Hermaphrodism caused by hormonal medication given during pregnancy
During the course of trying to understand the cause of some gender identity issues and hormonal problems that have affected me throughout my adult life, I’ve discovered what appears to be a major unrecognised medical problem potentially affecting several million genetically male people (and probably a somewhat smaller number of genetically female people too): disrupted sexual development in the unborn child caused by doctor-prescribed hormonal medicines. There’s good reason to believe that unborn children are at risk of developing as the opposite sex during the time they are exposed to the medication. Due to the way these medicines are typically prescribed, those affected will nearly always look completely normal at birth, but have a brain that has developed partly as male and partly as female.
There are two complementary processes that I think are taking place: female development in the genetically male (XY) unborn child due to chemical castration; and male development in the genetically female (XX) unborn child due to progestin- or steroid-induced virilization. In the first case, the chemical castration results in abnormally low testosterone levels that cause development to go down the female pathway instead of the male one; in the second, the progestin or steroid medication mimics the action of testosterone sufficiently well to drive development out of the female pathway altogether and into the male one. In either case the result is a person who developed as their genetic sex before and after the time their mother was being given the medication, but as the opposite sex during the time she was receiving the treatment.
Regulatory restrictions in force since the 1970s prohibit the use of these medicines during the first 4 months of the pregnancy, which is when all the developmental events that build a person’s reproductive organs and define their physical sex take place. However, there’s no restriction on the use of these medicines during the later stages of the pregnancy, when the brain is being wired up with its final, permanent structure (the “axonal growth” phase of brain development). Because the use of these medicines is restricted to the later stages of the pregnancy, I think nearly all of those affected will have been born looking no different from anyone else of their genetic sex, but will have a brain where some parts are wired up in the male configuration and other parts are wired up as female.
I’ve been chatting online with a group of “DES sons”, genetically male people who were exposed in the womb to the oldest of these hormonal medicines, a drug called diethylstilboestrol (DES). From about 1940 to 1971, DES was commonly prescribed to expectant mothers thought to be at risk of miscarriage, and under the standard “Smith and Smith” treatment protocol for prevention of miscarriage these women would have been receiving 125 mg per day of the drug during the later stages of the pregnancy. Putting that in context, the dose of DES required to chemically castrate adult men with prostate cancer is 3 mg per day, so the DES sons are a group of people who were almost certainly in a state of full chemical castration for at least part of the pregnancy.
Around a third of the DES sons in the group are pre- or post-operative transsexuals, and a full 50 percent of them self-identify as transsexual or transgendered. This has led me to think that exposure to hormonal medication in the womb must be a major reason why gender dysphoria and transgenderism have become increasingly commonplace in recent years. I think the bulk of those affected won’t be transgendered though, they’ll just be living very unhappy, confused lives, knowing that they are somehow different from other people but having no idea what that difference is or how to deal with it.
Although few if any of the DES sons in the group regard themselves primarily as intersexed, many of them nonetheless seem to have been born with intersex conditions such as cryptorchidism or hypospadias. I’m pretty sure physical intersexing and gender dysphoria are two manifestations of the same underlying phenomenon, i.e. a disruption to the hormonal environment in the womb. Physical intersexing occurs when the disruption occurs during the first trimester, the time when all the developmental events that give rise to the genitals and reproductive organs are taking place. Gender dysphoria and transgenderism occur when the disruption takes place during the second and/or third trimester, when the “axonal growth” phase of brain development is taking place (the brain is being wired up with its permanent structure). DES was pulled from the market in 1971, and a whole raft of restrictions were brought in at around the same time preventing the use of hormonal medication on expectant mothers during the first 4 months of the pregnancy. That has probably largely put a stop to medically induced physical intersexing, but of course has done nothing to prevent people being born with brains that are partially those of the opposite sex.
The potential scale of the problem is huge. These drugs (manmade versions of the sex hormones estrogen, progesterone and testosterone) are in widespread use in medicine, and are routinely being given in eyewateringly high doses to pregnant women for a variety of medical reasons. Based on what I’ve been able to discover about the medical uses and side effects of these medicines, the total number of those affected must surely number well into the millions. Any medicine that mimics the action of estrogen, progesterone or testosterone is definitely suspect; what I don’t know is whether there are other classes of medicines (such as corticosteroids, chemotherapy drugs and immunosuppressants) that might be able to affect sexual development in the unborn child too.
I’d urge anyone reading this with gender identity issues to try to find out whether their mother was given any kind of hormonal medication during the pregnancy, and particularly whether there was a history of miscarriage or premature birth that might have led to some of these drugs being prescribed (or any chance an exposure to hormonal contraception could have occurred during the pregnancy).
In the binary world we live in there’s a very strong compulsion to “adopt” a male or a female gender identity. The difficulty is that anyone affected by this isn’t entirely one sex, but has some things that are male and other things female. Therein lies the problem. In attempting to adopt my chosen male gender I tried to suppress all the female parts of my persona, and that does seem to have had some very damaging consequences. Hopefully through this webpage I can raise awareness of the situation so that others similarly affected are able to avoid making the mistakes I made, and make the most of the unusual situation they’ve been placed in.
Hormones and Gender
A little-known fact is that the testicles of the unborn male child are highly active from about 8 weeks after conception until a few months after birth, not producing sperm but instead producing hormones. The whole process of male development is driven by two hormones produced in the testicles: testosterone and Anti-Mullerian Hormone or AMH. AMH plays an important role in the development of the internal reproductive organs, but it is really testosterone that is the key gender-determining hormone. If there is testosterone present during the time the unborn child is developing in the womb then the end result will be a baby boy, and if there is no testosterone present, the child will be born a girl – irrespective of what their genes might say. Due to the level of ignorance and misinformation that surrounds the topic that isn’t a widely appreciated fact (even among many doctors and scientists), but it is provably the case.
There’s a condition called Complete Androgen Insensitivity Syndrome (CAIS), where a single mutation in the gene encoding the androgen receptor means that the cells throughout that person’s body are completely unable to detect or react to testosterone. The sole difference between people with CAIS and ordinary genetically male people (the ones who are born as boys and grow up into men), is that their bodies couldn’t detect or respond to the testosterone their testicles were producing during the time they were developing in the womb. That single difference is enough to make genetically male people with the condition develop a vagina instead of a penis, to be born as baby girls instead of boys, and to grow up to become highly feminine people who look, feel and behave exactly like women. The universal consensus seems to be that these people are women and not men, which proves that a person’s sex is programmed into them before birth by the action (or absence of action) of testosterone.
There are other medical conditions that confirm that fact (such as Swyers syndrome and “XX male” syndrome), and also experiments carried out on a wide range of different animals. Counterintuitive it may be, but a person’s sex at birth and throughout life is entirely determined by the presence or absence of male hormones during the time they were developing in the womb, not by their genes.
Genetically male people with CAIS (source: Wikipedia)
Development in the unborn child
Development in the unborn child is a highly structured process that occurs as a series of events, each event occurring in a fairly narrow fixed time slot at a particular stage of the pregnancy. Once the time slot for that event has passed, then whatever happened (or didn’t happen) during the event becomes fixed in stone and stays with that person for the remainder of their life. All the key developmental events associated with the genitals and reproductive organs occur during the first trimester of the pregnancy, so a person’s physical gender is irrevocably fixed in place by the end of the first trimester of the pregnancy and cannot later change, even if the hormonal environment was to be completely altered at some later stage of the pregnancy.
The same isn’t true of the brain though. During the first trimester the brain was in a state of rapid growth and continual remodeling, with cells dividing and changing their position as they migrate to their final locations. Because the brain is changing so much during the first trimester, I think the effects on the brain of any hormone exposure early in the pregnancy aren’t likely to endure.
Most brain cells have reached their final location by about week 16 of the pregnancy, and that’s when the next phase of brain development begins. Known technically as axonal and dendritic growth, it’s the process of wiring up the brain’s permanent structure, and it continues at a very active pace for the remainder of the pregnancy and for the first few months after birth. Anything that affects this axonal growth phase of brain development will alter the way the brain is wired up and have lifelong consequences. It’s around week 16, right at the beginning of the axonal growth phase of brain development, that I think my hormonal exposure and period of chemical castration began.
There’s a general rule of thumb that development in the unborn child follows a kind of evolutionary progression, starting with the most evolutionarily ancient and ending with the most evolutionarily recent. If that rule holds true for the brain (and I see no reason why it shouldn’t), then the more primitive parts of the brain should get wired up first, while work on the most complex, evolutionarily advanced part (the cerebrum) probably doesn’t start in earnest until the more primitive bits are largely complete. That is what my own experiences suggest anyway. All the more primitive parts of my brain seem to have been wired up in the female configuration instead of the male one.
The colours are wrong, but here’s what I think my brain looks like inside:
The brick-coloured part of the brain in the above illustration is the cerebrum, the most evolutionarily advanced part of the brain, the part where consciousness is generated. Mine seems to be almost all male. The lighter-coloured parts (inside and underneath the cerebrum) are “everything else”, all the more primitive parts of the brain. Mine are, I think, pretty much entirely female. The things I’ve identified in myself as being female are: body language, arousal, orgasm, instinctive social and sexual behaviour, and hormone control. The things that are male are my conscious identity and self image, sexual orientation, and things such as ability in maths and sciences.
Because the female part of the brain includes the hypothalamus and pituitary (the parts that control hormones), throughout my life my brain has attempted to regulate my hormone levels and growth as if I were a woman. I like to think that’s how I’ve ended up with a body structure that bears quite a lot of resemblance to that of a woman, even though it is actually a fully male body. As far as I can tell it is actually just the more primitive parts of my brain that are female, everything else seems to have developed as male.
Female development induced by chemical castration
I’m convinced my condition is the result of a period of chemical castration partway through the second trimester of the pregnancy. By temporarily interrupting testosterone production for a limited period of time during an otherwise normal pregnancy, chemical castration could selectively cause a few specific things to develop as fully female while everything else develops as fully male, which is what appears to have happened in my case. None of the conventional intersexing scenarios I looked at can do that, they all tend to result in development that is intermediate between male and female throughout the pregnancy.
The thing that first drew my attention to chemical castration as a possible cause of my condition was a passage in the book “Brain Sex”. It mentioned a characteristic set of behavioural traits often seen in adolescent boys who were exposed in the womb to a drug called DES. The teenagers in the study who’d been exposed to it before birth were described as: shy, unassertive, having low self esteem, no sporting or physical prowess, regarded as sissies by other boys, and being unable to fight back. Although I was quickly able to rule out DES itself as the cause of my condition, the parallels with my own teenage years were so strong that I immediately began to think about the possibility that I too had been exposed to some sort of chemical agent in the womb.
All the research looking at the harm DES does to the unborn child seems to have focused on its estrogenic properties, but I discovered that it’s also a powerful chemical castration agent. Women on the standard “Smith and Smith” treatment protocol to prevent miscarriages were receiving 125 mg per day of DES during the later stages of the pregnancy, over 40 times the dose required to chemically castrate an adult man!
The more I thought about what effect chemical castration would have on the gender development of an unborn male child, the likelier it looked as an explanation for my condition. Before the chemical castration began, development would be proceeding no differently then in any other pregnancy of a male child. After it ended (assuming the testicles hadn’t been irreversibly damaged), male hormone production would resume and development would revert to going down the male pathway as before. There would just be that period of time while the chemical castration was in effect where testosterone wasn’t being produced, during which any development taking place would go down the female pathway instead of the male one. The result at the end of the 9 months would be a baby who had developed partly as male and partly as female. Exactly which bits were what would depend on the timing and duration of the period of chemical castration.
My reproductive organs are fully male, which means that normal levels of male hormones must have been present throughout the early stages of the pregnancy. My conscious self-identity and higher brain functions score as strongly male, so there must have been normal levels of male hormones present towards the end of the pregnancy too. There are just a few specific things (all associated with the more primitive parts of the brain) that are female. Based on what I’ve read about development in the unborn child, the period of chemical castration seems to have begun around week 16 or 17 of the pregnancy, when the process of building the structure of the physical reproductive organs is drawing to a close and the very first elements of the brain’s permanent structure are just starting to get laid down. It seems to have remained in effect throughout the time the more primitive parts of my brain were developing, but the hormonal environment must have returned to normal very soon after the cerebrum started to develop its final structure.
Unfortunately I’ll probably never know for sure exactly what happened. My mother passed away a couple of years ago, and my dad doesn’t know of anything unusual that might explain it. It was probably an overdose of contraceptive pills though. My mum suffered from depression a lot when I was younger, and I have established that she had the means to hand while she was pregnant with me. There was also something that happened later in my childhood that makes me think she must have been hiding a guilty secret along those lines. Although the actual contraceptive hormones themselves would have cleared from her body and mine within a matter of days, recovery from chemical castration typically takes several weeks (in adult men at least). That would probably be enough time to account for what’s happened to me; I haven’t been able to find any other explanation remotely as plausible anyway.
Physical consequences of having a mixed-gender brain
Although my reproductive organs both internally and externally are fully male, there do nonetheless appear to have been consequences for my body structure and physical appearance. This seems to be because the parts of my brain that control hormones (the hypothalamus and pituitary gland) are female, and have attempted to regulate my hormones as if I were a woman. The result is that I’ve had unusually low testosterone levels throughout my life (and I suspect other hormones involved with growth have been similarly downregulated too). That has caused my limbs, hands, feet, and facial features, to all adopt a quite feminine appearance. Two important measures of masculinity vs femininity are the leg to trunk ratio and the digit ratio.
A Female leg to trunk ratio
These body shape drawings represent a leg to trunk ratio of 1.0, 1.1, 1.2 and 1.3 respectively.* The ideal ratio for a man is 1.0, i.e. the leg length and upper body height are about the same. As you can see, my ratio is around 1.3, which is close to the ideal ratio for a woman.
* Body Image 3 (2006) 317–323, Swami et al., The leg-to-body ratio as a human aesthetic criterion
Clothing tends to break up the outline of the body, making it quite difficult to judge the ratio. Here’s another picture that perhaps better illustrates just how long my legs are in relation to my trunk:
A Female digit ratio
I’ve also got a female digit ratio. My index finger on each hand is as long as or slightly longer than the ring finger:
It should be the other way around for a man; the ring finger should be longer than the index finger. Digit ratio is generally thought to be most strongly influenced by testosterone levels early in life.
Both my leg to trunk ratio and my digit ratio seem to be more feminine than those of a lot of women, and I suspect well outside the range of what’s normal for a man. My flatbed scanner hasn’t presented them in a very good light, but I think the shape of my hands (and feet) is quite feminine too; certainly their shape is a lot different from those of my brother.
My armspan is 4cm greater than my height, which combined with my leg to trunk ratio, sparse body hair and inability to build upper body muscle, probably does meet the medical criteria for clinical eunuchoidism. It shows that my testosterone levels must have been well below normal during adolescence and throughout my adult life, which I think is the result of a female hypothalamus and pituitary trying to make sense of “ovaries” that are churning out testosterone instead of estradiol. I like to think that the female part of my brain has actually done it in a purposeful kind of way. Quite a few people seemed to find the end result quite aesthetically pleasing when I was younger anyway!
Although I’ve been unable to locate any research looking into the effects of chemical castration during prenatal development, I did find some studies in which parts of the brains of female sheep (i.e. ewes) were masculinised by administering testosterone to the mother during pregnancy. In “Prenatal Programming of Reproductive Neuroendocrine Function”, (Endocrinology 144:1426–1434, 2003), the researchers created a generation of experimental ewes with a male hypothalamus and pituitary. Due to the complexity of what goes on with female hormones to make the eggs ripen and get released, the researchers were expecting their ewes to be completely infertile. As it turned out, most of their experimental sheep were actually fertile for their first breeding season, but all suffered premature reproductive failure in the second breeding season. I think what happened to me before birth is basically the opposite sex version of what was done to those sheep. My own “premature reproductive failure” occurred shortly after my 43rd birthday, and is why I’m now having treatment for hypogonadism.
Psychological consequences of having a mixed-gender brain
Far more important than having a somewhat unmanly appearance are the psychological issues which seem to stem from having a brain built from a mixture of male and female tissue. For me at least, the problems during my adolescence went well beyond the gender identity issues you might expect, and I suspect that if similar things happen to others then quite a high percentage of people who’ve had a period of opposite gender development during the pregnancy will have been wrongly diagnosed with mental illnesses such as depression, ADHD or Asperger’s syndrome. Part of the problem for me was that I was bullied quite a lot as a teenager due to my lack of manliness and reluctance to fight back, but there was definitely more to it than that. I think that having a brain containing both male and female tissue makes it highly likely that a situation of internal conflict will arise, and when it’s carried on over years, that conflict eventually causes neurological changes that are effectively a type of self-induced brain damage. Looking back over my life, that’s what I think happened anyway. The parts of me that were male wanted to do things one way, while the parts that were female wanted to do things completely differently. The differences between the two weren’t so large to start with, so I was able to function as a fully integrated person throughout my childhood. It’s around the time I hit puberty that the problems began. Presumably the rush of pubertal hormones caused the differences between male me and female me to grow to the point where they could no longer work together, and my entire persona seemed to split into two fairly evenly matched warring factions. I spent my teens and twenties a completely divided person. I managed to hide what was going on and hold things together just well enough to avoid being locked up somewhere, but it was a crazy, nightmarish, highly self-destructive time. I was my own worst enemy, and pretty much anything I tried to do would end up being sabotaged by one side or the other.
In my early thirties I somehow found a way of burying the lot and basically reinventing myself, and since then I’ve led a relatively unremarkable life testing computer software. Part of that process of reinvention definitely involved watching and imitating people, and when I was first trying to understand how all this has affected me I thought there must have been bits of my brain controlling behaviour that had just never formed. I now think the “missing” things are actually there, it’s just that they belong to the female parts of my brain which I was actively trying to suppress. The big change that took place in my 30s seems to have been that the male part of my persona decisively gained the upper hand over the female part, and been progressively crushing her out of existence ever since. That did allow me to function a lot more like an ordinary man, although I can see now that it came at a very high cost in terms of happiness and overall quality of life. I suspect it’s caused actual neurological damage too. I’m pretty sure that having a brain built from a mixture of male and female tissue isn’t harmful in itself; it’s the act of trying to suppress things that don’t conform to your chosen gender that causes the damage. The way to prevent that from happening is, don’t choose a gender! Just accept that you’re partly a man and partly a woman, and let the man bits be manly and the woman bits be womanly.
For about a year now that’s the theory I’ve been trying to put into practise anyway, by doing the exact reverse of everything I’d been doing previously, and actively encouraging all the female parts of my persona rather than trying to suppress them. I’ve also been teaching myself to dance (since the combination of performing complex movement linked with sound seemed like a good way of getting lots of different parts of my brain to work together). Basically what I’ve been trying to do is get the male and female parts of my brain “talking” to each other and working together as a team instead of fighting each other. Since doing that my coordination has definitely improved, but the interesting thing is that my ability to express myself and use language seem to have noticeably improved too. I’ve made quite a few changes in my life recently so this transformation probably isn’t entirely due to one thing, but it does make me wonder whether, in trying to suppress the female parts of my persona, I’d inadvertently been creating barriers that were impeding the free movement of messages between the male and female parts of my brain. Complex movement and the use of language are both functions that involve a lot of widely distributed brain regions working together, so if something were to impede the free movement of messages around the brain, those two functions are where it would be likely to show up. At the very least, I’ve felt a lot happier and more at peace with myself since giving my female side free rein, so for anyone else similarly affected it’s something I’d recommend trying!
I get the impression from some of the things people have said in the DES discussion group that other DES sons have undergone experiences not dissimilar to my own, although there is only one other group member who has talked openly about having a separate male and female subidentity. It seems like quite a few have been diagnosed with ADHD though, and looking at the writing style of some of the group members I get a strong impression that quite a few have the same issues I’ve experienced with jumbled thought processes that get endlessly sidetracked, and difficulty in clearly expressing those thoughts to other people. Not all the group members are affected, and I get the impression that the most lucid ones with the greatest clarity of self-expression are also the ones who are the most completely female. It may be that they have so little male in their brains that no issues of conflict arise.
Why doesn’t anyone know about this?
I’ve been trying to understand how the fact that such disastrous consequences can occur for the unborn child when hormonal medication is given to the mother has remained a secret for more than 50 years. It has been going on for at least that long, starting with the artificial estrogenic compound DES. Until 1971, during the later stages of the pregnancy doctors were routinely giving women thought to be at risk of miscarriage 40 times the dose of DES required to chemically castrate an adult man. The official line is that it had no effect on their unborn sons, which does seem rather unlikely. If you actually talk to some of the people affected it is blatantly obvious that something has gone terribly wrong for them. Around a third of the members of the DES sons group I’ve joined are transgendered, quite a few have been born with partially feminised reproductive organs, and all seem to have experienced psychological consequences of one kind or another. The numerous harmful effects of DES exposure in the womb on women are common knowledge, but somehow the profound feminising effects and psychological effects it has on men have been completely airbrushed out of existence as far as the public at large are concerned. The question I’ve been asking is how a disaster of such magnitude could have gone unnoticed for so long.
I think prejudice against effeminacy in men, the mentally ill and particularly those with intersex conditions has a lot to do with it. Not, I hasten to add, because I think anyone affected by exposure to hormonal medication before birth is mentally ill, but because it does seem to be able to produce a combination of odd, effeminate behaviour and difficulty expressing ones self coherently that could very easily be misdiagnosed as mental illness. At the very least it leads to the person not being taken seriously, either by doctors and other professionals or even by own their friends and family. That’s been my experience anyway, and I get the impression that quite a few of the DES sons in the group I’ve joined have had similar experiences.
There are other things too, such as a long latent period that tends to obscure the link between the medication that was given to the mother during pregnancy and behavioural problems that generally don’t emerge until adolescence. My own childhood was relatively unremarkable and the odd behaviour only started to come out as I approached puberty. I suspect that will turn out to be quite a common thing, because although it’s laid down before birth, the neural circuitry that drives adult behaviour remains largely dormant throughout childhood and only becomes active once puberty is reached. Certainly the gender differences between boys and girls are a lot smaller than those between men and women, so it makes sense that if someone has a brain built from a mixture of male and female tissue, the two tissue types will be pulling in different directions a lot less strongly during childhood.
I suspect political correctness and Dr Money’s now discredited “gender neutrality” theory could have had something to do with it too, by making the study of sex differences in the human brain and how they arise into a bit of a no go area for several decades. The whole topic does seem to be woefully under-researched, with far more strongly held opinions flying around than there are hard facts on the ground. On top of that, nearly all the research into artificial female hormones and their effects on the endocrine system seems to have been done on women. Not a lot is known about what these drugs do to adult men, let alone an unborn male child!
The worst thing about this condition, for me at least, is that, although I’ve always known something was wrong, I had no idea what the problem was or how to deal with it. If I’d only known 20 years ago what I know now, my life would have turned out very differently and I think, much more enjoyably too. Hopefully by raising awareness of the problem I can help others similarly affected make better use of the unusual situation they’ve been placed in.