46xy children with feminized genitalia developed male

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Unformatted text preview: n their lives or even now, not one of them ever told me they wished they were different, more like others. No one. Imagine that. Imagine, for just a moment, that some of these people have no wish to be exactly like others. Imagine happiness in singularity. Dr. Dreger has “time and again suggested to the physicians doing these studies that they should [also] study that population of people Choices 157 who didn’t have surgery. But they told me, ‘Well that’s not for us to do, because they’re not our patients.’”2 It looks like it may be some time before we have those data. So what do we do in the meantime? If you ask this question of a surgeon, he or she is likely to suggest surgery. But that is not the only course, and we know that some people untouched by a knife can achieve happiness, or something a lot like it. With the exception of a few conditions such as cloacal exstrophy, choosing to postpone surgery does not seriously limit a child’s later options. A potential advantage is that the child will have his or her genital and gonadal tissue intact and can decide if he or she wishes to change that. That would obviously be of major importance if the gender assignment made at birth turns out to be the wrong one for this child. The process by which each of us comes to identify with one sex or the other is complicated. And which sex a child relates to—that is, his or her gender identity—results from the interaction of many different factors, including genetics, prenatal environment (including whether the child develops next to another boy or girl fetus), pre- and postnatal hormones, and childhood psychosocial and environmental factors. According to a report in the Archives of Childhood Diseases, genderidentity selection is a process that lasts for at least the first five years of a child’s life. At one year, most children can easily distinguish men from women, and a few children already show some preference for more masculine or more feminine toys. But it isn’t until they are two or three years old that children regularly and correctly identify their own sex and the sex of others. The exact significance of that isn’t altogether clear since it may simply be that the child cannot articulate their gender identity in a way that is meaningful to adults until the child is two or three years old.3 By age three, most children relate strongly with one sex and have a definite sense of being a boy or a girl. Interestingly, the genitalia of children and adults don’t figure preeminently into a child’s decisions about someone’s sex. Instead, and maybe not so surprisingly, it is the more easily visible features that aid in a child’s decision about another’s sex—things like clothing, hair length, and size. But, even if a child can 158 Between XX and XY see another child or adult’s genitalia, what they see is relatively unimportant to that child’s decisions about that person’s sex until the child is around age eight. And it is at about age five that children come to believe that sex is unchanging with time. This is the point at which many people think that a child’s gender identity becomes fully established and fixed. Then all the child’s energy seems to focus on adopting behaviors consistent with that sex.4 That means that for the first several years of a child’s life, some aspects of sex remain molten, and they only solidify after months of hormones, contemplation, indoctrination, and socialization. And, perhaps most important, it appears that children’s genitalia play a relatively small part in this process, and that, though the data are still few, the studies that do exist suggest that unusual genitalia do not interfere with a child’s development of a gender identity. Research that followed the development of babies with ambiguous genitalia showed that the condition of the children’s genitalia had little effect on the development of gender identity. 46,XY children with feminized genitalia developed male gender identity following almost the same schedule as boys or girls with more traditional genitalia.5 Clearly, under the right circumstances, ambiguous genitalia are no impediment to becoming a boy or a girl. It seems that left to his or her own devices, an intersex child may find his or her own gender identity as easily as any other child. But Dr. Frader and Dr. Dreger both believe that gender assignment at birth is critical to this process. According to Dr. Dreger: We don’t have any social system for accepting as human somebody who doesn’t have a gender assignment as male or female as a child. There are some adults who manage and struggle with having no gender, or having a third gender, or having two genders, but there is no social system at all for a child like that. I think it would be incredibly cruel and incredibly damaging to try to raise a child without a gender. Choices 159 But clearly gender identity development does not depend on surgery. According to Dr. Frader, there is no convincing reason to d...
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This document was uploaded on 02/04/2014.

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