Prenatal Treatment May Change Sexuality in the Womb

Those who insist that homosexuality is a matter of choice may soon be faced with a dilemma: where to take a stance on a controversial drug administered to pregnant mothers who may be at risk of giving birth to daughters with ambiguous genitalia--a drug that seems to "feminize" fetuses and prevent lesbianism.

The medication is administered to women whose children are at risk for congenital adrenal hyperplasia, reported the Los Angeles Times on Aug. 15. Adrenal hyperplasia involves abnormal function of the fetus' adrenal gland, leading to elevated masculinizing hormones that can affect fetal development and cause the genitalia of female newborns to be ambiguous in appearance--and, there is some indication, also lead to lesbianism once the infants reach sexual maturity.

The medication offered to pregnant mothers can prevent the development of ambiguous genitalia. It might also, the Los Angeles Times article says, promote more "female" behavior in young children. At least one researcher, Mt. Sinai's Dr. Maria New, has reported that there is a higher incidence of lesbianism among women who were born with the condition, and whose mothers did not receive any medication to treat it in utero.

But no one has yet done research that would conclusively prove that prenatal treatments would decrease the number of infants born with adrenal hyperplasia who then grew up to become lesbians. Even so, there are fears that mothers might be prescribed the drug--which carries some risk for side effects--to prevent lesbian offspring as much as to treat adrenal hyperplasia.

Professor of bioethics Alice Dreger worries that the treatment might constitute "engineering in the womb for sexual orientation," and adds that some doctors "suggest that you should prevent homosexuality if you can. But being gay or lesbian is not a disease and should not be treated as such."

Warns pediatric endocrinologist Dr. Phyllis Speiser, "There is not a lot of information on [the] long-term safety" of the medication, which has been linked in animal studies to memory loss and changes in brain structure, as well as to high blood pressure. "The efficacy has been demonstrated in case reports--a fairly sizable number of cases that used untreated siblings for comparison--but not in randomized, controlled clinical trials," Speiser noted.

A colleague and sometime collaborator of Dr. New, Dr. Heino Meyer-Bahlburg of Columbia University Medical Center, noted, "The majority [of people with the condition], no matter how severe [it may be], are heterosexual. But the rate of CAH women attracted to females increases with their degree of androgen exposure during prenatal life."

However, added Dr. Meyer-Bahlburg, "I would never recommend treatment in order to take lesbianism away if that is someone's predisposition." Noted Meyer-Bahlburg, "Any treatment can be misused. That could happen here. But this is not the focus of the treatment."

The Shape of Things to Come?

Not yet, anyway. The report comes in the wake of a 2007 study that indicates that the biological causes of homosexuality--physiological, hormonal, and genetic--may be one day fall within the power of physicians to manipulate. At that point, the question becomes whether it is morally acceptable to change a human being in order to accommodate social or religious preferences regarding innate characteristics such as sexuality.

The 2007 report, published in Nature Neuroscience, showed that by altering the way fruit flies responded to pheromones, the flies could be induced to change their courtship behavior. Flies that had previously courted the opposite sex began to pursue flies of their own gender--while flies that had only shown a predisposition to pursue those of their own gender began to court flies of the opposite sex.

One of the researchers, the University of Illinois at Chicago's Dr. David Featherstone, called the results "amazing," and said, ""I never thought we'd be able to do that sort of thing, because sexual orientation is supposed to be hard-wired. This fundamentally changes how we think about this behavior."

Featherstone told New York Times science writer John Tierney that similar manipulation of sexuality might one day be possible for human beings. "The question of whether or not homosexuality should be turned on and off is not a scientific question. It is an ethical/societal dilemma," noted Featherstone, adding, "I am glad my work is stimulating the discussion earlier rather than later. History is replete with poorly thought out attempts to 'cure' societal/behavioral 'illnesses' that turned out, with proper perspective, to not be 'illnesses' at all."

In a follow-up article, Featherstone told Tierney, "The response to our research has been fascinating, and highlights the giant gap between what neuroscientists already know and what the public believes." Added the researcher, "The fact is, 'gay genes' have been known to exist for a long time, in flies and other animals, including humans. Genetic links to all sorts of human traits have been identified."

Featherstone went on to cite research that had suggested similar changes in sexual behavior had been demonstrated in mice, telling Tierney, "So the question is not if we will understand the biological basis of homosexuality enough to alter it, but when. And what people will choose to do with the knowledge. If there is a demand, I guarantee some pharmaceutical company will make the stuff.

"Or will the government outlaw treatments for behaviors that are obviously no threat to the individual or society?" asked Featherstone. "Would this imply that the government officially thinks that homosexuality is no one's business but one's own?"

Tierney speculated that, moral and ethical questions of biological engineering aside, a future in which sexuality can be changed through pharmaceutical means might lead to a greater openness regarding sexual mores, rather than more stringent enforcement of social and religious norms, envisioning a time when individuals truly do choose their sexuality--through chemical means, and for lifestyle reasons rather than moral ones. That could well mean that heterosexuals looking to try something different actually opt to "go gay," Tierney suggested, going on to speculate that social conservatives who otherwise object to science manipulating human beings might make an exception and endorse treatments that would "cure" gays.

The social and ethical questions of "curing" or even identifying gays and lesbians in the womb have been explored already in literature. One notable mediation on the issue is Jonathan Tolins' 1993 play Twilight of the Golds, in which a pregnant couple learn that their baby will probably be gay. The mother decides that she wishes to terminate the pregnancy rather than rear a gay child, but her younger brother--who is a gay man--objects strenuously, only to be told by his own parents that had the same technology been available to them, he would have been aborted as a fetus. The play was made into a 1997 TV movie starring Jennifer Beals, Brendan Fraser, Rosie O'Donnell, and Faye Dunaway.