Why some doctors are moving away from performing surgery on babies of indeterminate gender.
By Claudia Kolker


Approximately 10 times a year in Houston, at the birth of a certain type of baby, a special crisis team at Texas Children's Hospital springs into action. Assembled in 2001, the unusual team includes a psychologist, urologist, geneticist, endocrinologist, and ethicist. Its mission: to counsel parents of infants sometimes referred to as "intersex" babies—that is, babies of indeterminate physical gender.

That such a team exists—and that it often counsels deferring surgery for infants who are otherwise healthy—reflects a radical new thinking among doctors about gender identity and outside efforts to shape it. Instead of surgically "fixing" such children to make them (visually, at least) either male or female, a handful of U.S. specialists now argue that such infants should be left alone and eventually be allowed to choose their gender identity. The approach challenges decades of conventional wisdom about what to do with infants whose genitalia don't conform to the "norm." Until very recently, such children were automatically altered with surgery, often with tragic consequences.

Each year, about one in 2,000 children is born with ambiguous-looking genitalia. A wide range of disorders may be responsible—genetic defects, hormonal abnormalities, or unexplained developmental disruptions that occurred in utero. Sometimes the gender anomalies don't appear until puberty or later when children's bodies begin to mature, or fail to do so: A child with, say, an androgen disorder who formed male-looking genitals might genetically be a girl; another child might have the male hormones of a boy but, because of an interruption in the process that forms male genitalia, may look externally just like a girl. Many anomalies, however, present themselves with bewildering immediacy: tiny penises, enlarged or "virilized" clitorises, or what appear to be a hybrid of male and female genitalia.