Important clarification: CAH is a real and serious disease. There are no objections to pediatricians treating the physiological disorders in utero. However, lesbianism, traditionally masculine career choices, and disinterest in having children are not diseases…and the problem in this work is that the doctors involved clearly think they are, and are interested in using the drug dexamethasone to modify behavioral choices. That's the scary part.
Ladies, are you independent, stubborn, or mildly aggressive in your social interactions? Are you perhaps less interested in having sex with men than your neighborhood nymphmaniac? Are you possibly even lesbian or bisexual? Worst of all, are you pursuing a career in a masculine profession, and possibly deferring pregnancy and child-rearing to a later date, or even indefinitely?
*Researchers couldn't possibly have suggested this, could they? Yes, they did.
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…"
See? It's abnormal to have career interests that are not aligned with your gender!
By the way, "46,XX" just means chromosomally normal.
Your diseased state may be due to a congenital abnormality, prenatal exposure to excess androgens. You've been mildly masculinized. There are specific heritable traits such as congenital adrenal hyperplasia that can, in extreme cases, lead to ambiguous genitalia, but even at low levels of effect may contribute to such horrors as female homosexuality, childhood playing with trucks, and the ambition to pursue careers in physics or medicine or computer science, where you don't really belong.*
I fear that if you're reading Pharyngula, you're probably one of those more assertive, man-like women, and you're rapidly reviewing your personal history and realizing it's true: you didn't make Scarlett O'Hara your role model, you aren't submissive to your husband (if you even have one!), and the prospect of churning out a baby a year does not appeal to you. And you're wondering what went wrong with your life, and what can you do to change your personality to something more demure, more delicate, more passive.
I'm sorry, it's too late. There's nothing that can help you now. I told you it's caused by congenital exposure to androgens. Weren't you listening, woman?
But wait, don't despair. You might be condemned to a life of misery trying to compete with men by your aberrant brain, but your children don't have to. What you need to do is use your ovaries and get pregnant right now — don't complain, it's your natural destiny — and if it's a boy, be happy and relieved, but if it's a girl, there is a drug you can take that might make her a girly girl girl, one who is joyously heterosexual (unlike you), happy to have sex with men (unlike you), a perfect fit to traditional gender roles (unlike you), and enthusiastic about having babies (unlike you, who is only doing this out of a sense of duty and a diminished self-esteem).
Now the evidence that prenatal androgenization is the cause of your weird unladylike attitude is a little shaky, and the use of this drug is experimental and hasn't really been tested that well to see if it works as claimed, but never mind all that — its use has been endorsed by the American Academy of Pediatrics, the Lawson Wilkins Pediatric Endocrine Society, the European Society for Paediatric Endocrinology, the European Society of Endocrinology, the Society of Pediatric Urology, the Androgen Excess and PCOS Society, and the CARES Foundation. The rather tenuous chain of evidence for this claim, and the peculiarity of diagnosing as a problem something that most of the poor, afflicted, purblind women do not recognize as a problem, is being disregarded because it is so very important that we reduce the incidence of lesbianism by an entirely hypothetical and unmeasured percentage. Lesbianism is just that bad.
Ask for it by name. It's a glucosteroid called dexamethasone, and tell your doctor you need it because you want to make sure your baby likes pink frilly dresses when she grows up and doesn't try to compete with men. It's a convenient anti-uppitiness pill for your baby!
Meanwhile, just sit around and feel miserable about your congenital failures.
Oh, by the way — dexamethosone is a potent little steroid, and there may be a few trivial side-effects of the chronic exposure to the hormone to you while pregnant, including weight gain, diabetes, immunosuppression, hypertension, catabolic muscle atrophy, osteoporosis, and psychiatric disturbances, like mania, depression, and mood swings. It's just one of those little sacrifices I'm sure you'll be happy (remember—destiny, natural order, womanly role, etc.) to make in order that your baby grows up knowing her place as an appropriately obedient little receptacle of manly desires, and liking it.
Before you less-than-hyper-macho men get all smug, though, let me warn you: prenatal hormone effects is a hot, hot topic in the heteronormative world of pediatrics. You're going to be diagnosed as suffering from a prenatal androgen deficiency and shamed if you're anything less than a man's man with stereotypic masculine interests. Look for intrauterine testosterone treatments for women carrying boy children, just to make sure they grow up to like football (American, not that pansy soccer stuff) and follow macho careers!
I, for one, look forward to our brave new world of drug-enhanced sexual dimorphism and the extermination of all sexual ambiguity and androgyneity. Aren't you?
If you aren't, give us time: we'll come up with a pill for that, too.
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