O, brave new world that has such practices in it! A recent study published in the Journal of Bioethical Inquiry reveals a disturbing practice in which U.S. doctors use a non-FDA-approved steroid to prevent lesbianism, bisexuality, tomboyism and intersexuality in fetuses.
The study — conducted by Northwestern University’s Alice Dreger, American University’s Ellen K. Feder and Anne Tamar-Matis from Advocates for Informed Choice — chronicles the history of the drug dexamethasone in treating pregnant women at risk of carrying a child with congenital adrenal hyperplasia (CAH), a “disease of the endocrine system that can cause virilization (i.e., development of masculine traits) in female fetuses.”
Because some forms of CAH are very dangerous, every state requires that newborns are screened for it. Women “at risk” of giving birth to a CAH-affected daughter are often identified because they have already given birth to a child with CAH.
First cited in 1984, the use of the off-label steroid has since become part of standard prenatal care, despite a lack of published supporting evidence. Though the FDA has never approved dexamethasone in the treatment of CAH, a clinician is allowed to promote the use of an off-label drug as “safe and effective” as long as the clinician doesn’t work for the drug-maker or as an FDA-approved investigator of the drug.
Dexamethasone treatment cannot prevent an affected child from being born with CAH, but instead causes a fetus to develop in a “more female-typical fashion.” Some experts posit that prenatal dexamethasone prevents the need for genital surgery in the case of genital abnormalities. However, dexamethasone’s use is often promoted in misleading ways and for purposes that are not legitimately medical, such as the prevention of tomboyism and lesbianism.
New research indicates that prenatal dexamethasone may lead to serious metabolic problems that won’t become apparent until adulthood and its administration is already being called into question. In 2010, Mount Sinai determined that the use of dexamethasone “should require a rigorous informed consent process with detailed documentation that the risks and benefits of this treatment have been clearly communicated to the parents making a decision to engage in prenatal treatment.”
Now if only the FDA felt the same way. You can read the study for yourself here and make sure to leave your opinions in the comments below.