Bioethicists are raising alarms over pregnant women being treated with a drug called dexamethasone—a risky Class C steroid aimed at female fetuses that may have a form of congenital adrenal hyperplasia (CAH)—outside the context of IRB-approved clinical trials. Prenatal ‘dex’ treatment is known to carry certain health risks for mother and fetus (and sorry, I can’t seem to find a run-down of what those risks are, but they’re not the story, so just go with me that there are risks). Why take the risk?
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.
Risking the health of woman and fetus for the sake of avoiding ambiguous genitalia. Okay, seems dodgy, but we don’t know what the risks are; maybe they’re minimal. But then there’s more…
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.
Yes. Now we see a problem. But alas it gets even worse…
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.”
So, it’s not just that they may turn out to be lesbians: they may turn out to be lesbians who want to enter the workforce!
Researchers working on an interesting project tend to suggest how their work could have broader implications. This is no exception: the 2008 paper by Meyer-Bahlburg et al hints that variation in sexual orientation beyond the population of girls with CAH might also be partly explainable through prenatal androgen exposure. Such reasoning could lead to the pursuit of other “screening” and “treatment” methods for manipulating intrauterine environments.
While everyone has been busy watching geneticists at the frontier of the brave new world, none of us seem to have noticed what some pediatricians are up to. Perhaps it is because so many people are fascinated by the idea of a “gay gene” that prenatal “lesbian hormones” have slipped past public scrutiny. In any case, we think Nimkarn and New’s “paradigm for prenatal diagnosis and treatment” suggests a reason why activists for gay and lesbian rights should be wary of believing that claims for the innateness of homosexuality will lead to liberation. Evidence that homosexual orientation is inborn could, instead, very well lead to new means of pathologization and prevention, as it seems to be in the case we’ve been tracking.