Medical "ethics": Curing lesbians and cutting up little girls

The blogs are abuzz with a recent article in the Bioethics forum, describing an "off label" usage of the drug dexamethasone ("dex"). Congenital Adrenal Hyperplasia (CAH) is a condition that results from excessive exposure to androgens in developing female fetuses that can lead to intersex morphologies and other health problems. Some physicians have treated this with dex, although a variety of professional bodies consider this a potentially dangerous, experimental treatment that should only be done with rigorous review and follow up. (More in this Time article).

The article in Bioethics Forum describes one researcher who is doing unsupervised administrations of this drug essentially to "cure lesbianism". It's less the physical aspects of CAH that she's targeting, than the behavioral ones. She is very deliberately targeting behavior and orientation rather than the physical manifestations of CAH, and THAT is why everyone is concerned.

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. ...

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 ... 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 norm....

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...

(emphases mine)By pathologizing women who aren't interested in babies, or who are interested in men's jobs (like scientist or doctor?) these physicians are invoking a "Handmaid's Tale" view that would put women back, walking 3 steps behind the men.

There are real concerns with this. From the Time article:

Perhaps most controversially, prenatal dex must be given as soon as a woman learns she is pregnant, which is usually several weeks before genetic tests can determine if the fetus is in fact a female affected with CAH — the chance of which is 1 in 8 for parents who already have an affected child or know they are carriers of the genetic disorder. If the baby is healthy, treatment is stopped, but at that point, the fetus has been exposed to the steroid drug for weeks. There is no data on how many mothers receive prenatal dex, but according to the odds, 7 of 8 may be taking medication unnecessarily.

I am a lesbian. I never wanted children, I was a tomboy who preferred toy cars to baby dolls, and I work in a "man's profession" as a science professor. I'm certainly not a sufferer of CAH; my body isn't at all "masculinized" (quite the opposite! ;-) but at some level, I am the sort of person this "treatment" is intended to eliminate. Who I am is considered a pathology by this "doctor".

From this, I point out another Bioethics post on female genital mutilation on CAH patients. Seems there's another pediatrician in New York who makes a living "cutting down" the clitorises of little girls who are deemed to be "over-endowed". Not that there is anything really WRONG with them, just a somewhat larger than average clitoris, but there is discomfort from their parents that they are different and a physician who "recommends" amputation. Many medical professionals decry these surgeries as unnecessary. Again, with no institutional research subject approval,

At annual visits after the surgery, while a parent watches, Poppas touches the daughter’s surgically shortened clitoris with a cotton-tip applicator and/or with a “vibratory device,” and the girl is asked to report to Poppas how strongly she feels him touching her clitoris. ....Poppas has indicated in this article and elsewhere that ideally he seeks to conduct annual exams with these girls. He intends to chart the development of their sexual sensation over time........Ken Zucker, a psychologist [said]"Applying a vibrator to a six-year-old girl’s surgically feminized clitoris is developmentally inappropriate." "

What sort of parent lets a doctor do that to her little girl?

What all of this boils down to is not simple heterosexism. It's also fear of all women's sexuality, gay or straight, and it attempts to pathologize any female who doesn't fit a rigid gender binary of traditional sex roles. It's absolutely offensive to me that any "physician" would justify these "treatments" which are not based on the needs or desires of the young patient, but on the fears and biases of their parents or of the physicians themselves. I hope the institutional review boards (IRB) go after these doctors, and I hope that patient advocates consider bringing suits for medical abuse.

What this also shows us is that even if the bad guys are forced to admit being gay is not a choice, but a biological fact, we are still deeply endangered by their efforts to turn us into a pathology to be eliminated, or a variant to be cured.