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 the drug’s use as something in the distant past. It’s been half a century since DES was found to increase risk of clear cell adenocarcinoma, and it was pulled from clinical use for pregnant women very soon afterward.
But DES never really went away. It remains a common chemical in use today for a wide range of purposes, including pharmaceutical ones. It was also used for medical purposes in the past aside from prescribing it to prevent miscarriage.
Other Uses in Female Health
DES was most widely used for preventing miscarriage, but it has also been prescribed in the past for other women’s health issues. And again, it was not always tested properly or shown in research to have enough of a benefit to justify these uses.
Drug companies had submitted DES for approval in 1940 for treating menopause symptoms, but 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 called 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 preventing lactation after giving birth, gonorrheal vaginitis and atrophic vaginitis.
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 and one in 1967, claiming that DES could prevent pregnancy after intercourse.
These studies were so poorly done that they should hardly be called studies. The one from 1967 notes, “Any estrongenic substance in sufficient dosage would probably prevent implantation.” That does not exactly inspire confidence about how well different estrogens and doses were tested.
The study describes several different estrogens, including DES, at different doses used for five days after sexual intercourse. Proof of their effectiveness was that “In over 100 midcycle exposures there have been no pregnancies,” while women with lower doses did have pregnancies. However, that kind of evidence would never pass muster today since any number of reasons could have accounted for no pregnancies, including simple chance.
The use of DES as a morning after pill became so controversial that the FDA would only allow it for rape or incest, lowered the dose available in pharmacies from 25 mg to 5 mg or less, and required packaging to include 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, 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 at least, though it may have lasted longer in some areas. Today, DES is no longer used to stunt the growth of tall girls.
It’s possible that the discovery of DES’s harms in 1971 eventually led fewer doctors to prescribe it for this purpose, considering the findings of a 1978 study in the journal Pediatrics.
The study reported findings 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 European pediatric endocrinologists.
Still, the findings showed that DES was still used for slowing the growth of tall girls and several other uses in adolescent females. 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 was the simple fact that being tall is not a disease—it’s simply a physical characteristic, so using a drug with possible negative side effects to treat it was not 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 in the survey were as hormone replacement therapy in teens who had not yet developed normally in puberty and as a form of birth control for sexually active teens.
Other Pharmaceutical Uses
Aside from use in women’s health, DES has also been “used within treatment protocols to ‘manage’ intersex patients,” according to the research of Jacquelyn Luce, a professor for Gender Studies at Mount Holyoke College, and the study investigator behind the Gender, Sex, Sexuality and DES-Exposure: A Research Study.
Intersex patients are those who are born with ambiguous genitalia and sex organs. They may have both female and male organs, or one type of internal sexual organ with the external genitals of the other sex.
For example, a study from 1971 reported on five patients who had not developed sex organs who were prescribed stilbestrol. Sadly, a study one year later reported on 24 patients who received DES for five years or longer to treat underdevelopment of sex organs, and three of these patients developed endometrial cancer. The women were an average age of 31 when they developed the cancer.
More studies followed in 1975 and through the end of the 1970s that reported on endometrial carcinoma in patients treated with DES for underdevelopment of sex organs. There were also reports in the 1970s and 1980s showing that DES was sometimes prescribed as hormone therapy for transgender women.
DES has also been used to treat cancer. DES was found in 1941 to be one of the first effective drugs for treatment of prostate cancer since it can suppress production of the male sex hormone androgen.
DES remained the standard treatment for prostate cancer until 1985, when newer drugs became available, though people with prostate cancer today still have the option to take DES as part of their overall therapy.
Most ironically, 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 androgen in prostate cancer, DES has very recently found a completely new, and highly unusual, use among some women in China.
According to several articles published this year, some Chinese wives are looking for ways to prevent their husbands from cheating. They have decided that preventing their husband from achieving an erection is one way to accomplish that goal.
Therefore, some Chinese wives have purchased DES through online shops and then secretly mixed it into their husbands’ meals and drinks to cause impotence. Of course, there have definitely never been any studies showing that DES can prevent cheating, but that has not stopped some wives from claiming it’s effective.
“The medicine took effect just two weeks after I started feeding it to my husband. Now he basically stays at home, behaving himself well,” one woman reported in an online forum.
Shortly after these articles appeared, several stores in China removed DES from their shelves, but it appears it’s still possible to purchase it online. It’s impossible to know whether this is a widespread trend or only a small group of women secretly spiking their husbands’ meals with DES.
Veterinary and Agricultural Uses
Many people are surprised to learn that DES has found uses outside the field of human medicine, both in veterinary medicine and in agricultural applications.
For example, DES can be used off-label to treat urinary incontinence in dogs, though it should never be prescribed to female dogs with estrogen-sensitive tumors.
DES was also used for years to increase cows’ growth. It was the first major hormone to be used to increase how quickly and how large cows grew, starting in 1947 at Purdue University with a tablet implanted under the skin.
Later, scientists at Iowa State College found the growth effects of DES were stronger when it was given orally, so it was soon added to feed for cattle and sheep.
DES’s use in cattle feed was formally approved by the FDA in 1954, and it quickly became a widespread practice. Within a few years, nearly 90% of all cattle in the United States fed from cattle feed supplemented with DES.
Eventually, however, studies found high levels of hormones in chickens who ate feed with DES. Then low levels of DES were detected in some cows’ livers, suggesting they were receiving too much DES. There is not any evidence suggesting that people who ate beef or beef liver during this period of time ingested DES that affected them. Though we cannot rule out that possibility entirely, people would have to have eaten extremely large amounts of beef liver to equal even one dose of DES.
Nevertheless, it was concerning to find any DES in the livers. The combination of those findings and the news about CCA in DES Daughters led the FDA to ban the use of DES in cattle feed in 1972.