Some children in China are being injected with human growth hormone by their parents hoping to make them taller out of concern that being short might hinder the kid’s future. The trend has emerged due to multiple factors: children growing up in a hyper-competitive environment , increased wealth making the products affordable to more people, and the relative safety and effectiveness of the treatment. The US Food and Drug Administration approved the use of synthetic growth hormone for children in 2003, and subsequent studies found that it helped kids grow about 2 inches (5cm) if they are treated for 5.5 years. Yan Yiping, an 11-year-old girl from Jian, in eastern China’s Jiangxi province, describes herself as strong and healthy. And while she is shorter than average, it did not cause her any issues. But her parents disagreed , thinking she was so short that she needed medical treatment to catch up with her peers. “It’s my parents who think I’m short. I don’t think so. There are shorter students in my class,” she said. Yan was less than 120cm (3 feet 11 inches) tall when she started taking the growth hormone. Over the next year, she took one shot every night upon her parents’ request. She now measures 131cm (4 feet 3.5 inches), although it is impossible to know if she would have had the growth spurt naturally. The mean height of Chinese girls at her age is about 147cm (4 feet 10 inches), according to a 2018 report from the National Health Commission. Yan is not alone in her experience. “We have received a lot of parents who demanded growth hormone injection for their kids in recent years,” said Dr Wang Xiumin from Shanghai Children’s Medical Center. “They were anxious either because they themselves were not tall, or they believed a short kid would have a harder time finding a job when they grew up,” she said. In her opinion, most of the kids she saw did not really need the growth hormone. And for those who do not need medical treatment, “the addition of synthetic growth hormones breaks the balance of hormones in the body, leaving a relatively low amount of other hormones,” Wang added. But many families believe the risk is worth the reward to avoid potential problems from being short. Nancy Lin, a mother in Shanghai who is considering a growth hormone treatment for her 5-year-old son, was worried that he would be more likely to be bullied by other children, as he is the smallest child in the class. “And then when he is older, he may not look as good as taller people, and that might affect his confidence. Last but not least, he might not get some jobs because they have a height requirement,” she said. It’s my parents who think I’m short. I don’t think so. There are shorter students in my class. Yan Yiping, an 11-year-old who takes growth hormones The average height of Chinese teenagers has already increased significantly over the past 35 years because improvements in quality of life have allowed more families to access the nutrients needed to promote growth. The average height of a 19-year-old woman has grown 5cm (about two inches) from 1985 to 2019. For men, that number is 7.6cm (about three inches) The increase in boys’ height is the largest in the world over that period, while the rise in girls’ height is third. Manufacturing and selling growth hormone has also become a profitable business. The size of the industry in China reached 7.7 billion yuan (US$1.19 billion) last year, according to Southwest Securities, a financial services firm. The gross revenue for GeneScience Pharmaceuticals, a leading manufacturer of the drug in China, increased from 1.06 billion yuan (US$163 million) in 2015 to 5.8 billion yuan (US$893 million) in 2019. According to Song Tao, a pharmacist in Qingyang People’s Hospital in Qingyang city, Gansu province, in northwest China, the most popular treatment comes in a liquid form, which requires a shot every day. It usually costs between 3,000 yuan (US$461) and 4,000 yuan (US$615) per month. Song said the hospital experienced a steady increase in the number of parents who visited the hospital’s children’s growth clinic after it was opened in April 2019. They have received more than 500 patients at the clinic, and over 100 of them have been treated with growth hormone. “Usually, we’ll prescribe the medicine if a parent asks for it unless the child is only a few centimetres shorter than their peers or has a medical condition that might cause a problem, such as diabetes,” said Song. Yan said she was taken to hospital every three months for new prescriptions and a routine physical check-up, and it cost her parents over 10,000 yuan (US$1,500) per visit. Asked whether the cost was worthwhile, the girl said: “My heart aches for so much money being spent. It’s enough for me to buy other things for a very long time!”