Preventing homosexuality and uppity women in the womb

June 30, 2010 3:00 PM

“Gender-related behaviors, namely childhood play, peer association, career and leisure time preferences in adolescence and adulthood, maternalism, aggression, and sexual orientation become masculinized in 46,XX girls and women with 21OHD deficiency [CAH]. These abnormalities have been attributed to the effects of excessive prenatal androgen levels on the sexual differentiation of the brain and later on behavior.” Nimkarn and New continue: “We anticipate that prenatal dexamethasone therapy will reduce the well-documented behavioral masculinization…”

• Wikipedia on the steroid dexamethasone, including side effects;
• congenital adrenal hyperplasia, the actual condition for which dexamethasone is proposed as a treatment;
• another method of treating some of the symptoms of CAH;
• the Bioethics Forum on “Preventing Homosexuality (and Uppity Women) in the Womb?”

posted by kipmanley (55 comments total)

The hell?
posted by nola at 3:02 PM on June 30, 2010

It's the Cure! Whoooo!
posted by Wataki at 3:04 PM on June 30, 2010

PZ Meyers is awesome - calls himself a Godless liberal biologist. He'd be the most popular kid on the MeFi block if he moved in. I call dibs on being his best friend.
posted by helmutdog at 3:11 PM on June 30, 2010

Somehow I feel this has less to do with the health and well being of the child-to-be and more to do with controlling women's bodies... hmm...

Does this mean by the time I choose to reproduce I will have to sell ownership of my future daughter-property to her future husband-master?

Because seriously WTF.
posted by yeloson at 3:11 PM on June 30, 2010 [1 favorite]

I see. So all gender-related behaviors and traits are strictly biological in nature. They are never observed or interpreted through a sociocultural lens. Learn something new every day.

If snark is caused by prenatal hormones, many of us are doomed.
posted by rtha at 3:12 PM on June 30, 2010 [7 favorites]

Fuck that. I'm grateful for the congenital abnormality that caused my diseased state. Without it, good god I'd be boring.
posted by mudpuppie at 3:14 PM on June 30, 2010 [7 favorites]

“CAH women as a group have a lower interest than controls in getting married and performing the traditional child-care/housewife role. As children, they show an unusually low interest in engaging in maternal play with baby dolls, and their interest in caring for infants, the frequency of daydreams or fantasies of pregnancy and motherhood, or the expressed wish of experiencing pregnancy and having children of their own appear to be relatively low in all age groups.”

Oh heavens, what could possibly be worse than that?
posted by lullaby at 3:16 PM on June 30, 2010 [21 favorites]

Just you wait. There will be a group of lesbian gang members going around inducing this by spraying pregnant women with prenatal androgen foam. Wait you mean they won't? Damn you media and your lies!
posted by msbutah at 3:18 PM on June 30, 2010 [1 favorite]

It's worth noting that the primary purpose of this therapy is to prevent birth defects: actual physical deformities. The Nimkarn and New paper is kind of an "and also...." thing.
posted by mr_roboto at 3:20 PM on June 30, 2010 [3 favorites]

rtha: hey now, it sounds like you're dissing evolutionary psychology, and we can't do that according to the folks a few threads down.
posted by kmz at 3:20 PM on June 30, 2010

I love the irony in one of the first female pediatric endocrinologists in Florida trying to treat fetuses so they won't have "masculine" careers.

I hate this normalizing bullshit. Variety is the spice of life, people. Stop being asses about people who are different than you, OK?
posted by stoneweaver at 3:22 PM on June 30, 2010 [3 favorites]

I saw this movie. It doesn't have a happy ending.
posted by Cool Papa Bell at 3:23 PM on June 30, 2010 [4 favorites]

And I hope I did so note, Mr. Roboto, or at least provide the raw materials by which it could be so noted. But that "and also" is one hell of a thumping huge "and also."
posted by kipmanley at 3:24 PM on June 30, 2010

Do they not teach bioethics in medical school these days?
posted by GuyZero at 3:24 PM on June 30, 2010 [5 favorites]

Did anyone else check the date on the article before reading anything else?
posted by hellojed at 3:24 PM on June 30, 2010

rtha: "If snark is caused by prenatal hormones, many of us are doomed."

For a while, I was taking dexamethasone for its anti-inflammatory and immunosuppressive properties (I have some arthritis and arthritis like conditions). Shortly after I started, about a week in, I noticed my favorites received here on mefi increasing. Checking my comments, I saw that there were a rash of smarmy and hurtful comments made by my account from midnight to about 4AM, but I'd been asleep then. Well, my wife watched me carefully the next night. Just around midnight, I put on my robe and walked to the computer room, booted up my pc, signed in and made some perfectly coherent but mean-spirited comments on the blue, shut everything down, and went back to bed! We talked with my rheumatologist the next day, who wasn't surprised. He told us, "It's a common side effect, snarkolepsy".
posted by boo_radley at 3:25 PM on June 30, 2010 [42 favorites]

The Last Psychiatrist was a few days ahead of the curve on this one, and offers some useful references calling into question the in utero androgen exposure-digit length correlation.
posted by rudster at 3:27 PM on June 30, 2010 [1 favorite]

dexamethasone is an anagram of "a sex death omen"
posted by Sys Rq at 3:27 PM on June 30, 2010 [14 favorites]

We pumped our baby full of synthetic glucocorticoid steroids in the womb so that she would be straight... y'know, natural.
posted by XMLicious at 3:33 PM on June 30, 2010 [7 favorites]

For a less hysterical take on why this isn't about preventing lesbianism, see here

Would you prefer your child born with a vagina that isn't differentiated from the urethra, AKA, essentially, an birth defect that mimics fistula after childbirth? That's part of what can happen if there is no intervention in this condition.

Why is trying to mitigate the damage from this birth defect any different from say, preventing cleft palate? Most people tend to prefer not to be born as outliers in terms of physical characteristics that can be stigmatizing. This is certainly better than cutting people's clits off-- if the child's clit comes out normal rather than large, why is that a problem?
posted by Maias at 3:37 PM on June 30, 2010 [7 favorites]

I propose a moratorium on changing babies until we can effectively reduce the production of them in the first place.
posted by flarbuse at 3:39 PM on June 30, 2010 [5 favorites]

Do they not teach bioethics in medical school these days?

Not really, no.
posted by killdevil at 3:43 PM on June 30, 2010 [2 favorites]

Again, Maias, the issue isn't the actual condition for which the treatment has been proposed. --Though if we want to go there, Beyerstein's missing a couple of points: there has only been one long-term study on the use of dexamethasone to prevent ambiguous genitalia (per the Time article linked above); it was too small and inconclusive. Dr. New is proposing an experimental treatment as tested and perfectly safe. Nor does the treatment do anything to address the underlying condition. Anyone with CAH that threatens their health would still need to continue taking some sort of hormonal treatment throughout their life.

So this treatment in most cases is rather more similar than not to clitoroplasty, I think.

But New and Nimkarn aren't saying this treatment will correct physical defects caused by CAH. They're saying it'll correct and normalize behavioral defects caused by CAH. Only what they classify as behavioral defects most people would recognize--outside of this context--as just, y'know, behavior.

That's, well, that's just plain wrong.
posted by kipmanley at 3:54 PM on June 30, 2010 [1 favorite]

Somehow I feel this has less to do with the health and well being of the child-to-be and more to do with controlling women's bodies... hmm...

No, the "controlling women's bodies" will come in when/if this drug, and other such genetic tinkerings, are banned.
For now, I'm not sure what we're all so offended about. Ok, yes, there is a tacit implication here that certain personality traits are inherently birth defects, which is pretty offensive. But it's not like this drug is being forced on anyone. This type of research into ways we can alter child development is going to be very beneficial (and already have been) in preventing diseases and birth defects and such. If a few nuts wanna use some drugs to make sure they have girlie girls, who really gives a shit?
I mean, would you really want those people to have lesbian children anyway?
posted by DZack at 3:58 PM on June 30, 2010

lullaby: “CAH women as a group have a lower interest than controls in getting married and performing the traditional child-care/housewife role. As children, they show an unusually low interest in engaging in maternal play with baby dolls, and their interest in caring for infants, the frequency of daydreams or fantasies of pregnancy and motherhood, or the expressed wish of experiencing pregnancy and having children of their own appear to be relatively low in all age groups.”

So, is there a dating site or something where I can meet CAH women? Because they sound like just my type.
posted by Joakim Ziegler at 4:06 PM on June 30, 2010

My daughter loves trucks and is awfully girly as well.
posted by mrgrimm at 4:07 PM on June 30, 2010

I saw this movie. It doesn't have a happy ending.

For a moment, I thought you were going to link to Gattaca. Or Ferris Bueller.
posted by Blazecock Pileon at 4:09 PM on June 30, 2010

It's the Cure! Whoooo!

I have seen The Cure, and I assure you that they are not all that masculine.
posted by Parasite Unseen at 4:10 PM on June 30, 2010 [7 favorites]

I mean, would you really want those people to have lesbian children anyway?

The solution to that is not to prenatally drug dykes out of existence. The solution is to educate people that there's nothing wrong with having a lesbian kid.
posted by rtha at 4:10 PM on June 30, 2010 [8 favorites]

The solution to that is not to prenatally drug dykes out of existence. The solution is to educate people that there's nothing wrong with having a lesbian kid.

EXACTLY.
posted by zarq at 4:15 PM on June 30, 2010

Oh, is it outrage hour? I'm pretty sure that's what happened last time we had a link to this blog on this topic.

Important clarification: CAH is a real and serious disease. There are no objections to pediatricians treating the physiological disorders in utero.

There is no where that says they are trying to "Cure lesbianism" or anything like that. Jesus.

I see. So all gender-related behaviors and traits are strictly biological in nature.

No one said anything remotely like that.
posted by delmoi at 4:25 PM on June 30, 2010 [3 favorites]

an unusually low interest in engaging in maternal play with baby dolls, and their interest in caring for infants, the frequency of daydreams or fantasies of pregnancy and motherhood, or the expressed wish of experiencing pregnancy and having children of their own appear to be relatively low in all age groups

A new friend recently confessed (ie, sotto voce, embarrassed tone, awkward pauses) that before she had kids, she'd never been interested in maternal play or caring for infants or had daydreams about or particular desires to experience pregnancy and motherhood. Further, she confessed that I was the first person she'd ever admitted this to. She had always thought herself abnormal. She'd never admitted it to anyone because she could tell that people disapproved, as if such lack of interest was shameful.

"Oh heck," I said, "Really, you're perfectly normal. My mom was that way and so am I. So are some of my friends. Thanks for telling me. It's important to get it out in the open, the fact that we exist and there's nothing wrong with us. Just in the last ten or fifteen years, more people are starting to let go of being judgmental about it, but there's a long way to go so it's good that we keep talking about it."
posted by cybercoitus interruptus at 4:26 PM on June 30, 2010 [3 favorites]

But it's not like this drug is being forced on anyone. This type of research into ways we can alter child development is going to be very beneficial (and already have been) in preventing diseases and birth defects and such.

The Time article specifically addresses the fact that the treatment is happening outside of a research setting, and without full, informed consent of patients.
posted by evidenceofabsence at 4:31 PM on June 30, 2010 [1 favorite]

“Gender-related behaviors, namely childhood play, peer association, career and leisure time preferences in adolescence and adulthood, maternalism, aggression, and sexual orientation become masculinized in 46,XX girls and women with 21OHD deficiency [CAH]. These abnormalities have been attributed to the effects of excessive prenatal androgen levels on the sexual differentiation of the brain and later on behavior... We anticipate that prenatal dexamethasone therapy will reduce the well-documented behavioral masculinization…”

Yes, delmoi, they are indeed proposing to reduce instances of female homosexuality in 46,XX girls and women with 21OHD deficiency; yes, they are indeed stating that a whole constellation of what we see as gender-related behaviors is biological in nature.

I guess we can agree that the “strictly” was beyond the pale.
posted by kipmanley at 4:33 PM on June 30, 2010 [3 favorites]

I wasn't saying this should be done outside a clinical trial-- all new treatments should be tested in clinical trials before being used, that goes without saying.

But it seems here that people are saying that it's bad to treat a birth defect that produces severely enlarged clits, a lifelong need for hormone treatments, fertility issues, and urogenital defects that interfere with function and possibly lesbianism because you might prevent some women from becoming lesbians.

I severely doubt that any woman would enroll in a clinical trial to test this drug because she wants to make her future daughter straight-- I'm sure most would enroll because it would be great if the child didn't have urogenital defects that interfere with urination and would be great to avoid lifelong hormone treatments and preserve fertility.

If these other problems weren't associated with CAH-- if we were talking about a syndrome which only manifested as gender-aberrant behavior without hormonal issues and genuinely problematic anatomical issues beyond clit size-- then critics would have a case. Here, they are being unfair to people faced with a serious illness and the doctors who are trying to treat it and who are geeky enough to not use PC language in their papers.

This is nothing like that Cornell researcher who was cutting these girls clits down and then testing them for sensation.
posted by Maias at 4:35 PM on June 30, 2010 [2 favorites]

So does in utero CAH treatment help mitigate against future adrenal crises (or otherwise lessen the overall severity of the condition)? Or is it just for the junk part?
posted by evidenceofabsence at 4:40 PM on June 30, 2010

CAH is a family of symptoms and effects, some severe, some not so; not everyone with CAH is affected in the same ways or to the same degree. If you're proposing dexamethasone to treat the physological effects that afflict some, fine; make your patients aware that it still isn't approved for this use, is experimental, has horrendous side-effects for the mother, and merely treats some of the symptoms and not the underlying cause. Per the above, this isn't so much being done.

But if you propose dexamethasone as a means of correcting not physiological effects but behavior, and per the above that is definitely what is being done here, you are doing something far uglier and more sinister.

This isn't "This condition could well threaten your child's health and quality of life, and the treatment I'm proposing will help mitigate it."

It's "This condition could well threaten your child's ability to act in accordance with your idea of her gender, and the treatment I'm proposing will help mitigate it."
posted by kipmanley at 4:46 PM on June 30, 2010 [2 favorites]

Is this the original article? None of the blogs ranting about the study give any details about it beyond the authors' names and that it was published this year. This seems to be the only paper by Nimkarm and New from 2010 and, like their other papers together (1234), the abstract only mentions physiological changes. I'm not in work at the moment and can't be bothered to work out how to access the proxy; has anyone accessed and read the full text?

This paper from 1999 from a different group mentions decreased interest in sex and delayed sexual milestones (dating, first kiss, first sex, etc), but includes the observation that:
It seems likely that the awareness of having a functionally inadequate vagina and of experiencing reduced erotic sensitivity, orgasmic capacity, and sexual satisfaction inhibit courtship and perhaps reduce interest in sexuality altogether. Body image problems have been noted or documented by a number of researchers with regard both to general physical characteristics related to sexual attractiveness, such as short stature, lack of breast development, or hirsutism, as well as to genital status and function (19, 30, 41). Inadequate genital status may, therefore, contribute to the strikingly low sexual motivation seen in a considerable number of women with classical CAH.

...so while I'm perfectly willing to believe that these hormone abnormalities lead to differences in brain/mind development, it seems likely that they're not the whole story, by a long shot.

Also, it's a shame that everyone always gets so caught up in making and perceiving value judgements in these nature/nurture questions. (rudster links to a "Last Psychiatrist" post which, as far as I can understand the weird writing style, dismisses the entire field on the grounds that the blogger doesn't perceives the research questions to be based on values that they dislike). Research into how the mind forms and to what extent that's based on our (epi)genes and/or foetal conditions can tell us fascinating things about ourselves, with insights into what makes us... us. These questions have answers that are objectively true (even if we're still at the very early stages of finding what those answers are), and will continue to be so regardless of what politics gets projected onto them.
posted by metaBugs at 4:46 PM on June 30, 2010 [1 favorite]

an unusually low interest in engaging in maternal play with baby dolls, and their interest in caring for infants, the frequency of daydreams or fantasies of pregnancy and motherhood, or the expressed wish of experiencing pregnancy and having children of their own appear to be relatively low in all age groups

I just finished re-reading To Kill a Mockingbird on its 50th anniversary. These people would've ruined Scout Finch.
posted by headnsouth at 4:47 PM on June 30, 2010

Though if we want to go there, Beyerstein's missing a couple of points: there has only been one long-term study on the use of dexamethasone to prevent ambiguous genitalia (per the Time article linked above); it was too small and inconclusive.

Just to clarify, there's no controversy over whether this therapy works to prevent birth defects; it certainly does. Here's a recent review, and it lists a bunch of studies going back to the 70s. This treatment has been used for over 30 years.

Though there's no question about the effectiveness of this therapy in preventing virilization, there are some long-term health questions. These questions are obscured by the fact that CAH patients have underlying health problems, however. Unpacking these issues was the goal of the Swedish study discussed in the Time article.

So does in utero CAH treatment help mitigate against future adrenal crises (or otherwise lessen the overall severity of the condition)?

It helps prevent fertility problems that often accompany CAH.
posted by mr_roboto at 4:50 PM on June 30, 2010 [3 favorites]

I think the idea is that by blocking the hormones during development, the whole syndrome can be prevented or mitigated, at least. Hormones during development affect the way the brain and body are set up-- so presumably, if you prevented excess androgens from having an effect in the womb, not only would genital and brain development be normalized, but the baby wouldn't have ongoing problems that were a result of bad signaling in the womb.

To take an example I know, certain neurotransmitters are involved not only in sending signals throughout life, but in telling nerves where to wire themselves in the first place. If there's too much of one in utero, the brain will wire wrong and reducing levels later won't help. But if you fix this in utero, the problem won't exist later because development proceeded normally. A different problem might occur if you have too much of this stuff later in life-- but it wouldn't be a problem due to the brain being wired wrong and therefore could be fixed by giving a drug that lowered levels, for example. Lowering levels after there was too much in the womb, however, can't rewire what was miswired.

There's another birth defect in which babies are born who look like normal girls but are genetically male. It occurs because in utero, a problem with one receptor makes the brain fail to respond to male hormones. If it were possible to fix this in utero, these boys would develop normally even if they still had the bad receptor because you blocked it or did whatever at the time when it was necessary for this hormone to be present to create a penis, testes and masculinize the brain.

Timing is everything in development, basically-- which is also why exposure to things like alcohol cause different problems when it occurs in different trimesters.
posted by Maias at 4:51 PM on June 30, 2010

Also: How seriously are people taking the Time article as a source? I'm not at all familiar with Time. However, I've known a largeish handful of scientists who've been interviewed or reported on by respectable newspapers and magazines. All of them have complained that they were seriously misquoted and misrepresented, ranging from sloppy misunderstandings to what could only be deliberate distortions and lies to make a more exciting story. As such, I'm deeply skeptical of any news story about science or scientists -- especially on hot-button topics -- unless I can find the primary sources to check myself.

I'm going to save my outrage until I've read this paper that several people are ranting about and paraphrasing, but no-one has directly quoted or linked to. (Unless I've just missed it somewhere... spare a link, guvnor?)

an unusually low interest in engaging in maternal play with baby dolls, and their interest in caring for infants, the frequency of daydreams or fantasies of pregnancy and motherhood, or the expressed wish of experiencing pregnancy and having children of their own appear to be relatively low in all age groups

I just finished re-reading To Kill a Mockingbird on its 50th anniversary. These people would've ruined Scout Finch.
Presenting these preferences as a disease to be eradicated as terrible. Observing that they're the side-effect of a disease and investigating how that happens, is not.
posted by metaBugs at 5:03 PM on June 30, 2010

There's another birth defect in which babies are born who look like normal girls but are genetically male.

Androgen insensitivity syndrome. Well-known to fans of House.
posted by GuyZero at 5:05 PM on June 30, 2010

I'm going to save my outrage until I've read this paper that several people are ranting about and paraphrasing, but no-one has directly quoted or linked to. (Unless I've just missed it somewhere... spare a link, guvnor?)

It was tough, but I found it!

It's basically just a little review article in a little journal. It really doesn't propose this therapy as a "treatment for masculinization"; it just states that this therapy would be expected to reduce masculinization, which I guess it probably would. The main focus is on introducing the audience to the concept and practice of prenatal diagnosis.
posted by mr_roboto at 5:20 PM on June 30, 2010 [2 favorites]

mr_roboto - thanks. I saw that one but can only access the abstract, which only mentions genital ambiguity. I'll have a proper look when I get to work tomorrow.
posted by metaBugs at 5:32 PM on June 30, 2010

Here's the entire relevant paragraph for those of you without access:

Without prenatal therapy, masculinization of external genitalia in females is potentially devastating. It carries the risk of wrong sex assignment at birth, difficult reconstructive surgery, and subsequent long-term effects on quality of life. Gender-related behaviors, namely childhood play, peer association, career and leisure time preferences in adolescence and adulthood, maternalism, aggression, and sexual orientation become musculinized in 46,XX girls and women with 21OHD deficiency. These abnormalities have been attributed to the effects of excessive prenatal androgen levels on the sexual differentiation of the brain and later on behavior.^43,44 The rates of gender dysphoria and patient-initiated gender change in this population are higher than the rates of transsexualism in the general population;^45,46 this difference may, however, only be indirectly related to prenatal androgens.⁴⁷ Genital sensitivity impairment and difficulties in sexual function in women who underwent genitoplasty early in life have likewise been reported.⁴⁸ We anticipate that prenatal dexamethasone therapy will reduce the well-documented behavioral masculinization and difficulties related to reconstructive surgeries. Nowadays, 46,XX individuals with 21-OHD deficiency are almost always assigned to the female sex as their condition is diagnosed early by neonatal screening, and they have intact gonads, uterus, and vagina, "feminize" during puberty, and can be fertile in the female role.

I don't like that Meyers quoted the sentence beginning, "We anticipate that...." but left off the concluding words: "and difficulties related to reconstructive surgeries." It's as if he was trying to create the impression that the motivation for this therapy is not medical.
posted by mr_roboto at 6:23 PM on June 30, 2010 [3 favorites]

Yes, delmoi, they are indeed proposing to reduce instances of female homosexuality in 46,XX girls and women with 21OHD deficiency; yes, they are indeed stating that a whole constellation of what we see as gender-related behaviors is biological in nature.

I guess we can agree that the “strictly” was beyond the pale.

That has nothing to do with this:

I see. So all gender-related behaviors and traits are strictly biological in nature.

If the statement is just "Some gender-related traits are biological in nature" rather then "all" what exactly is the problem? And if "The Biology" is causing other problems what exactly is the problem with "Fixing" it? This isn't a pill that they're just handing out to any mother who wants a more 'girly' girl, it's for children with a specific, testable defect.

--

This whole Freakout seems like a moral panic to me, frankly. I mean look at this:

So, is there a dating site or something where I can meet CAH women? Because they sound like just my type.

So we should withhold medical treatment from children en utero because it makes them more, uh, dateable.

---

It's basically just a little review article in a little journal. It really doesn't propose this therapy as a "treatment for masculinization"; it just states that this therapy would be expected to reduce masculinization, which I guess it probably would. The main focus is on introducing the audience to the concept and practice of prenatal diagnosis.

So, they're not actually doing any experimentation on their own, just reviewing other papers and drawing some conclusions? And this what people are freaking out about? Jesus. If that's accurate, I have to say I've kind of lost respect for PZ Myers. Who would have expected someone who is generally a science advocate to flip the fuck out over misrepresented research.
posted by delmoi at 6:38 PM on June 30, 2010 [2 favorites]

I don't have problem with treating birth defects, especially if the treatment can take place before birth and therefore mitigate or eliminate the defect.

What I have a problem with - and perhaps this is explicated at greater length in the scientific literature - is classifying gender-specific play, career choices, leisure activities etc. as defective if they don't fall into some unnamed norm. It's personal for me, since I was a tomboy and I'm a dyke and a fairly butch one at that. Society has been very busy for a long time telling women like me that we are not "real" women, and it doesn't matter if I'm genetically female with all the correct anatomical bits where they should be. We get pathologized because of our "abnormal" behavior. So yeah, I'm wary.
posted by rtha at 6:45 PM on June 30, 2010 [2 favorites]

The support community for those with CAH is well aware of the controversy surrounding this issue and appropriate counseling is a component of virtually all established programs and groups. Those who mock this treatment fail to recognize the great trauma ambiguous genitalia (images warning) and the subsequent surgery can have for affected females in other countries. Dr New's perspective seems to be that prenatal treatment can be a boon (page 8) to these women who have been able to avoid the surgery. Although Dr New not been without controversy, she was a pioneer in researching genital ambiguity, steroid disorders and has been elected at to the the National Academy of Science. Dr New has also set up a research foundation for CAH.
posted by beaning at 7:07 PM on June 30, 2010

So we should withhold medical treatment from children en utero because it makes them more, uh, dateable.

I don't think that the ones who are in utero are the ones JZ wants to date. That would be robbing the... the... I can't say it. (But that would be some nice tail!)
posted by XMLicious at 7:16 PM on June 30, 2010

Okay, now that I’m home from work and have had some dinner and a nice glass of wine, I’m going to have to cop to a certain amount of moral panic, and to a distinct disappointment in PZ. Even a cursory reading was enough to spot the elision in his piece between “uppity women” and “girls suffering from CAH who might also have been inadvertently masculinized, for some values of inadvertent and masculinity,” but I was too willing to allow it as overheated rhetoric in the service of a good cause. But it’s not nearly so clear-cut as that, and the therapy’s misrepresented in the links I found; and so.

But.

(You knew there was going to be a but.)

The framing (sigh; does it come down to framing? Yes, yes, it does: framing) of Nimkarn and New’s findings is nonetheless deeply problematic. No matter the health problems faced by intersexed individuals, and they can be legion, lumping behavior in with them—childhood play, careers, whether you’re feeling sufficiently maternal, sexual orientation—well, it’s inexcusable. It sets a ludicrously simple bar of “normality” for individuals already considered “abnormal” to fail, because no one can meet our fiendishly stupidly self-contradictory ideals of “normal” femininity. (That’s one of the points of having such a bar.) —A post about that elision, and the complex and heartbreaking politics of intersexuality, might have been an interesting post, but it wasn’t the one I made.

And so.
posted by kipmanley at 8:34 PM on June 30, 2010 [3 favorites]

♫ "Mamas, don't let your babies grow up to be tomboys...
Don't let 'em enjoy sports and play with toy trucks,
Make 'em be heterosexual and such..." ♫
posted by Asparagirl at 9:04 PM on June 30, 2010 [2 favorites]

I don't have problem with treating birth defects, especially if the treatment can take place before birth and therefore mitigate or eliminate the defect.

What I have a problem with - and perhaps this is explicated at greater length in the scientific literature - is classifying gender-specific play, career choices, leisure activities etc. as defective if they don't fall into some unnamed norm. It's personal for me, since I was a tomboy and I'm a dyke and a fairly butch one at that. Society has been very busy for a long time telling women like me that we are not "real" women, and it doesn't matter if I'm genetically female with all the correct anatomical bits where they should be. We get pathologized because of our "abnormal" behavior. So yeah, I'm wary.

I think there is a very fine line here. Yes, nobody should be telling people their identity and feelings and preferred activities are wrong.

And I think this article's tone is not right.

But there are tons of people out there with gender dysmorphia and other sorts of discontinuities between who they are and the "hardware" they were born with. Not simply females who sexually prefer other females, but (oversimplifying) male brains in female bodies, or male hormone encoding in female brains and bodies. The people they are talking about live lives of desperation because they can never be what their brains tell them they are supposed to be. It's not about "fixing" homosexuality, but about hopefully fixing people who are hetero, but born in the wrong body. If treatments like this could help that, it would be good.
posted by gjc at 4:58 AM on July 1, 2010

I just finished reading Between XX and XY: Intersexuality and the Myth of Two Sexes by Gerald N. Callahan PhD, which is a fantastic book if anyone's interested in the biology related to this topic.
posted by odinsdream at 9:20 AM on July 1, 2010 [1 favorite]

Do they not teach bioethics in medical school these days?

No, not really. (PART TWO! electric boogaloo!)
posted by bitter-girl.com at 4:21 PM on July 1, 2010