Baltimore US
— Two Johns Hopkins Children's Center
<http://www.hopkinsmedicine.org/pediatricendocrinology/>studies
confirm that prenatal exposure to normal male hormones
alone dictates male gender identity in normal XY male
babies, even if they are born without a penis. The
results seriously question the current practice of
sex-reassigning some of these infants as females,
performing castrations or other surgery to align them
cosmetically and hormonally with a female role.
In what are believed to
be the first studies of their kind, Hopkins researchers
followed the development of 27 genetically male children
- with normal XY male chromosomes. All were born with
cloacal exstrophy <http://en.wikipedia.org/wiki/Cloacal_exstrophy>,
a rare, major defect characterized by lack of a penis,
but presence of normal testicles, indicating exposure to
normal male hormone patterns before birth. Twenty-five of
the children were reassigned by physicians at birth,
castrated and raised as females. Presenting the findings
at the Lawson Wilkins Pediatric Endocrine Society
<http://www.lwpes.org/>
Meeting in Boston today, William G. Reiner, M.D., a child
and adolescent psychiatrist and urologist at the Hopkins
Children's Center, reported that the majority of these
children, between the ages of 5 and 16, have subsequently
"reassigned" themselves back to males. All 27 showed
strong male behaviors, activities and
attitudes.
"These studies suggest
that male gender identity is directly related to normal
male patterns of male hormone exposure in utero," says
Reiner. "These children demonstrate that normal male
gender identity can develop not only in the absence of
the penis, but even after the removal of testicles or
castration at birth, and unequivocal rearing as female.
Rather than the environment forming these children's
gender identity, their identity and gender role seem to
have developed despite a total environment telling them
they were female."
In the first study,
Reiner and Director of Pediatric Urology at the Hopkins
Children's Center John Gearhart, M.D., followed 14
children whose testicles and male hormone levels in utero
had been normal at birth. All but two had been surgically
reconstructed as females and raised unequivocally as
females. Today, the 12 raised as females are strongly
male-typical in their activities, attitudes, friends, and
play. Six of them reassigned themselves back to their
male gender, at ages 5, 7, 8, 9, 11, and 12 years old.
The two who were not reassigned female at birth were
developmentally far more like their normal male peers and
psychologically better adjusted than the sex-reassigned
children, Reiner reports.
In the second study,
Reiner followed an additional 12 genetically male
children in his Child and Adolescent Psychiatry Clinic
for Gender Identity and Psychosexual Disorders, in the
Johns Hopkins Children's Center. Referred from outside
university centers, all had been born with this same
pelvic field defect, and sex-reassigned as females at
birth. Eight of the 12 have since sex-reassigned
themselves back to male. Three sets of parents plan to
tell their children their genetic sex of birth "soon";
all expect their children to switch back to a male gender
when they learn their birth gender.
Reiner called for a
thorough reexamination of the practice of
sex-reassignment of children, and urged extreme caution
in surgically reconstructing these children at birth.
"These studies indicate that with time and age, children
may well know what their gender is, regardless of any and
all information and child-rearing to the contrary. They
seem to be quite capable of telling us who they are, and
we can observe how they act and function even before they
can tell us."
He urges parents to get
all the data before making surgical or gender decisions.
"Children with major, severe genital anomalies - not
necessarily hypospadias or other common anomalies - but
those with severe genital problems need early and full
consultation at a medical center where such children are
routinely evaluated and followed long-term, and where
outcomes are thoroughly studied."
