Betsy
01-27-05, 07:24 PM
I pulled this response off a list-serv that physicians frequent and often share case studies. The original poster was discussing an XY boy with micropenis (cause yet to be determined) and inquired of his colleagues about sex reassignment surgery.
None of the responses recommened doing surgery (in fact, their silence on it was revealing) however, one brave doctor from a major children's hospital had this to say:
His testes have clearly produced AMH at some point (no Mullerian structures
seen) and enough androgen effect to cause at least partial virilization
(enough to fuse the scrotum). What is our basis for thinking that he will
not respond to exogenous testosterone with increase in the size of the
phallus? How severe is the hypospadias? Is it severe enough for the surgeon
to believe adequate repair is impossible?
Shouldn't we make sure the structures are really androgen insensitive before
we proceed?
If some surgical repair is possible (maybe after testosterone
administration) then female sex assignment may no longer be an issue?
After reassignment, he will be converted from a (probably) non-functional
male to a non-functional female (certainly infertile, very likely to have
significant sexual dysfunction) who may have a "male brain" (genetically,
chromosomally and at least partially hormonally male till this point). What
if he grows up and wants to be male?
There is an underlying assumption here that if a male doesn't look 100%
male, he is much worse off than a male who has been surgically (crudely)
turned into a female. Is this assumption justified? And couldn't this
decision be taken later in childhood?
Being ambiguously male may be very distressing for him, but how can we be
sure that making him female is not even more distressing? The ambiguity is
the work of God, but the surgical reassignment would be the work of
(potentially liable) humans!
This was refreshing to read...
Betsy
None of the responses recommened doing surgery (in fact, their silence on it was revealing) however, one brave doctor from a major children's hospital had this to say:
His testes have clearly produced AMH at some point (no Mullerian structures
seen) and enough androgen effect to cause at least partial virilization
(enough to fuse the scrotum). What is our basis for thinking that he will
not respond to exogenous testosterone with increase in the size of the
phallus? How severe is the hypospadias? Is it severe enough for the surgeon
to believe adequate repair is impossible?
Shouldn't we make sure the structures are really androgen insensitive before
we proceed?
If some surgical repair is possible (maybe after testosterone
administration) then female sex assignment may no longer be an issue?
After reassignment, he will be converted from a (probably) non-functional
male to a non-functional female (certainly infertile, very likely to have
significant sexual dysfunction) who may have a "male brain" (genetically,
chromosomally and at least partially hormonally male till this point). What
if he grows up and wants to be male?
There is an underlying assumption here that if a male doesn't look 100%
male, he is much worse off than a male who has been surgically (crudely)
turned into a female. Is this assumption justified? And couldn't this
decision be taken later in childhood?
Being ambiguously male may be very distressing for him, but how can we be
sure that making him female is not even more distressing? The ambiguity is
the work of God, but the surgical reassignment would be the work of
(potentially liable) humans!
This was refreshing to read...
Betsy