A New York doctor named Maria New has been advising pregnant women to take a steroid called dexamethasone to prevent homosexuality and "masculine behavior" in their daughters. How did she get away with this form of anti-gay genetic engineering?


New is an endocrinologist who studies, among other things, a condition called congenital adrenal hyperplasia (CAH). It's caused by overexposure to male hormones in the womb, and it can result in developmental abnormalities that often mean, as Time magazine puts it, "a lifetime of taking powerful steroid medications to compensate for faulty adrenal glands." It can also cause girls to be born with ambiguous genitalia. (They have large clitorises that appear penis-like, though they also have perfectly ordinary vaginal openings and wombs.)


Working with several collaborators, including Columbia psychologist Heino F. L. Meyter-Bahlburg, New has written a series of scientific papers suggesting a strong connection between CAH and lesbianism. CAH, they write, is also associated with a disinterest in mothering, as well as "masculine behavior" in girls.

Enter dexamethasone, dex for short. It's a steroid that New and some of her colleagues believe can prevent some of the outward signs of CAH in girls - specifically, there is a small amount of evidence that it can prevent ambiguous genitals. But dex has never been approved by the FDA for treating CAH in utero. New is recommending it for this off-label use based on a tiny study done in Sweden. According to Time:

But the study, with just 26 participants, was too small to be definitive. "We just don't know what we are doing to these kids," says Dr. Walter Miller, the chief of endocrinology at University of California, San Francisco. "It's not sufficient to say, The baby was born and had all fingers and toes, so it's fine."

And it gets worse. The Bioethics Forum uncovered a tape of a presentation New gave to parents 9 years ago, where she recommended dex for a lot more than correcting possible ambiguous genitals. In the tape, New tells parents:

The challenge here is . . . to see what could be done to restore this baby to the normal female appearance which would be compatible with her parents presenting her as a girl, with her eventually becoming somebody's wife, and having normal sexual development, and becoming a mother. And she has all the machinery for motherhood, and therefore nothing should stop that, if we can repair her surgically and help her psychologically to continue to grow and develop as a girl.


New's longtime collaborator Meyer-Bahlburg amplifies this sentiment in a paper he published a few years ago:

CAH women as a group have a lower interest than controls in getting married and performing the traditional child-care/housewife role. As children, they show an unusually low interest in engaging in maternal play with baby dolls.


This year in Annals of the New York Academy of Sciences, New and pediatric endocrinologist Saroj Nimkarn suggest dex can reduce these "problems":

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 . . . We anticipate that prenatal dexamethasone therapy will reduce the well-documented behavioral masculinization.


Note that one example of "masculinization" has to do with "sexual orientation." But another is "career and leisure time preferences." So dex will prevent girls from picking masculine careers and hobbies? The message here is not just that dex can cure lesbianism, but also that it will encourage girls to desire the traditional roles of wife and mother.

As if trying to engineer straight, "feminine" girls wasn't problematic enough, New is encouraging doctors to prescribe a drug that can't even cure CAH. It may prevent ambiguous genitals in girls, but it doesn't help the underlying condition. Many of the women receiving dex treatment don't realize that the drug doesn't cure CAH, and are shocked to find out that it's not approved by the FDA. Time offers this story:

Jenny Westphal, 24, who took dexamethasone throughout her pregnancy at the recommendation of another doctor, says she feels misled . . . Her daughter, now 3, who has CAH, has also had serious and mysterious health problems since birth, including feeding disorders, that are not commonly associated with her adrenal-gland disorder.


But New would probably count this as a triumph: Westphal's daughter has perfectly normal genitals. Maybe she'll even grow up to be a heterosexual.

Read more at Bioethics Forum and Time magazine. Hat tip to Dan Savage.