Cutting back on coffee…

October 25, 2007 § 4 Comments

Yesterday I had the shakes all day long from coffee overload (couldn’t even write in Calc class!), so today That’s it. Even if it kills me.

Work at the PCBE was wunderbar: gollee I think I do more work in a day now working for Sam than I did in four weeks in the summer! Most of my time is spent studying diseases and screening technology. My teachers keep wondering why strange disorders like “severe combined immunodeficiency“, “congenital adrenal hyperplasia“, and “carnitine: acylcarnitine translocase deficiency” keep showing up in my papers. Interestingly, I did base my entire first Descartes paper this semester on SCID. And, believe it or not, I convinced my medieval theology teacher to let me write my term paper about nano.

I came across this article by Dr. Paul McHugh (of Johns Hopkins U) a while back, but was re-reading it yesterday. He brings up some very interesting issues relating to congenital adrenal hyperplasia:

Several conditions, fortunately rare, can lead to the misconstruction of the genito-urinary tract during embryonic life. When such a condition occurs in a male, the easiest form of plastic surgery by far, with a view to correcting the abnormality and gaining a cosmetically satisfactory appearance, is to remove all the male parts, including the testes, and to construct from the tissues available a labial and vaginal configuration. This action provides these malformed babies with female-looking genital anatomy regardless of their genetic sex. Given the claim that the sexual identity of the child would easily follow the genital appearance if backed up by familial and cultural support, the pediatric surgeons took to constructing female-like genitalia for both females with an XX chromosome constitution and males with an XY so as to make them all look like little girls, and they were to be raised as girls by their parents.

Sooo…what’s the way to go on this one? How should families raise their children? Male or female? Under the circumstances (and I think that it would be hard to make this decision *for* a parent of a child with CAH), I think it is best to reinforce the original sexual identity of the child. The problem with CAH is that the girls are often born indistinguishable from males, and the earlier they undergo surgery the better for their reproductive prospects later in life. These unfortunate girls should be raised as females alongside consistent hormone treatment and psychological counseling. Evidence seems to show that raising them as men leads to ambiguous sexual identity and confusion especially at puberty. One has only to look at a few forums frequented by those affected by the disorder to see the turmoil of their daily lives.

Ah well. That is enough thinking for one morning. If you would like to read the rest of the article, you can find it here at First Things.

As a side note, I was fortunate enough to meet Dr. McHugh personally in the summer, and found him to be personable, gentle, humble and sincere. Even knowing nothing about him (I was ignorant of his impressive work at the time), I knew him to be (excuse the Woody Allen quote) “a truly remarkable human being, a credit to his race”.

§ 4 Responses to Cutting back on coffee…

  • Father Joe says:

    Goodness me, the things that you talk about!

    I read the article by Dr. McHugh several years ago in my “hard-copy” of FIRST THINGS. (I keep the issues in a box. Do you want them?) If I recall correctly, it was a follow-up to a book by a young man who had been surgically altered and raised as a female. He was on 60-Minutes (CBS) one night as well and his story had caused a sensation. The debate was this: Are we male or female by our genetics or because of social upbringing. It had become increasingly evident that the brain maintained the initial sense of sexual identity despite physical alterations and social conditioning.

    Urinary defects must be urgently resolved and I suppose corrective surgery of some sort is also preferable to the emergence of she-males possessing both male and female genitalia. However, I would contend that it is crucially important to follow the DNA markers, no matter how much easier it is to fashion females than males. Despite the female-stage of genetic development, the Church does not regard sexual identity as an accidental element. It touches the core of a person: what and who are we? Society increasingly regards sexuality as interchangeable. The Church contends that men and women complement each other but they are not the same and that this difference is a mystery that will be preserved and, if need be, corrected and restored, with the resurrection of the dead.

    This is not a new topic. It was much discussed in the 1960’s and 1970’s. I recall reading a book a few years ago by a person who had been altered in infancy to resemble a female (because the surgeon had initially slipped during the circumcision and took too much off). Despite the hormone injections, surgery, and upbringing as a female, the poor fellow felt like an alien in his own skin. He only discovered as an adult what the doctors and his parents had done to him. Although the male genitalia had been permanently destroyed, he opted for hormonal treatments to restore an outwardly male appearance.

    The presence of female reproductive organs, either partial, reconstructed, or in whole (preserved from a fetal state) does not mean, in itself, that the individual is truly female. If the genetic make-up is XY, then the Church would probably recognize such persons as males with female genitalia. As such, they would not be eligible for membership in religious orders for women. Even more problematical would be attempts by such feminized-men to seek marriage. The Church’s prohibition against homosexuality would apply, just as it does to adult men who have undergone so-called sex-change operations. Unfortunately, given that they are truly men, the absence of male genitalia would also exclude marriage to females because of the lack of potency in regard to the marital act.

    Similarly, no XX-female who is reconstructed to resemble a male would be eligible for the priesthood. This will become much more an issue when techniques for genitalia transplants are perfected.

    Even in days of old, most castrated men were not deemed eligible for holy orders. I knew a poor man, now deceased, from a previous parish, who was XXY. Such individuals have large bulky bodies and disproportionately large male genitalia. They are also sterile. If his condition was made known, he could also neither get married nor receive holy orders in the Church. My presumption is that he was a defective male because of the lonely presence of a Y-chromosome.

    It is all rather nightmarish!

  • Genna says:

    You say that “The Church contends that men and women complement each other but they are not the same and that this difference is a mystery that will be preserved and, if need be, corrected and restored, with the resurrection of the dead.” I did not know that the Church had come out with any official teaching regarding this problem. But I still feel that genetic disorder is a special case…if you read the lit about CAH, you see that a huge increase in male hormones causes (obvious) problems for the females. Would the Church recommend that the females not get hormone therapy or reconstructive surgery to make them females? This cannot be the case!

  • Father Joe says:


    You write: “But I still feel that genetic disorder is a special case…if you read the lit about CAH, you see that a huge increase in male hormones causes (obvious) problems for the females. Would the Church recommend that the females not get hormone therapy or reconstructive surgery to make them females? This cannot be the case!”

    How did you get that out of what I wrote? I think we are arguing at cross-purposes. Where is our disagreement? You, yourself, said you would “reinforce the original sexual identity of the child”. I would insist upon it. My qualm was with the quote which seems to imply that it is preferable (because it is easier) to remove the male genitalia of XY boy babies and restructure them as females. If they are truly boys then the destruction of the male genitalia would fail the test in regard to the Church’s prohibition against mutilation. If the babies are truly female then they should get hormonal treatment and the male genitalia should be removed, particularly given that the female genitalia are also present. It is not true mutilation because these organs do not belong there.


    When it comes to Church teachings there are some things spelled out and other matters that become clear when we read between the lines. Further, the reason why I introduced sacramental matters into the discussion is because Catholic teachings do not stand alone but as an interlaced structure. We can deduce things regarding new questions by looking at parallel concerns in other doctrinal areas. The Church has placed a tremendous gravity upon the specificity of human identity and the significance of the incarnation and how it points to human restoration in a glorified state. While Jesus says that the just in the life to come will neither marry nor be given in marriage; it is generally accepted that the male and female element of human identity will be preserved. Thus, all priests are male so as to function in the likeness and unity of Christ the heavenly bridegroom of the Church. Similarly, Mary remains both virgin and mother in heaven.

    The Church has consoled the sick and the suffering with the message that Jesus will bring them healing and everlasting life. If they have limbs missing or if they were made into eunuchs, we can be confident that God will restore that which properly belonged and which was taken away from them. If through some genetic accident or through the machinations of men, people suffered gender confusion (psychologically and/or biologically), then we can trust that God will make us brand new as he intends us to be for all eternity. Obviously, this means that if a man was configured to resemble a woman, God will set things right. However, it would be best had this never happened. After death, we will not remain ghosts forever. God has promised that we will be restored, body and soul.


    During this life it is important that we try to discern, not what might be the less problematic gender configuration of a child with impairment, but what was God’s intention as Creator when he fashioned the person. Did God intend the person to be male or female? It would seem to me that DNA and chromosomes are a much more basic place to start in this deduction, and that it will have a lot more to say about the gender markers in the brain. As a Christian, I would also think that it would say something about how the soul will inform the person materially or bodily.

    Let us say that an adult male has testicular cancer. He is told by his doctor that the testicles will have to be removed. Depending upon the spread of the disease, he might even have to have the rest of his external genitalia removed. It is the height of chauvinism to contend that such a person is no longer a true male. He is a man— that is who and what he is— not because of personal choice or the preference of parents and the intrusion of a doctor, but because that is how God made him. When we say that all human beings go through a female stage of fetal development, this does not mean that the particularized human being is a true female any more than the vestigial penis makes a woman a male.


    Following the link you give, I would concur with this statement:

    “The goal of treatment is to return hormone levels to normal. This is done by taking a form of cortisol (dexamethasone, fludrocortisone, or hydrocortisone) every day. Additional doses of medicine are needed during times of stress, such as severe illness or surgery.

    “The gender of a baby with ambiguous genitalia is determined by examination of the chromosomes (karyotyping). Reconstructive surgery for girls with masculine external genitalia is usually performed between the ages of 1 and 3 months to correct the abnormal appearance.

    “Parents of children with congenital adrenal hyperplasia should be aware of the side effects of steroid therapy. They should report signs of infection and stress to their health care provider because increases in medication may be required. In addition, steroid medications cannot be stopped suddenly, or adrenal insufficiency will result.”

    This course of action seems most prudent. Where is our debate?


    The situation might be quite rare, but I have known two similar instances and they were both XX female. One became a world-class skater but gave it up when officials gave her a hard time about her strength and hormonal levels. Today, she is an attractive 30-ish woman, married, and practices law in DC. The other young woman was a more severe case. She developed significant male accidentals. She tried to kill herself and I had to offer her regular counseling in the psychiatric wing of a hospital. What made things worse was that her sister was a beautiful blond with all the right curves. Things were further complicated given that her mother was rabidly pro-abortion and used to speak about her as “the mistake”. She was a sweet girl with a body shaped like that of a boy. Her health problems seemed endless. I reaffirmed her self-worth and told her that she was beautiful…which I still believe. I urged her not to judge herself by society’s fickle take on things or by comparison with others. She was a wonderful and caring young woman who was more sensitive about the needs of others than her sister or mother ever displayed.

  • Genna says:

    I suppose I should have been more clear in my purpose in posting the quote from Dr. McHugh. His article does not specifically mention the problems involved in CAH, but rather seems to discuss sex-change from male to female when the child is born male but is altered surgically and raised as a girl. This, I agree, is not right.

    My point was that the surgery and treatments involved in CAH, while also involving surgical alteration and hormone treatments, are not wrong because there is a disorder present. The baby should be female but looks for all purposes, male. In this case, as you seem to agree, there is nothing wrong with surgery and treatment to proper sex.

    So…I guess I didn’t clearly state what I was trying to say at the first, and consequently didn’t understand your answer to what I said.

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