Hormone-Containing Hair Product Use 
in Prepubertal Children 

Arch Pediatr Adolesc Med v.156, Jan02

Su-Ting T. Li, MD Child Health Institute 146 N Canal St, Suite 300 Seattle, WA 98103-8552 (e-mail: sli@u.washington.edu) 
Paula Lozano, MD, MPH 
David C. Grossman, MD, MPH 
Minor Graham, MD, MPH Seattle

Some cosmetics contain estrogens, representing a potential source of exogenous estrogen for children. In contrast to pharmaceutical preparations, the Food and Drug Administration (Rockville, Md) does mot regulate cosmetics containing less than 10000 IU of estrogen per ounce, only stating that the label should direct consumers to limit the amount of product used to less than 20 000 IU/mo.[1, 2] A therapeutic dose of oral ethinyl estradiol For hormone-replacement therapy in adults is 0.02 to 0.05 mg/d (4000-10000 IU/d). An equivalent therapeutic transdermal estradiol dose for hormone-replacement therapy is 0.05 mg/d.

Two case series suggest that exogenous hormones Found in hair products may be associated with early pubertal development in African American girls.[2, 3] In 3 of 4 cases, pubertal characteristics regressed on discontinuation of these products.[3] Patterns of use of hormone-containing hair products (HCHPs) are unknown. One survey of parents at 4 southern US Army hospital clinics revealed that 64% of African American parents and 6.9`% of European-American parents used HCHPs, and 55.5% of those parents used them on their children.[4]

We estimated the prevalence of HCHP use among different ethnic groups in an urban clinic population, which included immigrant populations. We surveyed parents with children younger than 10 years attending 3 Seattle, Wash, pediatric clinics between November 1999 and January 2000. Color copies of product labels of HCH Ps were used as pictorial guides. Age, sex, and frequency of exposure to HCHPs were documented to better understand whether prepubertal children were regularly exposed to these products.

A total of 130 parents were surveyed. Race/ethnicity was reported as follows: 25% African American, 25% African immigrant, 20% European American, 12% Asian/Pacific Islander, 11% Hispanic, and 6% other/unspecified. Of the 247 children reported, 55% were girls, 41% were boys, and 4% did not specify sex. Age group distribution was as follows: 8%, younger than 1 year; 48%, 1 to 5 years; 26%, 6 to 9 years; and 19%, 10 to 18 years. The use of HCHPs was reported by 21% (27/130) of respondents (Table). More African American parents (45%) used HCHP than parents of all other races/ethnicities (x²=16.4; P<.001), including African immigrant parents (12%). Eighty-five percent of parents using HCHPs also used these products on their children, including children younger than 5 years. Most families (65%) who used HCHPs on their children used them only occasionally but a third of families reported regular use. One limitation of this study is that we were unable to quantitate the exact close or absorption of these products.

A recent study revealed that girls are developing at am earlier age than has been observed previously and there is a significant difference between mean age of onset of puberty in European American compared with African American girls."' Since it is unknown why African American girls are entering puberty at an earlier age than their European American or African counterparts, it is possible that the use of HCHPs may contribute to earlier onset of puberty in this population. More research is needed to ascertain whether am association exists between the use of HCHPs and the early onset of puberty.

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Prevalence of Hormone-Containing Hair Product Use*

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Race/Ethnicity 
			African 	African 	European 
			American 	Immigrant 	American 	Other 		Total 
			(n=33) 		(n=33) 		(n=26) 		(n=38) 		(N=130) 
Parent 			15(45) 		4(12) 		3(12) 		5(13) 		27(21) 
Child 			14(42) 		4(12) 		2(8) 		3(8) 		23(18) 
Regular use by child 	5(15) 		2(6) 		0 		1(3) 		8(6)

Data are given as number (percentage) of participants.

We thank Michelle Terry, MD, and Sue Hott, MD, for assistance with surveying patients in their clinics.

1. Estrogens in cosmetics. Med Lett Drugs Ther. 1985,27:54-55

2. Zimmerman PA, Francis, GL. Hormone-containing cosmetics may cause signs of early sexual do development Mil Med. 1995,160 :628-630.

3. Tiwary CM. Premature sexual development in children following the use of estrogen -or placenta-containing hair products. Clin Pediatr. 1998;37:733-739. 

4. Tiwary CM. A survey of use of hormone/placenta-containing hair preparations by parents and/or children attending pediatric clinics. Mil Med. 1997.. 162:252-256.

5. Herman-Giddens ME., Slora FJ, et al. Secondary sexual characteristics and menses in young girls seen in office practice: a study from the Pediatric Research Office Settings Network. Pediatrics. 1997;99:505-512.

6. Kaplowitz PB, Oberfield SF. Reexamination of the age limit or defining when puberty is precocious in girls in the United States: implications for evaluation and treatment. Pediatrics. 1999:104:936-941.