When virilisation is noted at birth, great care must be taken to determine genetic sex by karyotyping: parents should be reassured as to the baby’s sex (never ‘in between’). Blood levels of adrenal hormones are measured to obtain a precise diagnosis. Traditionally, doctors have advised parents to ‘choose’ their child’s gender on the basis of discussing the likely condition of the genitalia after puberty. Thus, where the phallus is likely to be inadequate as a male organ, it may be preferred to rear the child as female. Surgery is usually advised in the ?rst two years to deal with clitoromegaly but parent/ patient pressure groups, especially in the US, have declared it wrong to consider surgery until the children are competent to make their own decision.
Other treatment requires replacement of the missing hormones which, if started early, may lead to normal sexual development. There is still controversy surrounding the ethics of gender reassignment.
See www.baps.org.uk... adrenogenital syndrome
Anabolic steroids have been used to stimulate protein anabolism in debilitating illness, and to promote growth in children with pituitary dwar?sm and other disorders associated with interference of growth. Stimulation of protein anabolism may also be of value in acute renal failure, and the retention of nitrogen and calcium is of probable bene?t to patients with OSTEOPOROSIS and to patients receiving corticosteroid therapy. Anabolic steroids may stimulate bone-marrow function in hypoplastic ANAEMIA.
They have been widely abused by athletes and body-builders aiming to improve their strength, stamina, speed or body size. However, there are considerable doubts over their e?cacy, with little experimental evidence that they work. Dangerous adverse effects include precocious myocardial infarction (see HEART, DISEASES OF – Coronary thrombosis), DIABETES MELLITUS, liver disease, precocious carcinoma of the prostate, acne, and severe psychiatric disorders. Anabolic steroids should not be used by athletes, who face bans from o?cial competitions if they take them.
The anabolic steroids in therapeutic use include nandrolone and stanozolol.... anabolic steroids
The other dangers of administering drugs in pregnancy are the teratogenic effects (see TERATOGENESIS). It is understandable that a drug may interfere with a mechanism essential for growth and result in arrested or distorted development of the fetus and yet cause no disturbance in the adult, in whom these di?erentiation and organisation processes have ceased to be relevant. Thus the e?ect of a drug upon a fetus may di?er qualitatively as well as quantitatively from its e?ect on the mother. The susceptibility of the embryo will depend on the stage of development it has reached when the drug is given. The stage of early di?erentiation – that is, from the beginning of the third week to the end of the tenth week of pregnancy – is the time of greatest susceptibility. After this time the risk of congenital malformation from drug treatment is less, although the death of the fetus can occur at any time.... drugs in pregnancy
Intersexuality inevitably leads to considerable psychological disturbance as the child grows up. It is therefore important to reach an early decision as to the child’s sex – or at least, the sex that he or she is to be brought up as. Surgical or hormonal means should then be employed, when appropriate, to develop the attributes of that sex and diminish those of the other, together with psychological counselling.... intersexuality
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