Oklahoma,
USA — Male babies surgically turned into girls
at birth because of a rare birth defect frequently
continue to feel like boys and may eventually switch
their gender back to male, even with no knowledge of
their history, according to a new study.
The finding, reported in
the current issue of the New England Journal of
Medicine <http://content.nejm.org/>,
suggests there is an intrinsic, biologically determined
feeling of sexual identity that is hard to override
through rearing, experts said.
The study also suggests
that surgeons should reexamine the practice of altering
the gender of babies born with this condition.
''This paper says a very
important thing -- that it's difficult for nurture to
overcome nature,'' said Dr. Eric Vilain, associate
professor of human genetics, pediatrics and urology at
the University of California, Los Angeles
<http://www.berkeley.edu/>.
``It shows that the theory of gender neutrality at birth
has holes in it.''
The study, conducted by
Dr. William Reiner, a psychiatrist at the University of
Oklahoma <http://www.ou.edu/>,
and Dr. John Gearhart, chief of pediatric urology at the
Johns Hopkins Children's Center <http://www.jhu.edu/>,
examined the progress of 16 genetically male children who
had been born with a rare birth defect known as cloacal
exstrophy.
Babies with this
condition, which affects one in 400,000 births, have
severe abdominal abnormalities in such organs as the
bladder, intestine and genitals.
Because male babies with
cloacal exstrophy lack a penis, the decision in these
cases traditionally has been to remove the testes,
construct a vagina and raise the children legally and
socially as girls.
Theory from
1950s
This decision is in line
with theories espoused from the 1950s by American
psychologist John Money <http://en.wikipedia.org/wiki/John_Money>
that babies are blank slates at birth, adopting gender
identities through the influence of their
environment.
For decades, Money's
theory, coupled with the greater ease of surgically
turning boys into girls, influenced doctors and parents
in deciding the gender fate of children born with
malformed or ambiguous genitals.
Until the late 1970s,
proper studies weren't performed on children who had been
assigned a sex at birth to assess whether they had
adjusted well, said Sheri Berenbaum, professor of
psychology and pediatrics at Pennsylvania State
University, University Park <http://www.psu.edu/>.
The studies were hard to do, and ''people just believed
John Money; they just believed we were neutral at
birth,'' she said.
In the current study,
Reiner and Gearhart reported on 16 genetically male
children age 5 to 16 with cloacal exstrophy, 14 of whom
were raised as girls. Children and parents were asked
questions about the children's play patterns, levels of
aggression, career goals and attitudes toward sex
roles.
The families were
followed for between 34 and 98 months.
At the last assessment,
eight of the 14 individuals raised as girls had declared
themselves boys, including four who had not been told of
their surgical transformation. Reiner said that one child
refused at age 12 to accept estrogen injections for
induction of puberty because he felt he was a boy.
Another five subjects were living as females, apparently
without complaint. One was too angry to discuss the
issue.
Should be left
Male
''We challenge the wisdom
of routine gender conversion of these people,'' Gearhart
said. ``The science is telling us that the majority of
these children should be left as the male
sex.''
The study also could have
implications for more common conditions in which babies
are born with malformed or ambiguous genitals.
There is debate whether
sex-assignment surgery should be delayed in such
cases.
However, Berenbaum and
other experts noted that five children appeared happy
living as girls, implying that nurture can win out. They
added that issues of gender identity need to be weighed
against emotional consequences of growing up as a boy
lacking a penis.
