Pregnant women are being offered an experimental medication which reduces the risk of "ambiguous genitalia" in unborn children, drawing criticism from bioethicists.
Dr Alice Dreger and colleagues of Northwestern University in Chicago have slammed the controversial practice of giving the steroid dexamethasone (dex) to pregnant women concerned their daughter may have congenital adrenal hyperplasia (CAH).
CAH is an inherited condition that affects the adrenal glands. High exposure to androgens (masculinising hormones) in the womb can cause girls to develop symptoms such as ambiguous genitalia, facial hair and a deep voice.
In an essay published on the Bioethics Forum website, Dr Dreger and her colleagues argued "off-label" prenatal use of the steroid should be used in controlled clinical trials only.
She also took aim at Dr Maria New, paediatric endocrinologist of Mount Sinai Medical Centre in New York, and her colleague, Columbia University psychologist Dr Heino Meyer-Bahlburg, who suggest administering dexamethasone to pregnant women may prevent some of the symptoms of CAH — including homosexuality.
"This may apply also to sexual orientation in at least a subgroup of women is suggested by the fact that earlier research has repeatedly shown that about one-third of homosexual women have (modestly) increased levels of androgens," Dr New wrote in the Archives of Sexual Behavior in 2008.
"The findings support a sexual-differentiation perspective involving prenatal androgens on the development of sexual orientation."
In an article published in the Journal of Endocrinology & Metabolism in 1999, Dr Meyer-Bahlburg suggested CAH women have less interest in getting married or performing traditional "child-care/housewife" roles.
"Long-term follow-up studies of the behavioural outcome will show whether dexamethasone treatment also prevents the effects of prenatal androgens on brain and behaviour," he wrote.
Dr Dreger and her colleagues conclude their essay arguing against the use of drugs to determine sexuality.
"Needless to say, we do not think it reasonable or just to use medicine to try to prevent homosexual and bisexual orientations," they wrote.
"Nor do we think it reasonable to use medicine to prevent uppity women, like the sort who might raise just these kinds of alarms. Consider that our declaration of our conflict of interest."
Dexamethasone is not approved by the FDA for prenatal use and it doesn't cure congenital adrenal hyperplasia but rather reduces the effects. Only one long-term study on the safety of prenatal dex has been conducted, which was too small to be definitive, while animal studies have shown the steroid can cause birth defects.
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