Via Dan Savage (and reader Susanna by email) comes this story about a pediatric endocrinologist working on a natal hormone therapy to prevent girls from being lesbian, bisexual, uppity, or intersex.
The story centers around Dr. Maria New, who's been giving the experimental medication dexamethasone (dex) to pregnant women concerned their child might have congenital adrenal hyperplasia (CAH, an adrenal condition that results sometimes in intersexuality in girls, rarely in death, sometimes in life-long medication, but has also been associated with tomboyishness and lesbianism) without informed consent. It's not approved for use by pregnant women, it doesn't cure CAH so much as reduce some of the masculinization associated with it, and there are studies showing that it results in birth defects in animals.
Alice Dreger, who's been working to get the off-label use banned, also found that New is selling the treatment as a way of preventing daughters from growing up lesbian and making sure that girls will be willing to
enjoy sex submit to men and produce babies:
[New and colleagues] 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."
Dreger goes on to describe how these doctors' goal is to make girls conform to the heterosexist expectations of their parents:
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."
There's a lot to be said in a debate about whether it's ethical to try to medically prevent a child from growing up queer or gender-nonconforming or just interesting in something other than child-bearing. But when the goal is to eliminate part of human diversity in order to make some people feel more comfortable, there doesn't seem to be much need for discussion: this is a simple crime against humanity.
It'd be easy to write off New, et al., as people who aren't even close to reaching that goal so we shouldn't be concerned (they're working on one treatment that'll work on, at most, one-third of women, with no hard data as of yet to show that it works, with a treatment that will remain inaccessible to most parents), if it weren't for the fact that they're aren't the first, won't be the last, and definitely aren't the only medical professionals working on this.
I'm working through some of George Rekers's old child psychology papers on preventing homosexuality in boys through what can only be described as psychological torture, which he was doing well after homosexuality was removed from the DSM and deemed a normal variation of human sexuality instead of a psychological disorder. But curing it is still some scientists' goal. They're probably uncomfortable with their own sexuality and are looking for a cure so because they think it'll make them feel better about themselves, and as long as there's homophobia and smart researchers with access to resources, they'll keep on working on it. Eventually they're going to stumble on something.
There are lots of reasons why this is bad when it comes to bioethics, reasons that should appeal to both the right and the left should this question ever become political. Alice Dreger discusses a few bioethical issues with engineering sexual orientation in Psychology Today, but here's the one that gets to the heart of the issue:
The fact is that children are inherently unpredictable, and so (surely) what it means to decide to be a parent is to agree that you will accept the uncertainty that comes with being a parent. Having a child is not like taking a spouse; there is no mutual agreement entered into. It is up the parent to make the commitment. And to make the commitment by saying, "I'm willing to have you, but only if you are a boy, and a straight boy at that, and a straight boy with blue eyes and a very high IQ" is, frankly, to not really make the commitment that parenting requires.
Am I suggesting that people who want to engineer their children's sexual orientations are unfit to be parents? Yes, I am. Being gay is not a terrible, tragic disease that requires prevention or treatment chosen for you by your parents.
I am reminded here of a colleague who works as a social worker on a craniofacial team at a children's hospital. She was telling me one day, despairingly, of having a consultation with a pair of expectant parents. Their fetus had been diagnosed with a cleft lip, one that would be reasonably correctable without major trauma. It was true the baby would be born with the odd-looking mouth, and that the child might always have a noticeable lip scar. But this was not a child with a fatal disease or anything. Yet the father was flipping out, saying to his wife and the social worker, "I can't handle this! I can't handle this!" He wanted to abort for this.
My friend and I both were both thinking: Come on! If you can't handle this, what are you going to do when your kid smokes a little dope? What are you going to do if she ends up pregnant at 16? What are you going to do if she sucks at math or suffers from a lot of acne? Sure, abort. But don't have any children if you can't handle this.
The problem with such a parent is that he is planning to live his entire existence with his child on the shame-pride axis, where everything his child does is rated according to whether it makes her father proud or ashamed. You want a child who never makes you anything but proud? Please. Don't bother taking on parenthood if you can't handle the fact that sometimes your child's identity won't be what you would have chosen. And if you want to prevent a child from ever suffering? Well, then don't have a child. No one is born into the world never to suffer.
Is having a child with a less-than-idealized identity or anatomy sometimes really hard? Yup. And when you sign up for parenting, that's part of what you're signing up for. You can't seriously expect your whole parenting experience to consist of softball trophies and bumper stickers that brag about your Honor Roll child. It is not your child's job in life to make you proud. It is your job to make your children proud of you as their parent.