Very accommodating

Instead of using terms such as "hermaphrodite" or even "intersex," you recommended that the field use specific diagnoses under the term, "disorders of sex development." Why did you and other geneticists feel a nomenclature change was necessary?For the past 15 to 16 years now, there really has been an explosion in the genetic knowledge of sex determination.

But these antimale genes may be responsible for the development of the ovary. Is the conceptual framework for sex determination changing, then, because of these discoveries?

I think the frame has slightly changed in the sense that even though it's still considered that the ovary is the default pathway, it's not seen as the passive pathway.

In this case it was more like people would say it was just common sense—if the clitoris sticks out this much, you have to fix it. There were a lot of patients and it was always the same discussions. She goes to this religious institution for girls until eventually someone finds out, and then it's a big scandal.

Or if the penis is really too small, it has to be bigger. And you know, I was never convinced by common sense. She becomes a pariah, and she ends up committing suicide.

I felt it didn't rely on solid scientific evidence. I was reading at the time this book by Michel Foucault. He basically tells the story of this girl who clearly has a large clitoris.

I mean, I'm a scientist, I'm a big believer of you can't just do things without being supported by evidence. She goes and gets sexually aroused as she sleeps in the bed of other girls, as it was normal for girls to do.

The two things that we contributed was, one, to find the genes that are antimale, and reframing the view of the female pathway from passive to active. We're the first ones to show that there were genes involved in brain sexual differentiation, making the brain either male or female, that were active completely independently from hormones. Do you think this difference in gene expression in the brain explains anything about gender identity? They're certainly good candidates to look at to be influencing gender identity, but they're just goodcandidates.

At a recent international meeting to discuss management of people with genital and gonadal abnormalities, you successfully pushed for a change in nomenclature.

In particular we've discovered genes, such as WNT4, that's female-specific and not present in males, and that's sort of shifted the paradigm of making a male as just activation of a bunch of male genes. What we've shown is that making a male, yes, is activating some male genes, but it's also inhibiting some antimale genes.

It's a much more complex network, a delicate dance between pro-male and antimale molecules.

What we discovered, though, was not just pro-testis determining factors.

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