Study Questions 'Sex Reassignment'

By Seth Hettena
Associated Press Writer
Saturday, May 13, 2000; 1:02 a.m. EDT

BALTIMORE -- The practice of surgically "reassigning" boys born without penises is being called into question by a new study that suggests gender identity is determined in the womb.

Researchers at the Johns Hopkins Hospital on Friday said the study found that such boys, raised as girls, had masculine behavior and most declared themselves to be boys.

In what is believed to be the first study of its kind, researchers tracked the development of 27 children born without a penis, a rare defect known as a cloacal exstrophy. The infants were otherwise male with normal testicles, male genes and hormones.

Twenty-five of the children were sex reassigned, meaning doctors castrated them at birth and their parents raised them as girls.

But over the years, all of the children, currently aged 5-16, exhibited the rough-and-tumble play of boys. Fourteen declared themselves to be boys, in one case as early as age 5, said Dr. William G. Reiner, a child and adolescent psychiatrist and urologist at the Hopkins Children's Center.

"These studies indicate that with time and age, children may well know what their gender is, regardless of any and all information and child-rearing to the contrary," he said. "They seem to be quite capable of telling us who they are."

The two children who were not reassigned and were raised as boys fit in well with their normal male peers and were better adjusted psychologically than the reassigned children, Reiner said.

He called for a thorough review of the practice of sex reassignment of children.

The study was presented Friday at the Lawson Wilkins Pediatric Endocrine Society Meeting in Boston.
The results contradicted a Canadian study published in the journal Pediatrics in 1998 that suggested gender identity develops after birth. In that study, researchers found that a boy who was raised as a girl after his penis was mutilated during circumcision continued to live as a woman.

"This has very profound implications for the development of gender identity," said Michael Bailey, an associate professor of psychology at Northwestern University who studies gender identity and sexual orientation. "This suggests that hormones' effect on the brain has a major impact on gender identity."

Dr. Marianne J. Legato, a Columbia University professor of clinical medicine who studies the differences between men and women, said sexual differentiation occurs in the first trimester of pregnancy.

"When the brain has been masculinized by exposure to testosterone, it is kind of useless to say to this individual, 'You're a girl,'" she said. "It is this impact of testosterone that gives males the feelings that they are men."

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