Surgery-saving prenatal intervention or nefarious anti-lesbian plot? You decide.

First do no harm?

First do no harm?

If you’re in the mood for a science-wonky tale of hormones, gender roles, a possible anti-lesbian plot, and a ‘medical intervention-versus-human experimentation’ controversy,  skip on over to a post I wrote for Our Bodies Ourselves (OBOS) in December.

The subject? Prenatal treatment of congenital adrenal hyperplasia (CAH), a rare inherited defect in hormone production that leads to an overproduction of male hormones in utero. CAH can cause deformity of the developing female genitalia (male genital development is unaffected), and can also lead to more “masculinized” behavior in affected girls and women. Though most are heterosexual, women with CAH are more likely to be lesbian or bisexual than the general population.

The prenatal treatment of CAH, in which mothers take very high doses of a steroid medication their entire pregnancies, is primarily intended to prevent genital deformity in girls. But some critics suspect a hidden agenda–the prevention of masculinized behavior and, by extension, lesbianism.

Other critics point out that very few affected girls really need the very aggressive genital surgery performed in the past, and that very high doses of prenatal steroids appear to increase the risk of serious consequences for treated children, including poor growth, learning disabilities, and even mental retardation. Such alarming reports have led many researchers in the United States and Europe to call for an end to the practice.

Still, Dr. Maria New, a pediatric endocrinologist in New York–by far the most prominent advocate of prenatal treatment–has declared the practice to be effective and “safe for mother and child.” Problem is, she and her colleagues haven’t been very diligent in following the babies they’ve treated over the last three decades, so the real risks of the prenatal steroid therapy aren’t yet completely known.

There’s much more detail in the post, and if you’re not feeling science-y enough to tackle that one, fear not. I’ll be back with lighter fare soon!

PS: Even if you’re not feeling science-y today, head to OBOS and donate money to that very worthy organization! Start racking up those 2013 tax deductions!

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Photo credit: Jason Pratt

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2 Comments

Filed under Development, Newborns, Science, Sex & Sexuality

2 responses to “Surgery-saving prenatal intervention or nefarious anti-lesbian plot? You decide.

  1. What kind of effect would this have on a male child? Do they really have any idea? Messing around with hormones during fetal development just seems too risky.

    Like

    • Hi Erin,
      CAH doesn’t cause abnormalities in male genital development. The risks of learning disabilities, etc., from steroid exposures are the same for both boys and girls, but boys are almost never exposed to the pregnancy-long treatment that some girls are. That’s because, by Dr. New’s protocols, a woman whose baby is at risk of inheriting CAH is started on steroids weeks before fetal gender can be determined. Once the gender is known at around 12 weeks, women carrying male fetuses (and those with females who test negative for CAH) stop treatment. That’s one of the very worrisome ethical issues that dog this intervention: Nearly 90% of the babies who are exposed to high doses of steroids for weeks early in pregnancy didn’t have CAH to begin with. (I explain the hows and whys of that 90% figure in the OBOS essay.)
      Thanks for writing,
      Mark Sloan

      Like

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