![]() ![]() ![]() Hormones are identical in children until they reach puberty, but by the time they are about 12 their bodies can change. "Some parents are so torn by the fear that they will make the wrong choice and mess up the child forever." "It's so hard to accept that my child will look different to anyone who changes the diapers," said Wu. "We try to predict what the gender identity will be, and three or four years later, the child psychologist can give us some kind of idea." "In this kind of case, she didn't fit into the typical DSD classification and it made it challenging," he said. He uses a nerve-sparing technique that removes the erectile portion of the clitoris. Wu said doctors no longer use a surgical technique that pulls the clitoris under the pubic bone, which can cause painful orgasms in adulthood. She'll need another one at puberty to widen the vaginal canal. The adrenal glands lack an enzyme to make the hormones cortisol and aldosterone, and so the girls' bodies create more androgen.Īs a result, their genitals, and some say their brains, are masculinized and they must take daily hormone medication to stay alive.Īt the age of 6 months, the baby had surgery to reduce the size of her clitoris and open her labia. The condition accounts for about 60 percent of all DSDs. The spring issue of Stanford Medicine magazine describes a baby with a potentially life-threatening form of the endocrine disorder, congenital adrenal hyperplasia.īorn with XX female chromosomes, the baby had ovaries, a uterus and fallopian tubes, a clitoris that looked more like a penis and partially fused labia. "Early on, we assumed all children with DSD got surgery. "The surgical approach has become much more nuanced in terms of who needs surgery," said Wu. Hsi-Yang Wu, a pediatric urologist at Stanford, said he sees a case of intersex about "once or twice a year," but endocrinologists may consult with two or three families a month. Stanford University has set up a multidisciplinary committee to explore these ethical issues and hopes soon to launch a DSD clinic.ĭr. It's important to talk to them about what we don't know." "There is a place for waiting and allowing children to have some voice in the decision and wait for long term effects or until something better is available. "A lot of urologists argue strongly for surgery," she said. They are made to feel, even by the medical community, as something shameful." "It would be good for families if someone said there may be an issue, but there is support for this. "They are made to feel ashamed," she said. Because they have been affected by some androgen, about 50 percent of them do not accept the gender that is assigned to them.īaratz, who works with advocacy groups like the Accord Alliance pushes for more support for parents and children dealing with intersexuality. When these cAIS babies are gender assigned as female, 99 percent of them go on to feel like women when they grow up.īut in a similar disorder, partial androgen insensitivity syndrome (pAIS), doctors can't always be sure. "These girls look completely female and they are girls," said her mother. Though she is infertile, she hopes to become a parent through adoption or gestational surrogacy. Today, at 26, Katie is married and in medical school hoping to one day be a child psychiatrist. When she was 6, doctors discovered small testes in a hernia sac. She has a vagina, but no uterus or ovaries. Because her androgen receptors are faulty, Katie developed female characteristics. So gender assignment is aimed at putting gender identity and role in sync with each other as the child grows older."īaratz's daughter Katie was born with male chromosomes, but has a DSD called complete androgen insensitivity syndrome (cAIS). "That is called gender identity and the gender role is how we live in society as a man or a woman. "Today, we anticipate how the child will feel as an adult and what they feel inside," said Baratz. "We expect XX is pink and a girl and XY is blue and a boy, but we know from children with gender identity conditions that is not always the case, even when their bodies are perfectly typical." Assign Gender, But Wait for Surgery Arlene Baratz, a Pittsburgh breast radiologist who has two intersex daughters. "Our chromosomes don't tell us who we are," said Dr. Waiting until puberty also allows the child to participate in the decision. Today, gender identification is still not well understood, but experts say that when sex cannot be determined, it's better to use the best available information to assign gender, then to wait and monitor the child's psychological and physical development before undertaking surgery, if at all.
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