Other Uses of DES

Exploring the Varied Roles of Diethylstilbestrol (DES) in Women’s Health, Veterinary Medicine, and Unconventional Avenues

 

The Many Uses of DES 

While the members of the DES community live with the effects of the drug every day, most of us probably think of its use as something in the distant past. More than half a century has elapsed since in utero DES exposure was found to increase the risk of clear-cell adenocarcinoma, and the drug was pulled from clinical use for pregnant women very soon afterward.

But DES never really went away. It remains a common chemical for a range of applications, including in pharmaceuticals. 

Other Uses in Female Health

DES was most commonly used for preventing miscarriage, but it has also been prescribed in the past for other women’s health issues. Again, it was not tested properly, nor was it shown in the research to have enough benefits to justify its inherent risks.

Drug companies had submitted DES for approval in 1940 for treating menopause symptoms, but US Food and Drug Administration (FDA) Commissioner Walter Campbell initially rejected it. He said there was no proof that it would not harm women, following what he called the conservative principle, which today is known as the precautionary principle.

However, the FDA came under political pressure and changed its position several months later, approving DES in 1941 for menopausal symptoms and other women’s health issues, such as gonorrheal vaginitis, atrophic vaginitis, and preventing lactation after giving birth.

The FDA removed its approval for DES for lactation suppression in 1978, but by then it was already being used for another purpose: an early version of the “morning after pill,” starting in the early 1970s and continuing in the 1980s. A letter to the editor of the Annals of Internal Medicine in 1970 cited two previous studies, one in 1966 (in rabbits) and one in 1967 (the first one in humans), and yet another one in humans in 1973, claiming that DES could prevent pregnancy after intercourse.

These studies were so poorly done that they should hardly be called research. The authors from the 1967 study note, “Any estrogenic substance in sufficient dosage would probably prevent implantation.” That statement does not exactly inspire confidence that the estrogens and doses were tested with appropriate scientific rigor, or that the researchers considered that different estrogenic substances might have different effects on the participants.

The study describes several different types of estrogen drugs, including DES, at different doses used for five days after sexual intercourse. Proof of their effectiveness was stated that “in over 100 midcycle exposures, there have been no pregnancies,” while women receiving lower doses did become pregnant. However, that kind of evidence would never pass muster today since any number of factors could have accounted for the lack of pregnancies, including simple chance.

The use of DES as a morning-after pill became so controversial that the FDA would only allow it to be prescribed for rape or incest, lowered the dose available in pharmacies from 25 mg to 5 mg or less, and required packaging to include the following warning on the label: “This drug product should not be used as a postcoital contraceptive.”

DES for tall girls

Growing to be well above average in height often led to social stigma in very tall girls in the mid-20th century, so families sometimes sought ways to slow down teenage girls’ height growth. Starting in 1956, DES was prescribed for exactly this purpose. The practice continued into the 1970s, though it may have lasted longer in some areas. Today, DES is no longer used to stunt the growth of tall girls.

The discovery of the harms of DES in 1971 eventually led fewer doctors to prescribe it for this purpose, considering the findings of a 1978 study published in the journal Pediatrics.

The study reported data from a survey of physician members of the Lawson Wilkins Pediatric Endocrine Society — today called the Pediatric Endocrine Society — and the European Society of Pediatric Endocrinology. The survey was small, with responses from only 74 American pediatric endocrinologists and 29 of their European counterparts.

The survey findings showed that DES was still used for slowing the growth of tall girls and several other indications in female adolescents. Yet half of the American endocrinologists and 17% of the European ones said they never treated tall girls with estrogen because the long-term effects of high doses of estrogen in adolescence were unknown.

Another reason they gave was the simple fact that being tall is not a disease—it’s simply a physical characteristic. Thus, using a drug with possible harmful side effects for this indication was not considered appropriate.

Still, the survey revealed that many doctors were still prescribing it, and for reasons other than stunting height growth. The other two uses reported were as hormone replacement therapy in teens with delayed pubertal development and as a form of birth control for sexually active teens.

Other Pharmaceutical Uses

Aside from its uses in women’s health, DES has also been prescribed “within treatment protocols to ‘manage’ intersex patients,” according to the research of Jacquelyn Luce, PhD, a senior lecturer in Gender Studies at Mount Holyoke College, and the investigator behind the Embodying Transgenerational Exposure: Gender/sex/sexuality and experiences of being DES-exposed research study.

Intersex patients are those born with ambiguous genitalia and reproductive organs. They may have both female and male organs or one type of internal sex organ with the external genitalia of the other sex.

A study from 1972 reported on 24 patients who received DES for five years or longer to treat conditions involving the underdevelopment of sex organs. Two of those patients developed endometrial cancer. Reports in the 1970s and 1980s revealed that DES was sometimes prescribed as hormone therapy for transgender women.

DES has also been used to treat cancer. The drug was found in 1941 to be one of the first effective drugs for the treatment of prostate cancer since it suppresses the production of androgens, the male sex hormones.

DES remained the standard treatment for prostate cancer until 1985, when newer drugs became available. However, men with advanced prostate cancer in some parts of the world may still be offered DES as part of their overall therapy.

Most ironically, high-dose DES was also a standard effective treatment for advanced breast cancer from 1960 until 1977, when it was replaced with tamoxifen.

For the same reason that DES can effectively suppress androgens in prostate cancer, a completely new and highly unusual use of DES has arisen among some women in China.

According to several articles published this year, some Chinese wives wishing to prevent their husbands from cheating have decided that preventing them from achieving an erection is one way to accomplish that goal. They mixed it into their husbands’ food and drinks to cause impotence.  Although no studies have shown that DES can prevent cheating, that has not stopped some wives from claiming it is effective.

Veterinary and Agricultural Uses

Many people are surprised to learn that DES has found uses outside the field of human medical practice, both in veterinary medicine and in agricultural applications.

For example, DES can be used off-label to treat urinary incontinence in spayed female dogs, though it should never be prescribed to dogs with estrogen-sensitive tumors.

DES was also used for years to stimulate growth in cattle and sheep, starting in 1947 at Purdue University. It was the first major hormone found to increase size and growth rate and was administered in the form of a tablet implanted under the skin.

Later, scientists at Iowa State College found that DES’s impact on growth was more potent when given orally, so it was soon added to the animals’ feed.

This use was formally approved by the US FDA in 1954 for beef cattle, and it quickly became a widespread practice. Within a few years, nearly 90% of all cattle in the United States consumed feed supplemented with DES.

Eventually, however, studies found high levels of hormones in chickens who ate DES-supplemented feed. Low levels of the compound were detected in some cows’ livers, suggesting they received too much DES. There is no evidence suggesting that people who ate beef or beef liver during this period ingested DES at levels that would have affected them. Though we cannot rule out that possibility entirely, consuming extremely large quantities of beef liver would have been required to equal even one dose of DES.

The combination of those findings, along with the news about CCA in DES Daughters, led the FDA to ban the use of DES in cattle feed in 1972.

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