Middle-class parents are "flocking" to pediatric departments, and height anxiety is enabling pharmaceutical companies to rake in tens of billions of yuan annually.
Text by | Hu Xiangyun
Edited by | Hai Ruojing
I Want to Be “Taller”
Spring is the season for all things to grow, including the height of human children.
In an era that values science, a child's height should, of course, follow a quantifiable growth formula.
A widely recognized method is to predict a child's future height range based on the parents' heights. For example, for boys, the height range = (father's height + mother's height + 13 cm) ÷ 2 ± 7.5 cm.
The first part of the formula is the so - called “genetic target height,” which is the unchangeable height base determined by genetics. The “± 7.5 cm” in the second part is the part that can be changed through postnatal efforts — as long as the child's growth potential can be “fully realized.”
Liang Yu works in R & D at a pharmaceutical company. Due to her professional sensitivity, she began to pay attention to her daughter Xuanxuan's height when Xuanxuan was still in kindergarten. She admitted that neither she nor her husband is very tall, and she “didn't have high expectations for her daughter's future height. It was obvious from a young age that she wouldn't be tall.”
Nevertheless, after Xuanxuan entered the senior kindergarten class, Liang Yu signed her up for a skipping rope interest class. Exercise, sunlight exposure, and vitamin D supplementation were the most basic scientific methods for “growing taller” that Liang Yu initially chose.
A few years later, Xuanxuan won a prize in a skipping rope competition, but her annual height growth remained at around 5 cm. According to the average, many children can reach 7 or 8 cm. Originally, Liang Yu had accepted this result, until Xuanxuan showed signs of precocious puberty around the third or fourth grade.
During a child's growth period, sex hormones and growth hormones are two key factors affecting height. The former determines the length of the growth period. The earlier the puberty, the shorter the “growing” time may be; while the latter determines the growth rate. That is, the higher the level of growth hormone, the faster the “growing” speed.
Liang Yu couldn't say exactly why her daughter showed signs of precocious puberty, but it was obvious that physical intervention methods were no longer enough. She took Xuanxuan to the hospital. After a series of examinations, they started using both “Diphereline,” which can inhibit precocious puberty, and growth hormone, which can promote growth.
Recombinant human growth hormone is a type of drug officially certified by the national drug regulatory department for children with slow growth. As early as the 1950s, scholars successfully chemically synthesized human growth hormone in vitro, and it was gradually put into clinical use later. Currently, this type of product has been approved for the treatment of multiple indications such as children's growth hormone deficiency and idiopathic short stature. It is a “height - chasing” good medicine in the hearts of many parents and a popular billion - level consumer medical product in the market.
On the market, there are three common types of growth hormones: powder, short - acting water injection, and long - acting water injection. The main differences lie in the injection frequency and price.
Image source: Minsheng Securities
In the past few years, Wang Xiumin has received many children similar to Xuanxuan. She currently works at Shanghai United Family Hospital and has more than 35 years of experience in the pediatric field. Based on her experience, this situation may be “related to the lack of exercise and excessive nutrition during the epidemic.”
The demands of parents in the consulting room are mostly the same, which is “Can my child take growth hormone?” to make the child taller as soon as possible.
“In the early years, there were more children who came to the clinic when they were about to enter puberty, mainly during the summer vacation. Because during the school years, height was not always the top priority. But in recent years, I can feel that more and more parents come to the outpatient department to consult about height problems. Some even bring their 2 - or 3 - year - old children.” Wang Xiumin mentioned.
Most of these children who come to the clinic at an early age are not the standard applicable group for growth hormone. According to the indication rules, recombinant human growth hormone is applied to children whose height is below the P3 curve (the shortest 3 out of 100 children). When it comes to the final height of males and females, it is generally no more than 160 cm for males or 150 cm for females.
However, an investment institution practitioner who pays attention to the growth hormone track mentioned that in actual clinical practice, “there are also many cases of using the drug between P3 and P10.”
Doctors admitted that in modern social standards, “P3 is really unacceptable.” Considering the impact of height on a child's mental health, and even future love and job - hunting, doctors will consciously lower the injection standard to some extent when the basic indications are met. “For example, if a girl's height is between 150 - 153 cm and a boy's is between 160 - 165 cm, the use of the drug may also be considered.”
But just relaxing the standard by a few centimeters obviously cannot meet the expectations of some parents. When it comes to height, “passing” is not the standard, and just exceeding the average can only be called “meeting expectations.” If possible, everyone hopes that their child is the tall and upright one in the crowd.
As a result, children with heights at P25, P50, and even above the medium level keep appearing in the clinic. A colleague of Wang Xiumin once brought a 16 - year - old boy with a height of 172 cm to consult about injecting growth hormone. But in Wang Xiumin's view, this is already a “very normal height.” Eventually, she rejected this case.
However, the demands of children who are already taller than the average are often more pitiful. They may not really be dissatisfied with their own height, but they want to be actors or play basketball. In these special professions, a difference of one centimeter may mean missing their dreams.
For children who have enjoyed the result of growing taller, this kind of happiness is addictive. In the first year of taking the injection, Xuanxuan's height increase also reached the average of about 7 cm. Now at the age of 12, she is already 152 cm tall, and her final height may reach 160 cm. “After all, it's a drug,” Liang Yu originally considered stopping the injection after half a year, but Xuanxuan was not willing.
She wants to keep growing taller. Liang Yu guessed that although she has never directly put pressure on her child, the casual remarks of family members like “It's better to be taller” or the little excitement when Xuanxuan was finally moved from the front row to the second row by the teacher may have been remembered by Xuanxuan.
“She now wants to grow to 166 cm. The child thinks that a height above 160 cm is good.”
Why “Chase Height”?
“Taking practical actions and sparing no expense in terms of money” is another impression that Wang Xiumin has of many families chasing height. In the early years, there was even a joke among doctors: “If you want to be taller, stack as much RMB under your feet as you want to grow.”
Especially, “spending money to increase height” also has a time window that won't wait. When the epiphyses unique to children in the growth and development period close, their height growth will also stop. The golden window period for growing taller is usually only 12 - 14 years.
So, many parents take their children to the pediatric endocrinology outpatient department early to chase height because “time waits for no one.”
College student A Lin deeply understands this. She has witnessed her younger brother's journey of chasing height.
When her younger brother was about 3 years old, the family noticed that he was different from his peers. “He was not only short, but also looked like a one - year - younger child.” Later, her brother was diagnosed with Noonan syndrome in a children's hospital, a rare genetic disease and one of the indications for which growth hormone is approved for treatment in China. “He can't secrete growth hormone at all by himself. If he doesn't take the injection, his predicted adult height is only about 130 cm.”
A Lin is over 160 cm tall. If her brother is only 130 cm tall, this is a number that the whole family “absolutely cannot accept.” Since then, her brother's “height - chasing” life has officially begun.
The whole family is always ready: They watch him eat well because “the doctor told them that when injecting growth hormone, nutrition and exercise should also keep up.” To store the medicine in a cold place, a small refrigerator, ice packs, etc. have become their constant companions. “Originally, our family preferred public transportation when traveling, but after my brother started taking the injection, we basically changed to driving because we had to carry a small refrigerator to store the medicine.”
Now, A Lin's younger brother is 13 years old and 152 cm tall, basically the same height as his peers. He has also gotten used to the daily companionship of growth hormone for the past 10 years. “We hope that he can grow as much as possible before his epiphyses close. He may only grow to a little over 160 cm in the end, but the key is to do our best.”
For economic reasons, A Lin's parents chose a domestic short - acting powder injection for her brother, which is relatively cheap, but the monthly cost is still about 2,000 yuan. If roughly calculated, the family may have spent more than 200,000 yuan on growth hormone over the years. As her brother's weight increases and the treatment dose increases, the cost may also increase.
Liang Yu, who comes from a pharmaceutical company, initially chose an expensive imported growth hormone for her daughter. Later, due to the withdrawal of this product from the domestic market, she switched to a domestic product. She roughly calculated that in the nearly two years of treatment, including the inhibitor and growth hormone, “it's at least 250,000 yuan.”
Wang Xiumin is sometimes confused about why people are willing to pay so much for height. Sometimes, she wonders if it's because she is in Shanghai, a first - tier city, so she sees more cases of “meticulous parenting”?
However, even if there are regional differences, they are by no means decisive factors. A harsh reality is that although few people will openly talk about height, short people often seem to feel an invisible scrutiny.
A research team from the University of Pennsylvania in the United States once conducted a survey. After analyzing two groups of male samples born in the late 1950s in the United States and the United Kingdom, they found that individuals whose height exceeds the average by 10 cm may have an income level about 10% higher.
This is because during adolescence, tall children are often more enthusiastic about participating in social activities. These activities not only exercise their cognitive ability and leadership skills from a young age but also expand their social circle.
Even outside the workplace, in the marriage market, it has become an unspoken fact that tall people often have the priority in “choosing a partner.”
From a market perspective, the “market education” of growth hormone manufacturers at all costs in the past decade cannot be ignored.
More than 20 years ago, at the turn of the century, growth hormone entered the domestic market. But at that time, it was a high - priced and rare item, and few doctors knew about this type of product. Later, the sales market was opened up, largely thanks to the business strategy of core player manufacturers, who both reduced prices and invested a lot of money in market promotion.
As early as 10 years ago, Jinsai Pharmaceutical, one of the domestic growth hormone players, was “continuously supporting the Chinese Medical Association to organize various academic conferences and supporting well - known large domestic hospitals to set up training programs for endocrinology pediatric doctors.” In those years, Jinsai Pharmaceutical helped more than 300 specialized outpatient clinics for children's short stature to be jointly established by tertiary - level and secondary - level hospitals.
Growth hormone manufacturers have been constantly sending out the “height - chasing” signal: Your child can grow taller, and the method is here with us.
After more than 10 years of penetration, the concept of height - chasing has finally, like a boomerang, landed precisely on the parents who pay for it, and directly promoted growth hormone products from being unknown to becoming a phenomenon - level best - selling product. With just this one growth hormone product, some pharmaceutical companies can achieve annual revenues in the tens of billions of yuan.
However, is this once - profitable exclusive business still easy to do today?
Is Growing Taller Still a Good Business?
In the past, growth hormone (HGH) has always maintained its leading position in sales, mainly because its mechanism of action is very clear. This peptide hormone secreted by the anterior pituitary gland, which dominates children's growth, can promote bone growth by stimulating the local and liver - derived insulin - like growth factor - 1 (IGF - 1). It's equivalent to “replenishing what's lacking.”
However, it cannot be ignored that although injecting growth hormone is the most common method, the outside world's doubts about this exogenous injection method have never stopped.
One of the core issues is the side effects. Pan Hui, an expert from Peking Union Medical College Hospital, once mentioned in the book Experts from Peking Union Medical College Hospital Talk about Growing Taller: Let Your Child Grow 10 cm More that although growth hormone products are “generally safe,” injection - type drugs inevitably have side effects, such as rashes, skin itching, and pain at the injection site.
Liang Yu also mentioned that during the period of injecting growth hormone, the doctor strictly required her to take her child for regular check - ups, such as various hormone indicators and tumor indicators, to ensure the safety of drug use. In addition, “if there are emotional problems such as depression, it is not recommended to continue using the drug.”
After all, when injecting a child, parents hope to ensure absolute safety. And this concern of parents has provided a breeding ground for more non - medicinal “height - chasing” products. In the past two years, a few new players have gradually emerged in this market.
For example, a technology company focusing on the children's height - increasing market has targeted the IGF - 1 principle and launched a dietary supplement for children to grow taller, targeting the P10 - P75 population who have a need to grow taller but have not injected growth hormone.
Another example is a biotechnology company invested in by well - known enterprises such as Hillhouse Capital. They believe that the gut microbiota can interfere with children's growth and development by affecting the secretion of substances such as growth hormone and neurotransmitters. Based on this principle, they developed a probiotic product for promoting growth, BL - 11. It is reported that in a controlled trial with a placebo, children with growth disorders who took BL - 11 for 3 months grew about 2.6 cm taller than the placebo group.
Some doctors have noticed that in recent years, there have indeed been more new mechanisms and new research on growing taller at academic conferences in the field of pediatric endocrinology. However, due to the lack of real clinical data support, it is still difficult to evaluate the effectiveness. The aforementioned investment institution practitioner believes in the rigid market demand brought about by “height anxiety,” but also believes that “non - medicinal height - promoting products that can reach the medical - level supply are very scarce in the market.”
As a new type of product, it's still hard to say whether they can divide up the stable market that growth hormone has accumulated over the years.
For domestic growth hormone manufacturers that already occupy a high market share, the biggest variable in performance actually comes from “centralized procurement.” Since 2022, provincial alliance centralized procurement for various dosage forms of growth hormone has been carried out one after another. Under the logic of exchanging price for volume, the profit of the powder injection dosage form, the “basic version,” has been severely compressed; the relatively “advanced” water injection products have also voluntarily reduced prices to maintain market competitiveness.
The high - profit era of growth hormone has thus begun to decline. A most obvious example is that the performance growth ability of leading manufacturer Changchun High - tech is far from what it used to be. On April 20, in its 2024 performance report, the company presented its first report card with both revenue and net profit declining in 20 years. The net profit declined by 43.01%, which even led to a sharp drop in the stock price.
For manufacturers, the high - profit era of growth hormone may be passing