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There's More to CAH than Gender Issues

babies are not the battleground for theories

Forum: WMST-L
Date: 05/25/2006

On May 25, 2006, at 12:14 PM, Michael Kimmel wrote:

In my never-ending quest to understand and debunk the casual essentialism of mainstream popular culture, I wonder if any listmembers have references for critiques of the CAH research. That's the research on Congenital Adrenal Hyperplasia, the genetic abnormality that affects girls and "causes" them to like playing with trucks and guns instead of Barbie.


As a point of information, CAH does occur in genetic males and females at approximately equal frequency. Boys with CAH simply doesn't receive equal attention from gender theorists because boys with extra androgen isn't considered pathological in the same way girls with the same situation. Of course, it's still considered a serious medical issue, as there's a huge risk of adrenal crisis unless proper treatment is prescribed. However CAH among genetic males just isn't considered a crisis of gender. See for more information about CAH (note: I don't personally endorse some of their positions, and I'm not even sure if I can recommend them as a good resource for the parents of children with CAH--but they do have some basic info nonetheless.)

There are many things to be critiqued about the medical treatment of people with CAH that are worth feminists' attention beyond the obvious surgery question. For example, there's a serious ethical concern over the uses of dexamethasone by a woman suspected of carrying a genetic female with CAH, whose main purpose seems to be the suppression of the fetus' clitoral enlargement. As a proof of this, they would abandon the DEX treatment once the fetus is discovered to be genetic male. There are side-effects to this treatment to the mother, but they are almost routinely being told that this is necessary for the child to be born healthy--which in reality only means "normal sized clitoris."

But as far as scientific evidences go, the connection between CAH females and their preference for stereotypically masculine toys and plays seems very strong, even in the presence of the parenting to the opposite direction (it's fairly common for parents to prohibit a girl with CAH from boyish interests while her non-CAH sister is free to explore her tomboyish side, since parents are told from early on that there's a significantly increased risk of "turning gay."

In related topic, let's compare CAH females with girls with other forms of DSD (disorders of sex differentiation and development). They may appear identical from external examination, but the conditions in which the brain receives an increased "shower" of androgens as fetuses consistently come out more likely to be boyish or gay (or trans, for that matter), even when they report similar parental influences.

The mainstream culture always distorts scientific findings and make everything too simple, but I think it'd be dishonest for any scholar to not recognise that hormones to play huge role in shaping one's tendencies in this world. That said, how these tendencies play out has a lot to do with what's culturally available, as do what's defined as masculine or feminine in a given cultural context.

Emi Koyama
Director, Intersex Initiative