- The Washington Times - Wednesday, July 7, 2010

A spate of headlines have criticized a New York doctor for purported efforts to “cure” lesbianism, but once hyperbole is removed, she is faulted more for not making sure pregnant patients are included in formal studies, so their children’s health outcomes can be tracked.

“Allegations that my goal is to prevent lesbianism are completely untrue,” pediatric endocrinologist Dr. Maria I. New said in a recent statement from Mount Sinai Medical Center in New York City.

Dr. New is an expert in congenital adrenal hyperplasia (CAH), an inherited hormonal condition that in baby girls can cause “masculinized” or ambiguous genitalia. Pregnant women who know they are CAH carriers can take a steroid known as dexamethasone or “dex” to reduce the likelihood of such genitalia in girls.

However, using dex this way is “off-label,” and medical professionals have started to question whether it should be prescribed, absent rigorous study on how it affected the children.

In her statement, Dr. New said she has been approved “to conduct long-term evaluations” of children who were given dex for CAH while in utero.

Dr. New noted she has not personally been prescribing dex for some time.

“In my six years at Mount Sinai, I have not administered the drug to any woman for the purpose of treating an unborn child,” she said.

But gay rights activists and like-minded bloggers, including Dan Savage, Andrew Sullivan and Alex Blaze, have reacted strongly to the idea that any doctor might be helping parents prevent potential lesbianism in children in the womb.

Eliminating human diversity to make some people feel more comfortable is a “simple crime against humanity,” Mr. Blaze wrote on the online Huffington Post in an item called, “The Sad Lengths Some Go to Avoid Having a Lesbian Daughter.” Mr. Sullivan also titled a series of posts at his Atlantic blog “The Final Solution?”

Alice Dreger, a professor of bioethics at Northwestern University; Ellen Feder, philosophy professor at American University; and Anne Tamar-Mattis, executive director of Advocates for Informed Choice (AIC), amplified the outcry with an June 29 article for the Hastings Center, called “Preventing Homosexuality (and Uppity Women) in the Womb?”

“We do not think it reasonable or just to use medicine to try to prevent homosexual and bisexual orientations,” the women wrote.

They especially faulted Dr. New and others for giving a “risky” steroid to women and children who have not been “enrolled in controlled clinical trials” with review board oversight. In August, the Journal of Clinical Endocrinology & Metabolism will reiterate the need to only allow dex to be used prenatally if it is part of a clinical trial, Ms. Dreger and her colleagues noted.

Doctors who do human research must have outside oversight, as required by law and by internationally recognized ethical standards, added Ms. Tamar-Mattis’ AIC, which is a new nonprofit that focuses on the legal and human rights of children with intersex conditions or disorders of sex development.

A review of CAH-related message boards shows that parents and CAH adults talk freely about prenatal dex. Most reported few or no ill effects from using the drug. Several said they believed their daughters’ genitalia were improved because of dex use during pregnancy, but a few mothers reported that their daughters’ health became worse.

CAH affects one baby in 16,000. It plays havoc with hormones, and patients typically take medicine for life to keep their hormones stable, and salt, blood and sugar levels normal.

Both boys and girls with CAH can experience early puberty and infertility, and boys can develop benign testicular tumors. In girls, however, CAH can make their genitalia look confused, neither clearly female nor male.

In addition, a few small studies suggest that CAH girls are more likely to play “like boys,” be more aggressive and career-oriented than other girls, and be less interested in getting married and having babies.

An unknown portion of CAH females grow up to identify as bisexual or lesbian. However, most CAH girls grow up to be heterosexual and very few seek a sex change, wrote Dr. Phyllis W. Speiser, pediatrics professor and chief of pediatric endocrinology at Schneider Children’s Hospital in New York.

For 20 years, doctors, including Dr. New, have sometimes prescribed dex for CAH-carrier woman as soon as they know they are pregnant. This is because using dex throughout pregnancy “has been shown to decrease or even prevent” a masculinization of genitalia in CAH-affected girls, Dr. Speiser wrote in a 2008 article for Endocrine News.

But Ms. Dreger and her colleagues point to the prenatal dex-CAH issue as evidence that if homosexuality and lesbianism were found to be inborn, it “could very well lead to new means of pathologization and prevention.”

“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,” they warned.

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