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Preventing homosexuality in utero: Could we? Would we? Should we?

July 2, 2010 |  7:00 am

A workhorse drug that's been around for decades has, in recent weeks, stirred up a biomedical debate that will likely resonate with any parent who's ever asked him or herself: If I could prevent my child from being gay, would I?

Dexamethasone is a corticosteroid that has been widely used in the treatment of arthritis, of intestinal, kidney and thyroid disease, in certain kinds of cancers. It's also been prescribed to — and used by — pregnant women carrying female babies who are at genetic risk of a condition called congenital adrenal hyperplasia, or CAH.

Children born with the genetic anomaly will need a lifetime of medication to ensure their normal growth, sexual development and reproductive function. But for girls, one manifestation of CAH is evident at birth: her external genitalia will look more masculine than feminine. The resulting person used to be called a hermaphrodite. The preferred term now is intersex, a condition of gender ambiguity that can be caused by a number of different conditions.

Dexamethasone, when administered in utero, appears to correct the development of a female fetus' genitalia. As a result, it relieves parents and child of a difficult decision — to have later corrective surgery, with all of its risks.

That a parent should take it upon him or herself to "correct" a child's ambiguous gender identity is debatable enough. (The Intersex Society of North America maintains that "parents' distress must not be treated by surgery on the child.") What ignites serious controversy is a side effect of  prenatal dexamethasone — its ability to feminize, not just the external genitalia of a girl with CAH, but her internal outlook and her behavior. That is significant because among CAH's more subtle effects, according to Mount Sinai Medical Center endocrinologist Dr. Maria I. New, is that women who have it tend to be more masculine in their behavior and interests, including sexual attraction to women. New has been a leading researcher on CAH and, in an earlier practice, is reported to have prescribed dexamethasone. She and a research collaborator, Columbia University psychologist Heino F.L. Meyer-Bahlburg, has investigated at length the "psychosocial" as well as medical issues faced by those with CAH.

In short, dexamethasone seems to hold the promise not only of sparing a child a difficult and risky surgery, it may also redirect a sexual trajectory that will lead to bisexuality or lesbianism.

That, say bioethicists, is going too far. In a recent posting on the Bioethics Forum of the Hastings Center, a nonpartisan bioethics institute based in Garrison, N.Y., Alice Dreger, Ellen K. Feder and Anne Tamar-Mattis warn that treatment of the external manifestations of CAH are debaeable enough in and of themselves: But, in this case, that treatment will make it possible for some parents to take actions motivated -- at least in part -- by a desire to prevent their child from becoming a homosexual.

Dreger, Feder and Tamar-Mattis suggest that in insisting that homosexuality is not a choice but a biologically determined fact of identity, gay and lesbian rights activists may have set themselves up for medical researchers to see sexual orientation as a condition that can be "fixed." They "should be wary of claims that the innateness of homosexuality will lead to liberation," they wrote. Instead, it might "very well lead to new means of pathologization and prevention," write the bioethicists.

Also unclear is whether the use of dexamethasone by pregnant women is safe — or for that matter, effective. Neither has been demonstrated by clinical trials. The prescribing of a drug in treatment of a condition other than that for which the Food and Drug Administration has approved it — called off-label — is very common and legal. But the debatable use of dexamethasone in pregnant women has caused sufficient concern among endocrinologists that the Endocrine Society next month is expected to issue a consensus document warning physicians who prescribe prenatal dexamethasone for CAH that the treatment should be considered experimental. That imposes far greater ethical strictures on physicians: They must seek the approval of an ethics and safety review board and satisfy other conditions designed to protect a patient's rights. 

Want to know more about what researchers have learned about the bases of homosexuality, and the ethical debates that result? Here's an article on the subject from the LA Times Health section.

--Melissa Healy

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Comments (39)

As a middle-aged gay man, I will continue to "insist" that homosexuality is not a choice for most gays and lesbians. And, if it is determined that homosexuality is preventable, I cannot imagine why any parent would want to subject their child to a world of hate and discrimination by failing to take action.

"Dreger, Feder and Tamar-Mattis suggest that in insisting that homosexuality is not a choice but a biologically determined fact of identity, gay and lesbian rights activists may have set themselves up for medical researchers to see sexual orientation as a condition that can be "fixed." They "should be wary of claims that the innateness of homosexuality will lead to liberation," they wrote. Instead, it might "very well lead to new means of pathologization and prevention," write the bioethicists."

It appears from these quotes that these "bioethicists" are saying that we should avoid the truth if the truth could lead to outcomes we don't like. The development of sexual orientation is complex, but the available evidence strongly supports the conclusion that sexual orientation has a strong biological component. To suggest that we avoid this conclusion because we don't like where it could lead is appalling and makes me wonder what sort of ethics these bioethicists practice.

The medical benefits of avoiding surgery and correcting a physical defect should be the first priority. The secondary issue of homesexuality should be the last consideration. That some would prevent such treatment due to political correctness is troubling.

CAH sounds like a real medical condition. Why not fix if you can? Also, why preserve the side effect of gender confusion?

Being gay is a blessing. Don't tamper with it.

god or nature created homosexuality for a reason. we should not tamper with its design.

If women have the right to abort babies in the country, they should also have the right to do whatever they want to them in the womb.

The beginning of the article says that this drug is used on pregnant women carrying "female" babies, but if the baby is intersex, why do they consider it female? And how do they know it is female?

How much worse off would it make a child if, in trying to "normalize" a baby they perceive as female in the womb, they have feminized a child that grows to identify as male? Think of runner Caster Semenya, what if doctors had decided in the womb that she was male (she has internal testes and no womb) and given her drugs to change her gender, even though she identifies as a woman?

There are so many variants in intersexed people that the thought of trying to anticipate a child's gender in the womb seems troubling and having a potential for lots of problems. Taking care of health impacting conditions is important, but not when they are not fully understood and could cause unintended problems later. I think that really the problem is that people need to see gender as the gradient it is, not the black and white of male and female.

"That a parent should take it upon him or herself to 'correct' a child's ambiguous gender identity is debatable enough." Well, I agree, but 55% of parents circumcise their babies, because they have a sexual fetish for circumcised men or do not understand a foreskin so they remove it. Parents don't really consider the baby until later, when it can speak.

Anything that would prevent homosexuality would be a good idea. Parents live in fear that one of their kids could be a homosexual. When parents, friends, relatives and others are told that someone is a homosexual, it is a traumatic and sickening thing to learn.
I have a dear friend who was in WWII. His unit was sleeping in small tents. He wound up in a tent with a homosexual unit leader. He was sodomized and suffered for it the rest of his life. HIV-AIDS is/are still with us, killing mercessly. Any unnatural swap of body fluids introduces diseases. Homosexuality is very destructive for the Roman Catholic Church, and not good for any other church. Naming homosexuals to high positions in certain churches is destroying them. Because guys often dress up like girls, I don't even want to go through San Francisco.
From my standpoint, the idea of two men kissing or doing anything intimate makes me want to throw up. Homosexuals have been fired from jobs historically because they upset other employees and because they can be blackmailed. And, the Holy Bible talks of utter disaster for homosexuals.

Oh and while you're at it...make it blonde, blue eyed, with Jesus features...ummm let's seee...oh small nose, HATE the body hair so can you clean that up a bit too? I guess that should do it! Finally my son will be accepted by society before he's even born. I mean WHAT parent would wish to put their kid through teasing... & taunting caused by our very own narrow minded, biggoted, racist, hate & fear filled teachings if they can help it right? Why not change nature to fit nurture? I mean I sure as heck ain't gonna take time out of my busy schedule to change the way I think about the world...just change my son's genes so I don't have to stop being a homophobe.

Sounds like a birth defect. Otherwise, more of the same propaganda.

This is the same old homophobic garbage we hear over and over. What's interesting is the article starts out addressing the physical development of a hermaphrodite or intersex person and an experimental treatment doctors know little about including if it's safe. Then the article goes into preventing homosexuality in the womb, and worse it ends with "want to know more about what researchers have learned about the basis of homosexuality." It comes from a place that homosexuality is "wrong" and could be "cured" or "changed." Here's another thought for them, if heterosexuality develops because of a specific set of physical conditions and homosexuality develops because of a specific set of physical conditions clearly they are both the natural development of humans. Homosexuality has always been part of our human family. The article is coming from a place where they are trying to find a reason and a way to do away with a common human characteristic. Even the Pope denounced that. The question is why would you want to. Parents don't have the right to design their children. They have to work with the human that is born. We are not going to start customizing every detail we want to have for our children in the womb. That is wrong on every level. Homosexuality is as natural as heterosexuality. People need to get over it. It's all part of our human family.

why are we still "experimenting" on women?

How about develping a pill that corrects peoples fearful and irrational sexual biases based on gender and gender identity? Oops, I almost forgot--that's the child's caregivers job.

I know this is very serious stuff, but on the lighter side, how about a pill that corrects Republicanism? Or religious fanatacism?

Yes, we should. We need girls to grow up to be good wives and mothers, and if they are biologically handicapped they'll grow up to be parasites instead.

This is quite possibly the best thing that has happened to the human race since electricity! The concerns about this are stupid and nonsensical. There is no downside to giving birth to a girl who is fully feminine, as nature intended.

Instead of preventing children from being gay so that they don't have to suffer discrimination, wouldn't it be nicer to prevent the discrimination in the first place.
I don't think the problem is "gay"; I think the problem is society.
There are way too many people on this planet anyway and of them, way too many children, most of them unplanned or unwanted. The only purpose of gender is for breeding and it is clear that breeding more people should not a priority right now.
Gender roles, marriage, and of course religious beliefs that lead to this discrimination is a hold over from the past when people were much less educated or civilized. It's 2010, we need to move past this. Let people be as long as it does not harm anyone. These children that are to be born are not what needs to be "fixed"...

Advocates for Informed Choice is a non-profit organization advocating for the legal and human rights of children with intersex conditions or differences of sex development, like the ones in this story. We work in collaboration with bioethicists, doctors, parents, affected adults, and many others. If you are interested in taking action to help protect these children, and to be sure that possible human rights violations are investigated, please join our Facebook page at http://ow.ly/20wTY or follow us on Twitter @aiclegal. You can also donate to support our work at http://aiclegal.org/we-need-your-support

Whaaat? Not only is it morally wrong, but where does it stop? Next, we'll be "preventing" babies with certain hair and eye colors. True, what a woman does with her baby in her womb is her decision, but providing those services can be regulated. Besides, if someone's gay, they're gay, what's the big to-do.

Oh and while you're at it...make it blonde, blue eyed, with Jesus features...ummm let's seee...oh small nose, HATE the body hair so can you clean that up a bit too? I guess that should do it! Finally my son will be accepted by society before he's even born. I mean WHAT parent would wish to put their kid through teasing & taunting caused by our very own narrow minded, biggoted, racist, hate & fear filled teachings if they can help it right? Why not change nature to fit nurture? I mean I sure as heck ain't gonna take time out of my busy schedule to change the way I think about the world...just change my son's genes so I don't have to stop being a homophobe.

Hilarious. Looks like the whole "I'm gay because I was born that way" is about to blow up in the LGBT's faces. Is it not obvious that the whole homosexual existence is based on abnormal endocrine levels, either contributed by the mother or the child during development and reinforced by environmental conditions such as Phthalates and BPAs?

If you don't believe so, just look at any of the transgenders! They take hormones daily for life to ensure their "transformation".

We're going to change our laws to support a pathology????

Now we'll finally see how far the LGBT's will go to prevent their own extinction. I can't wait to see them lining up at the abortion clinics along side the Pro Life groups begging expectant mothers not to abort their gay babies.

Homosexuality is obviously a pathological manifestation. In the future, it will be detected in the womb and will be dealt with as the parents choose, which means extinction except for a few minorites that, sickly enough, will choose to breed a gay baby.


"Preventing homosexuality in utero: Could we? Would we? Should we?"
Yes!, Yes!, Yes!, Yes!, Yes!... ad infinitum...
Yes! to @Goldy (an admitted homosexual!) and:
WRONG!!! @Chuck Stewart & @jeffsd!
It is so info/media obviously NOT a "blessing" and; no God didn't instruct you to be a homosexual. God... or nature only provided you the free will to MAKE A CHOICE as to your CHOOSEN behaviors. (That applies to everyone on every matter)
Debatable @Teaser38. Women only have the humanistic right to murder their unborn (see: "free will", above). The next life/karmic Supreme Judge n' jury are pending final word to be rendered on that matter.

I would like to read postings from gays, as to whether this is a good idea

Why don't we start with Heterosexual rapists, then child molesters, str8 murders, str8 fathers who rape their daughters while committing incest...and continue until we get to "Gays" who by and large pail when compared to the human atrocities committed by Heterosexuals.

Women or couples who undergo various types of fertility treatments create and choose from among different embryos created. They may even be choosing which gender embryo to bring to term, while destroying the rest. This is a type of "tampering" is it not?

I LOVE BABIES!

BABIES ARE THE BEST!

 


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