Concerns over gender change

According to &to=' target=_blank>NewsDay male babies surgically turned into girls at birth because of a rare birth defect frequently continue to feel like boys and may eventually switch their gender back to male, even with no knowledge of their history, according to a new study. The study in this week's issue of the New England Journal of Medicine suggests that surgeons should re-examine the practice of altering gender. The study, by Dr. William Reiner at the University of Oklahoma and Dr. John Gearhart at the Johns Hopkins Children's Center, examined the progress of 16 genetically male children born with a birth defect known as cloacal exstrophy.

Babies with this condition, which affects one in 400,000 births, have severe abdominal abnormalities in such organs as the bladder, intestine and genitals.

Because male babies with cloacal exstrophy lack a penis, the decision in these cases traditionally has been to remove the testes, construct a vagina and raise the children legally and socially as girls.

In the current study, Reiner and Gearhart reported on 16 genetically male children age 5 to 16 with cloacal exstrophy who had undergone the gender-altering operation, 14 of whom were raised as girls. Children and parents were asked about play patterns, levels of aggression, career goals and attitudes toward sex roles. The families were followed for between 34 and 98 months.

At the last assessment, eight of the 14 raised as girls had declared themselves boys. Reiner said one child refused at 12 to accept estrogen injections for induction of puberty because he felt he was a boy. Five were living as females, apparently without complaint. One was too angry to discuss the issue.

&to=' target=_blank> reports that today, prenatal ultrasound tests can detect the problem early in fetal development. Because many parents decide to terminate the pregnancy, doctors are seeing the disorder less often than in the past. Only recently have surgeons been able to fashion a cosmetic penis for boys with the disorder. So for years, doctors at Hopkins and other hospitals typically removed the male reproductive organs and surgically fashioned a cosmetic vagina. The babies were raised as girls and given the female hormone estrogen once they approached puberty. Hopkins stopped the practice about 10 years ago as surgeons learned better ways to construct a penis. Elsewhere, the practice has faded more slowly, and it persists at some hospitals. "Kids will tell you what they want you to know without saying a word," Reimer, now 37, said in an interview yesterday. "You know who they are when you watch them play with toys, when they pick out clothes and you watch the types of activities they play. It all starts before kindergarten."

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