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.”
So no more Elena Kagans, no more Donna Shalalas, no more Martina Navratilovas, no more k.d. langs, no more Constance McMillens—because all women must grow up to suck dick, crank out babies, and do women's work. And the existence of adult women who are not interested in "becoming someone's wife" and "making babies" constitutes a medical emergency that requires us to treat women who are currently pregnant with a dangerous experimental hormone. Otherwise their daughters might grow up to, um, be nominated to sit on the Supreme Court, serve as cabinet secretaries, take 18 Grand Slam singles titles, win Grammies, and take their girlfriends to prom.
And we can't have that.
Two things: Gay people have been stressing out about the day arriving when scientists developed treatments to prevent homosexuality. The preventing gay sheep freak out is here, Twilight of the Golds is here, and I recall—but can't quickly find a link for—a "fellow" at the Family Research Council or the American Family Association who backed in-utero hormone treatments to prevent homosexuality. Well, here we are—the day appears to have arrived. Now what are we going to do about it?
And will the Republicans on the Judiciary Committee invite Maria New to testify at Elana Kagan's confirmation hearings? New could argue that Kagan—childless, unmarried Kagan—is unfit to serve on our highest court because her "low maternal interest" pegs her as abnormal, well outside the "maternal mainstream." Maybe GOP senators would be mollified if Kagan knocked back a few bottles of dex during her confirmation hearings?
The specific drug we're talking about, dexamethasone, is not a benign drug for pregnant women, nor for the children exposed in utero. The studies we do have on the early prenatal use of "dex" are worrisome. The number of women and children missing from the follow-up studies of this drug use is more worrisome still.
This drug is unequivocally experimental and risky. That's why, back in February, I organized interested members of the Bioethics community to fight to make sure every woman offered dex for CAH knows the truth about its experimental and risky nature. (You can read about our efforts in Time magazine. And you can about the medical establishment's resultant mad scampering to make sure everyone knows this is experimental here.) Make no mistake: In spite of Dr. Maria New's outrageous FDA-regulation-flaunting claims that this off-label drug use "has been found safe for mother and child," it ain't been. New is a rogue pediatrician whom medical societies have been nudging (and sometimes yelling at) for years. Because she apparently wouldn't stop experimenting on these women and children without ethics oversight, in January I got called in to help by a few freaked-out clinicians. And I called in my colleagues to call out the feds. New just looks and sounds safe for mothers and children. Which is why she's really dangerous.