A Pill to Make Your Daughter Interested in Dolls and Boys?

Earlier this month, Time Magazine reported (here) on the off-label use of the steroid dexamethasone to treat prevent fetal development of ambiguous genitalia: 

The early prenatal use of dexamethasone, or dex, has been shown to prevent some of the symptoms of [congenital adrenal hyperplasia, known as] CAH in girls, namely ambiguous genitalia. Because the condition causes overproduction of male hormones in the womb, girls who are affected tend to have genitals that look more male than female, though internal sex organs are normal. (In boys, in contrast, the condition leads to early signs of puberty, such as deep voice, body hair and enlarged penis by age 2 or 3.) But while the prenatal treatment may address girls’ physical symptoms, it does not prevent the underlying, medical condition, which in some severe cases can be life-threatening, nor does it preclude the need for medication throughout life. * *  *

Research has also suggested that affected women who were treated with dex in the womb show more typical gender behavior than other women with CAH; the latter group tends to behave more tomboyishly and express little interest in having children.

The American Academy of Pediatrics and other professional groups object to the use of dexamethasone because the pregnant women receiving the drug are not part of supervised clinical trials.  Predictably, ethicists raise concerns about informed consent — were the pregnant women told that the dexamethasone was prescribed "off-label"?

Over at the Hastings Center’s Bioethics Forum, commentators are drawing attention to a claim by pediatric endocrinologists that administration of dexamethasone in utero "will reduce the well-documented behavioral masculinization," including stereotypically "male" "childhood play, peer association, career and leisure time preferences in adolescence and adulthood, maternalism, aggression, and sexual orientation."  (The paper, by pediatric endocrinologists Saroj Kimkarn and Maria New, appeared here in the Annals of the New York Academy of Sciences.)

The Hastings Center commentators say, "[W]e do not think it reasonable or just to use medicine to try to prevent homosexual and bisexual orientations. Nor do we think it reasonable to use medicine to prevent uppity women, like the sort who might raise just these kinds of alarms."

-Bridget Crawford