Just watched an old episode of House M.D. entitled "Skin Deep" last night, and it was about a bizarre condition that totally blows common sense out of the water.The patient, Alex, is a uber hot teenage supermodel babe, the physical epitome of feminine beauty. She was suffering from a number of weird symptoms, such as double vision, sudden aggression, short-term memory loss and muscle spasms.
After a few wrong turns, Dr. House makes an astonishing diagnosis.
The young lady has cancer - in her left testicle.
WTF??!?
It turns out that Alex has complete androgen insensitivity syndrome or CAIS (inaccurately called "male pseudohermaphroditism" in the show) - an uncommon (but by no means rare) condition that has an incidence of approximately 1 in 20,000 live births.
This means that genetically speaking, she has XY sex chromosomes - like a man.
Unlike ordinary men though, mutations in the androgen receptor gene in her genome (in the X-chromosome) has caused all the cells in her body to be insensitive to the male hormone testosterone. Thus, during embryonic development, male primary sexual characteristics do not develop. A penis does not form and the testes remain in the abdomen instead of descending into the scrotum.
However, the testes are still producing Mullerian inhibiting hormone (MIH), which inhibits the complete development of the uterus, fallopian tubes and cervix.
As such, individuals with CAIS have female physical characteristics, but have no periods and are infertile.
The incredible consequence of total androgen insensitivity is that CAIS women are likely to appear more sexually attractive due to enhanced female features such as a lush head of hair, long legs, well-developed breasts and clear skin.
In contrast, XX women are actually quite sensitive to testosterone (also produced directly and indirectly by the ovaries and adrenal glands) which plays a secondary role during their physical and behavioural development from infancy through puberty.
Thus, a XY woman may appear more "womanly" than a XX woman, leading Dr. House to quip that "the ultimate woman is a man."
Despite the inaccuracies and over-dramatization (the depiction of a CAIS woman and House's callous treatment of her in this episode drew the ire of a specialist in the field), I think this show highlights some interesting questions about sex and gender identity.
Does genetics determine your gender identity? Is gender something that fits into two distinct categories, or more of a continuum along a spectrum?
When a XY man falls in love with a XY woman (easy to imagine why), is he a homosexual?
If you're a guy, and the love of your life turns out to be a XY woman...
Will you stop loving her?
Would you like to know more?
- About Androgen Insensitivity Syndrome
- Original research article about AIS: Differential gene-expression patterns in genital fibroblasts of normal males and 46,XY females with androgen insensitivity syndrome (Holterhus et al. 2003)
- About the actress who played Alex: Cameron Richardson
9 Comments:
One of the best books, in my opinion, on this subject is Sexing the Body by Anne Fausto-Sterling. She discusses the biology of sex and the social history of constructing it.
To answer your questions, sex is not a dichotomy... and neither is sexuality.
Your blog is getting so interesting I hope you don't start charging subscription fees! LOL
Your blog is like the adult version of science mags I used to subscribe to when I was in primary school.
FB supporter
To Mybackstage:
Welcome to Fresh Brainz! Yes, at the individual level, sex and sexuality are not dichotomies. However, at the societal level, dichotomies (even false dichotomies) are of immense social power.
Thanks for pointing out Dr. Fausto-Sterling's book; interested readers can check out a primer of her book here:
http://www.symposion.com/ijt/gilbert/sterling.htm
To FB supporter:
Should I start charging a subscription? Hmm... ;)
I watched that episode with much amusement but didn't follow up to read what the real condition was called, thanks for enlightening me. I went away thinking that pseudofemalehemaphroditism thing was real. Kinda freaky its so common.
"Will you stop loving her?"
Hawhawhaw....sounds like the menopause dilemma;-)
Or as I like to say "men 'l pause" when they see those hot flashes coming on...
Or what most guys go through when they discover *gasp* that the clitoris has a mind of its own, not much different than a penis;-)
You said:
...at the societal level, dichotomies (even false dichotomies) are of immense social power.
As a sociological social psychologist, I would have to agree with you 100%!
To Edgar:
You're welcome, I thought Dr. House sounded quite authoritative too: to be sure, "pseudohermaphroditism" isn't totally wrong but it's an inaccurate and out of date terminology.
I think the incidence of intersex conditions remind us that embryo development is a physical process that can result in very variable outcomes. Too many people believe that it is some kind of magic or miracle.
To The Real CMF:
I would go further and argue that any organ potentially has a mind of its own, not just sex organs.
But that's an article for another time... :P
To Mybackstage:
Of course, that's because it's 100% true. Is the sky blue? Heh heh...
Androgen insensitivity syndrome is actually a specific type of male pseudohermaphrodism. The definition of pseudohermaphrodism is a condition in which a person's "gonads and sex chromosomes are discordant with secondary sex characteristics, which include the genital tract and external genitalia. Genetic males (46,XY) with feminized genitals are called male pseudohermaphrodites and genetic females (46,XX) with virilized genitals are called female pseudohermaphrodites" (Larsen's human embryology 2009). So while they are not being as specific as they could be, the general term of male pseudohermaphrodism is correct.
Hi!
Really interesting topic...
It's really hard to me, to imagine the immense social, and psychological stress this disorder may cause.
Sex, as all of you said, is not a dichotomy, but it depends what sense we are talking in.
Biologically, both, male and female, at the beginning, are the same structure, but due the genetic programming, our cells take one of two possible pathways... inhibiting one, and stimulating the other...
The clitoris, is the equivalent to the male pennis, since the sexual differentiation modifies it.
When I think about it, I ask myself... "So, our sexual attraction/behavior (heterosexuallity or homosexuallity) is learnt from the social rules and environment? or is genetically given to us?
If the last, why this "girl" with CAIS is attracted to boys? since "she" has a XY cromosomes in his/her cells?
Before i studied this disorder, I believed that the sexual behavior was genetically given to everyone.
Now, I doubt, I mean, I cannot say I'm sure, either I disagree with it, simply... I doubt, I don't know what to think.
But, maybe... it's best not to understand all the things now, and simply recognize that some things, are, still, beyond our understanding.
JameS
Post a Comment