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Study: Genes may trump nurture with intersex kidsRandy Dotinga,
Gay.com / PlanetOut.com Network
Friday, January 23, 2004 / 05:34 PM

Sex-change operations aren't just for grown-ups. A tiny number of newborn baby boys go under the knife when their genitals are so malformed that surgeons figure it's better to raise them as girls. But a new study suggests that switching genders is hardly so simple.

Researchers found that eight of 14 boys who grew up as females later declared themselves to be male. Nurture, it seems, couldn't beat out nature, at least in most of the children.

*It certainly will make doctors think twice before rapidly performing genital surgery on intersex children,* said Dr. Eric Vilain, a genetics expert at the University of California at Los Angeles. *Hopefully, the doctors will wait to see which gender develops before performing surgery.*

The fate of so-called *intersex* children has long been a major topic of debate. What do you do with babies who are born with birth defects that make it difficult to recognize their gender?

About one of every 3,000 babies has a more serious problem -- severely malformed or so-called *ambiguous* genitalia. The gender of the child may not be obvious, and the babies often appear to be both male and female.

In the past, influential psychologists theorized that *gender identity* had everything to do with environment: Raise an intersex boy as a girl, maybe with the help of surgery and hormone treatments, and he -- she -- will grow up to think and act like a woman.

This approach didn't always work. In a famous case documented in the book *As Nature Made Him: The Boy Who Was Raised as a Girl,* a Canadian boy who suffered a botched circumcision was operated upon and raised as a girl. He suffered through a tortured adolescence and later chose to live as a man and get married.

In reality, *Nature as well as nurture affects your gender identity,* says Dr. Melvin Grumbach, a pediatrician and professor emeritus at the University of California at San Francisco. 8It's not all one or another -- and in an individual, you can not be sure what is the deterministic factor.*

In the new study, researchers spent several years following the lives of 16 children who were born with a defect known as cloacal exstrophy that left them without normal penises. All the children are genetically male; all but two underwent surgery to remove their testes (which were inside their bodies) and create female genitalia.

The findings of the study appear in the Jan. 22 issue of the New England Journal of Medicine.

The two children with intact testes were raised as boys and continued to think of themselves as males. The other 14 were raised as girls, and even their birth certificates reflected their new genders.

Eight of the 14 later declared themselves to be male, and six of them said they wanted to undergo sex-change surgery to gain penises. All 14 had some male traits: They had trouble interacting with girls (but not boys), and they reported little interest in playing with dolls or playing house.

*In normal genetic and hormonal males, there's a rather district likelihood that their brain has been masculinized, both in terms of their behaviors and their identity, how they see themselves,* said study co-author Dr. William G. Reiner, a pediatric urologist at University of Oklahoma Health Sciences Center.

Experts said the study provides more evidence that psychologists and doctors need to tread carefully as they decide whether to *assign* an intersex child to a particular gender at birth.

*What's critical for all of us as surgeons is to operate when operations are indicated,* Reiner said. *If we don't know if they're indicated, we should be careful about doing them.*