Medicine: Mixed Sex

Such words as “hermaphroditism” and “pseudohermaphroditism” have been mostly textbook talk in the U.S. until last week, when newspapers and radio brought them into shop and household (see PRESS). If most of the pseudoscientific chatter at the luncheon table made little medical sense, doctors themselves were largely to blame, because they have used some of the key words in different and confusing ways.

Hermaphroditism. After about five weeks of life in the womb, the human fetus develops a sex gland (gonad) which at first cannot be identified as male or female. Within a week or two, in normal growth, it becomes recognizable as either the female kind that will develop into ovaries, or the male kind that will become testicles. Sometimes, nature gets its wires crossed and the luckless infant develops one ovary and one testicle, or an intermediate type of “ovotestis.” and some of the genital organs of both sexes. This is true hermaphroditism,* though Pediatrician Lawson Wilkins of Johns Hopkins, a top authority on the subject, prefers the term “intersexuality.”

On the rare occasions when such cases come to the operating table, their doctors must decide whether there is a physical leaning toward one sex or the other. They must also consider whether the patient has been reared as a boy or a girl. Then the surgeons leave as nearly perfect a male or female as they can. Less extreme cases, which show only a few features of the opposite sex, are proportionately easier to treat.

Pseudohermaphroditism. This clumsy term covers a wide variety of cases. Pediatrician Wilkins argues that one type, at least, should be classed as intersexuality. This covers cases in which the embryonic gonad definitely takes the form of one sex, but other sex organs resemble those of the opposite sex because of a mix-up in the genes and chromosomes. Surgery to correct the “accessory organs” is the only answer.

Such a case is likely to be a male whose masculine glands and organs are so malformed as to be mistaken for female. When this condition is discovered (often as late as puberty, though it should be earlier), the biggest problem is psychological. Such a child will have been reared as a girl, and the emotional switchover to boyhood or manhood is so difficult that some patients refuse the hurdle; then the doctors make them more womanly.

Probably commoner, says Dr. Wilkins, are cases in which disease of the adrenal glands causes an excess output of the male hormones. If the trouble starts in a baby girl still in the womb, it brings on outward physical changes and makes her look like a boy. In a few years she will have a deep voice and may start to grow a beard. If the trouble comes later in childhood (perhaps as the result of an adrenal tumor), most of the changes will be superficial—flat chest, narrow hips, deep voice and hirsutism. In a boy, the effect is to produce excessive virility, commonly shown in sexual precocity and premature growth of body hair.

In either sex, undetected adrenal tumors usually kill the victim. The best remedy is surgery to remove the tumor. This restores the normal balance for the patient’s sex. For overactive adrenals with no tumor, small doses of cortisone now do the trick.

Homosexuality. Because of emotional disturbances, usually in childhood, physiologically normal males may develop the social attitudes of females, and vice versa. Homosexuality is not inherited and has little (usually nothing) to do with hormone balance. But many homosexuals refuse to admit this, and they reject the psychiatric treatment which offers them some chance of a normal social life. Many of them wear the clothes of the opposite sex, and pester endocrinologists for hormone injections to make them more, not less abnormal.

A few homosexual men have tried to persuade U.S. surgeons to operate on them to change them into pseudowomen. Most surgeons will have nothing to do with what they consider a crime against nature and the laws of the 48 states.

*From the Greek myth of Hermaphroditus, son of Hermes and Aphrodite, who was joined to a nymph while bathing.