With more and more medical innovations that tell us surprising amounts of information about unborn children, the medical ethics of prenatal drugs become significantly complicated. It seems unproblematic to allow couples to see what gender their child will be, but what happens when pregnant women are informed that their children may have congenital adrenal hyperplasia (CAH), a group of inherited disorders of the adrenal gland? Drugs like the steroid dexamethasone are often prescribed for CAH, which can cause faulty adrenal glands and early signs of puberty in boys, and “ambiguous” genitalia and “masculine” tendencies in girls. Some are rightfully challenging the use of this drug, calling its necessity and dubious motivations into question. And much of the reason women are taking it appears to be because of the associations between “masculine” women and homosexuality — whether or not they are doing so consciously, the people who take the drug seem very clearly to want straight, feminine daughters, to the point where they’ll take an experimental drug to get the desired result.
The problematic elements are clear: women are taking dexamethasone (dex) because they are afraid of the “psychosocial problems associated with having ambiguous genitalia” (and here I’m quoting Time), as well as the threat of same-sex attraction, which is less explicitly addressed in the article but is clearly one of the main issues for the people who are prescribing and taking dex. Regardless of whether CAH can actually influence sexual orientation, the anxiety is reflective of fear of traits that blur gender lines. Girls with CAH do not exhibit traditionally feminine traits; they behave “tomboyishly” and do not express the same interest in motherhood. Dex can, essentially, create feminine children who will exhibit “normal” sexual orientations, as well as (and this is pretty shocking) de-masculinize “peer association, career and leisure time preferences in adolescence and adulthood.” Yes – this is implying “masculine” and “feminine” career paths, and suggesting that this drug can push girls toward the correct, feminine track.
I don’t know where to start with this. First of all, the idea of ambiguous genitalia being a problem has led, in the United States, to a shocking number of “corrective” surgeries on infants that, to my mind, seems not far off from the practice that in other countries we call “genital mutilation.” But here’s the kicker: the drug doesn’t cure CAH, and many women who take the drug are shocked to discover the ethical controversy, mostly centered around informed consent, that surrounds the drug. New York doctor Maria New has been leading in prescribing the drug, but her methods are extremely ethically dubious.
The impetus to prescribe and take dex is, clearly, spurred by a severe anxiety about the idea of giving birth to daughters who, whether or not they are lesbians, blur gender boundaries and challenge traditional conceptions of what is masculine and feminine. The solution, though, is not to take an unnecessary drug, but to rethink the way we deal with gender so that “masculine” daughters with “ambiguous genitalia” are no longer such a source of fear that women will take an experimental, off-label drug to “cure” them.
Read more: health policy, pregnant women, experimental drugs, gender anxiety