The majority of researchers and clinicians interested in the use of prenatal “dex” focus on preventing development of ambiguous genitalia in girls with CAH. CAH results in an excess of androgens prenatally, and this can lead to a “masculinizing” of a female fetus’s genitals. One group of researchers, however, seems to be suggesting that prenatal dex also might prevent affected girls from turning out to be homosexual or bisexual.
Pediatric endocrinologist Maria New, of Mount Sinai School of Medicine and Florida International University, and her long-time collaborator, psychologist Heino F. L. Meyer-Bahlburg, of Columbia University, have been tracing evidence for the influence of prenatal androgens in sexual orientation.... They specifically point to reasons to believe that it is prenatal androgens that have an impact on the development of sexual orientation. The authors write, "Most women were heterosexual, but the rates of bisexual and homosexual orientation were increased above controls . . . and correlated with the degree of prenatal androgenization.” They go on to suggest that the work might offer some insight into the influence of prenatal hormones on the development of sexual orientation in general. “That this may apply also to sexual orientation in at least a subgroup of women is suggested by the fact that earlier research has repeatedly shown that about one-third of homosexual women have (modestly) increased levels of androgens.” They “conclude that the findings support a sexual-differentiation perspective involving prenatal androgens on the development of sexual orientation.”
And it isn’t just that many women with CAH have a lower interest, compared to other women, in having sex with men. In another paper entitled “What Causes Low Rates of Child-Bearing in Congenital Adrenal Hyperplasia?” Meyer-Bahlburg writes that “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.”
In the same article, Meyer-Bahlburg suggests that treatments with prenatal dexamethasone might cause these girls’ behavior to be closer to the expectation of heterosexual norms: “Long term follow-up studies of the behavioral outcome will show whether dexamethasone treatment also prevents the effects of prenatal androgens on brain and behavior.”
In a paper published just this year in the Annals of the New York Academy of Sciences, New and her colleague, pediatric endocrinologist Saroj Nimkarn of Weill Cornell Medical College, go further, constructing low interest in babies and men—and even interest in what they consider to be men’s occupations and games—as “abnormal,” and potentially preventable with prenatal dex:
“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...”
It seems more than a little ironic to have New, one of the first women pediatric endocrinologists and a member of the National Academy of Sciences, constructing women who go into “men’s” fields as “abnormal.” And yet it appears that New is suggesting that the “prevention” of “behavioral masculinization” is a benefit of treatment to parents with whom she speaks about prenatal dex. In a 2001 presentation to the CARES Foundation (a videotape of which we have), New seemed to suggest to parents that one of the goals of treatment of girls with CAH is to turn them into wives and mothers. Showing a slide of the ambiguous genitals of a girl with CAH, New told the assembled parents:
“The challenge here is... to see what could be done to restore this baby to the normal female appearance which would be compatible with her parents presenting her as a girl, with her eventually becoming somebody’s wife, and having normal sexual development, and becoming a mother. And she has all the machinery for motherhood, and therefore nothing should stop that, if we can repair her surgically and help her psychologically to continue to grow and develop as a girl.”
In the Q&A period, during a discussion of prenatal dex treatments, an audience member asked New, “Isn’t there a benefit to the female babies in terms of reducing the androgen effects on the brain?” New answered, “You know, when the babies who have been treated with dex prenatally get to an age in which they are sexually active, I’ll be able to answer that question.” At that point, she’ll know if they are interested in taking men and making babies.
In a previous Bioethics Forum post, Alice Dreger noted an instance of a prospective father using knowledge of the fraternal birth order effect to try to avoid having a gay son by a surrogate pregnancy. There may be other individualized instances of parents trying to ensure heterosexual children before birth. But the use of prenatal dexamethasone treatments for CAH represents, to our knowledge, the first systematic medical effort attached to a “paradigm” of attempting in utero to reduce rates of homosexuality, bisexuality, and “low maternal interest.”
Women like me are doomed if this process A) works and B) becomes widespread. It's hard not to take it personally when I have every attribute they say is "abnormal" for a female:
- Masculine career choice: Check. Science has been and is a male dominated field. I guess these drugs are to keep it that way.
- Aggressiveness: Check. You don't need to know me that well to figure that out.
- Bisexuality: Sort of check. Let's just say while I'm significantly more attracted to men, I'm still probably not straight enough for the people doing this research.
- Abnormal peer association: Check. As a kid I had almost exclusively male friends. I did not relate to girls at all, and of the female friends I have now, most have the attributes of this list.
- Low interest in playing with dolls: Check. I hated girly toys as a kid. Screw Barbie, give me some Legoes!
- Low interest in caring for infants: Check. As cute as my nephews are, when they were babies I feared breaking them and had no interest in feeding them or changing their poopy diapers.
- Less frequent daydreams about pregnancy & marriage: Check. I'm supposed to daydream about these things? If anything I have nightmares about getting pregnant.
- Less interest in having children: Check. I want a kid, but not desperately or any time soon. Maybe in my thirties, or maybe not.
- Less interest in traditional housewife role: Check. Uh, fuck no.
Knowing the views of my typical blog reader, I'm going to assume we can all agree that wanting a masculine job or not wanting kids aren't life threatening traits that need to be corrected. I'm also going to hope that we can agree that bisexuality and lesbianism don't need to be fixed either, as they are not a disease or harmful to anyone.
But why are we trying to fix CAH? When PZ covered this topic, he mentioned that CAH is "a real and serious disease." The only major symptoms other than behavioral and physical masculinization are vomiting and hypertension, both which are regularly treated with supplements. Researchers and doctors are going out of their way to fix behaviors through hormones and restructure genitalia through surgery simply to make them fit into society's stereotypical gender roles.
If anything, conditions like CAH show that nature does not always create perfectly binary males and females. Why are we altering and mutilating baby girls without their consent to make them conform to our ideal of the female figure? It's not limited to this study - not long ago we also heard about people at Cornell who were surgically decreasing the size of young girls' clitorises to make them more "natural." Nothing is biologically or functionally wrong with their genitals - we decided to label them as "wrong" because of our own cultural biases.
Now, I don't blame science for this. As a scientist, I do find it interesting that an excess of prenatal androgens can apparently alter life long behaviors. But I do have a problem when people abuse scientific findings to fit their own political or ideological agenda. Just because science finds out we can do something doesn't mean we should do it. But humans are humans, and it seems like these abuses are somewhat inevitable.
That honestly worries me. For example, I've always been interested if there's some genetic component to homosexuality, since we have overwhelming evidence that it's biological in some way. Are there certain genes? Certain epigenetic differences? Copy number variation? Or is it all hormonal, like this study may suggest? I'm interested out of pure scientific curiosity. It's an interesting human behavior to me, and I want to learn more about it.
But what if I did find something? As a huge gay rights activist, it would absolutely kill me to see my research findings abused in any way. I don't want to see companies producing genetic tests for certain "gay gene"s so people can selectively abort gays. I don't want it used to out people. I don't want little kids screened so they can have their behaviors forcibly altered early on. There are so many horrible things that could come out of it. I personally don't think the cause(s) of homosexuality change how we should treat it (with acceptance), but not everyone thinks like I do.
So do we avoid this research altogether? I'd argue no. We can figure out the genes that contribute to skin color without it automatically leading to more racism. We can engineer bacteria to synthesize useful materials without it automatically leading to biological weapons. What we do need to do is make sure ethics and laws keep up with the advancement of science so findings can't be abused. But even ethics boards are made up of humans, and humans have their biases. Too many people would find nothing wrong with the studies in this post, including some people on review boards. We need to hold these people to higher standards.
It's bad enough that these studies are harming children with no real idea of what effects it'll have on them when they're adults. But it's also a shame that these studies give science a bad name - the image of a manipulative, powerful overlord found too often in SciFi novels. We must remember that science itself is neither good nor evil; the blame lies with people who abuse it.