You've (Still) Got Male

Boys with genital defects, raised as girls, revert back to original gender

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HealthDay Reporter

WEDNESDAY, Jan. 21, 2004 (HealthDayNews) -- New research provides more evidence that boys will be boys -- even if they're raised as girls.

Eight of 14 sexually malformed children who grew up as females later declared themselves to be male, a new study says.

All the children were born with a defect that left them without normal male genitals. Surgeons removed their testes, which were inside their bodies, and their parents chose to consider them to be girls.

Experts say the findings support the controversial notion that environment alone doesn't determine whether humans consider themselves to be males or females. "It just shows that nurture is not able to overcome nature in many cases," says Dr. Eric Vilain, who studies so-called "intersex" children at the University of California at Los Angeles.

An estimated 1 percent of babies are born with malformed genitals, usually minor problems that can be fixed surgically, such as undescended testicles or malformed openings of the urethra. But some have a more serious problem -- severely malformed or so-called "ambiguous" genitalia. The gender of the child may not be obvious; in some cases, the babies appear to be both male and female.

In past decades, psychologists tried to "fix" the children by assigning them a gender, even if it didn't match the gender determined by their chromosomes. Surgeons then operated on their genitals to make them match the assigned gender.

Many intersex children went on to rebel against their "gender assignments." In a famous case documented in the book As Nature Made Him: The Boy Who Was Raised as a Girl, a Canadian boy who suffered a botched circumcision was operated upon and raised as a girl. He suffered through a tortured adolescence and later chose to live as a man and get married.

In the new study, researchers talked to 16 children, aged 5 to 16, who were born with a defect known as cloacal exstrophy that left them without normal penises. All the children are genetically male.

The findings of the study, which followed some of the children for years, appear in the Jan. 22 issue of the New England Journal of Medicine.

Two children in the study were raised as boys and continued to think of themselves as males. The other 14 had surgeries to remove their testes and create female genitalia. They were raised as girls, and even their birth certificates reflected their new genders.

Eight of the 14 later declared themselves to be male, and six of them said they wanted prosthetic penises. Even the children who consider themselves to be females appeared to have some male traits. All said they have trouble fitting in with other girls (although none said the same about boys), and they reported little interest in playing with dolls or playing house.

The findings suggest gender identity "looks to be pretty much hard-wired" into the brain, says study co-author Dr. William G. Reiner, a pediatric urologist at University of Oklahoma Health Sciences Center. But he adds that environment -- the way children are raised -- plays a role, too. "Nature interacts with nurture constantly in ways that are complex and difficult to understand. They constantly change each other."

So what should be done with babies with the defect described in this study? "If there's a question about the child's sexual identity, we need to be very careful," Reiner says.

While it may make sense to choose a gender for a such a child early in his or her life, "how are you or I going to know what they want until they tell us?"

Dr. Melvin Grumbach, a pediatrician and professor emeritus at the University of California at San Francisco, also supports caution and patience when it comes to untangling questions of gender in these children. "It is not one size fits all," he says.

More information

To learn more about sexually ambiguous babies and prospects for treatment, visit this guide developed by the Johns Hopkins Children's Center. If you'd like to reach an expert on this subject, try the Intersex Society of North America.

SOURCES: Eric Vilain, M.D., Ph.D., associate professor, human genetics, pediatrics and urology, chief, medical genetics, Department of Pediatrics, and director, Laboratory of Sexual Medicine, Department of Urology, David Geffen School of Medicine, University of California, Los Angeles; William G. Reiner, M.D., associate professor, Department of Urology, Division of Pediatric Urology, Department of Psychiatry, Child and Adolescent Psychiatry, University of Oklahoma Health Sciences Center, Oklahoma City; Melvin Grumbach, M.D., professor emeritus, pediatrics, University of California, San Francisco; Jan. 22, 2004, New England Journal of Medicine

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