

He adds that the ethical problems of this treatment outweigh the benefits and so it is wise to think twice before embarking on it. He explains that the inaccurate observations done among children with precocious puberty led to the first ideas of treating healthy tall girls with hormones to reduce their adult height.

"It would otherwise be considered justified but extreme tallness is only likely to raise social and economic problems”, says Kalimba.

The first scientific report of this treatment published in 1956 described 14 girls who had been treated with oestrogen and testosterone but the breakthrough bleedings were excessive.

Clearly, the ethical justification of any treatment for healthy people to prevent future psychological harm is a serious issue and poses an ethical dilemma.

Though the disadvantages of a tall stature in adulthood have usually been taken for granted in medical literature, the unpleasant experiences of a tall mother are often the main reason why treatment is sought for a tall girl.

"Sometimes I feel that any treatment is better than daily discussions at home about the harmfulness of tall stature,” says Martha Nyinawindinda, a 1.75 metre tall mother of four.

She insists that excessive tall stature is seen as a severe physical and psychological burden for otherwise healthy adolescent girls.

According to her, it is common for a mother to want her daughter to seek medical treatment, whereas the girl herself may have  no opinion and the father is not involved in the decision.

The treatment for tall girls is of course not unique even when none of them suffers from any other disease and the human growth hormone for exceptionally short children is used.

In all of medicine, a decision to treat is of course always the result of facts and values being weighed. Sometimes the facts are so obvious that value judgments are simple.

The treatment for tall girls represents the other extreme in that the treatment decision must consist of a careful weighing of available facts and the values of the girl, her family, the doctor and society.

And as Kalimba also says, the issue of consent is complicated because the age at which the initiation of this treatment is useful (at least in terms of height) falls into a grey area between early childhood and maturity.

Thus, by the time a girl is of age to give her valid informed consent, she no longer benefits from treatment, as she is already too old for it.

"If the primary aim (future psychosocial well-being) is considered, it is not possible to know whether the treatment has been successful in a particular case or not,” he says.

Despite all the research that has been conducted, many uncertainties are still linked to Oestrogen treatment for tallness because the problem is unique in each case. The values of the girl and her family are seriously considered in individual treatment decision.

As in the case of human growth hormone treatment for constitutionally short children or surgery for children with big ears, pharmacological treatment to prevent psycho-social harm among healthy tall girls is in a way treating the victims of the attitudes of families and society.

Svetlana Pankratova (born August 29, 1971, Volgograd, Russian SFSR) has, according to Guinness World Records, the longest legs of any woman in the world. While she is not the world’s tallest woman, her legs are 132 centimetres (4 ft 4 in) long.

Because her upper body is of much more typical dimensions, she is 196 centimetres (6 ft 5 in) tall. She has also very large feet, which gives her lots of problems when shopping for shoes big enough for her size 13 (US) / 46 (EU) feet.

Pankratova appeared in Trafalgar Square in London on September 16, 2008 with He Pingping, the smallest man in the world, to promote the 2009 edition of the Guinness World Records.

Ends