IAAF offers to pay for Caster Semenya’s gender surgery if she fails verification test – Telegraph

IAAF offers to pay for Caster Semenya’s gender surgery if she fails verification test – Telegraph. This article was recently addressed in the Organisation Intersex International (OII) Forum and someone asserted that the reason why doctors remove testicles from women with androgen insensitivity syndrome (AIS) is because we want to prevent women from having them. So, I did a little research and this is what I found out:

There really isn’t a conspiracy to prevent women from having testes. The issue is that mammalian testes need to be cooler than core body temperature; thus testes have evolved to hang outside of the body in scrotums. Internalized testes are a cancer risk for both men and women. And the risk of cancer is greater in women with AIS than in men with undescended testes (UDT).

According to HM Wood (1):

  • The incidence of testicular cancer in men is 0.9 to 7.8 per 100,000 men per year
  • 1.1 to 1.6% of boys have unilateral or bilateral undescended testes
  • Among men with testicular cancer, 5-10% have had a history of UDT
  • Men with a history of UDT have 2.75 to 8 times the risk of testicular cancer compared to men who don’t; the risk is even higher in men with bilateral UDT, associated genitourinary anomalies, or late (after age 10-12 years) or uncorrected UDT
  • Orchiopexy (repositioning testes outside the body) by age 10 to 12 years results in a 2 to 6-fold decrease in relative risk of cancer compared with orchiopexy after age 12 years or no orchiopexy

According to SJ Robboy (2):

  • The incidence of complete AIS is 1 in 20,000 live births
  • There is a risk for malignancy in AIS gonads owing to the occurrence of germ cell tumors. The cumulative risk for a germ cell tumor is greater than 30% by 50 years of age
  • The risk of malignancy in patients with testicular feminisation is only 4% by the age of 25 years, but reaches 33% by 50 years

Thus, women CAN have testes, but they should be removed if they aren’t located in a scrotum.

(1) Wood HM. Elder JS. Cryptorchidism and testicular cancer: separating fact from fiction. Journal of Urology. 181(2):452-61, 2009 Feb.
(2) Robboy SJ. Jaubert F. Neoplasms and pathology of sexual developmental disorders (intersex). Pathology. 39(1):147-63, 2007 Feb.

Gene discovery could make FTM gender reassignment easier

Jessica Green of Pink News is reporting that researchers at the National Institute for Medical Research have discovered that switching off a single gene, FOXL2, is all that is needed to make ovarian cells turn into testicular cells. This discovery could lead to the development of a new drug that would allow trans-men to essentially convert their ovaries into testes and to develop male characteristics such as facial hair and a deepened voice without hormone therapy.

Talk to your kids about sex

Alice Park reports on Time.com that parents are talking with their kids too little too late according to a 2009 study in Pediatrics. In fact, approximately 40% will have sex before their parents finally bring up the subject of “the birds and the bees”. It certainly was true in my case.

I can remember being a teenager and one ordinary day my mother taking up the subject of sex. She just kept going on and on about how important it was to stay a virgin until marriage in spite of my protests “I know, Mom” and attempts to change the subject. Eventually I tired of her lecture and finally blurted out, “Mom, just stop. I’m not a virgin.” I still remember the look of shock in her eyes as she muttered, “I’m so disappointed in you” before walking away.

Frankly, I was disappointed in her. Waiting until your kid is 16 before having this conversation is way too long. I remember kids talking about sex on the playground in elementary school, don’t you? Kids aren’t dumb and kids are curious.

I took a different approach with my kids. Beginning in their toddler years I began addressing the subject of body parts using their correct anatomic names — a penis is not a “peepee” or “junk” nor is a vagina “private parts”. Eyes are eyes and noses are noses, why should sexual organs be any different? As their minds developed I added more to their knowledge, always addressing the subject in a matter of fact way and answering all of their questions. If a child is able to comprehend and formulate a question then s/he is mature enough to receive an answer.

I recently had a conversation with my son who is 11. He told me that now that he is in 6th grade he has to have health and sex education. He seemed rather annoyed by the idea and said, “I really don’t know why I have to learn about it in school, you’ve already taught me all about it.” I just listened and smiled.

Chronologic acceleration

I have now completed 4 rotations of my intern year which means that 24 weeks have gone by since the last time I wrote in my blog. So much has happened over that span of time but I have frankly been either too busy or too tired to write about it. Residency is not nearly as difficult as I was expecting – perhaps because I love what I am doing! – but it certainly eats up a lot of time. The march of time seems to be accelerating as my world spins faster and faster.

Since residency started in June I have now caught 38 babies (vaginal deliveries) and cut out 23 more (Cesarean sections). That’s 61 kiddos I’ve assisted bringing into this world! I have also either performed or assisted in many other procedures. Each experience is so much fun and my knowledge and skills continue to grow exponentially. The night before last I received my first obstetric baptism; just as the infant’s head was starting to crown (visible without the need to manually separate the labia) with me poised to catch, it’s bag of water (amniotic sac) burst and showered me. Fortunately there was no baby poo in the fluid (meconium) and I was wearing protective gear but it still managed to wet my hair. The first of many I’m sure.

During my first rotation I managed to take a tumble off my bike and break my left pinky just past my knuckle (5th proximal phalynx). I bike commuted all summer and early fall and on this particular day it was raining. As I attempted to veer across some railroad tracks along the parallel S-curving bike path my bike completely slipped out from underneath me and I dived face first toward the pavement. After skidding to a stop using my elbows and chest as breaks I noticed that in addition to the minor scrapes I had sustained my pinky was deviated away from my other fingers at an abnormal angle. Long story short, the orthopedic surgeon offered me two options: either wear a cast to my elbow for 6 weeks or have a plate and screws surgically placed (open reduction internal fixation). Given that I need my hands to do my job, I underwent surgery and was able to perform surgery on others the next day. It’s still not completely back to normal but the pain is gone and it is completely functional. Morals to the story are: 1, Don’t try to bike across wet train tracks at an oblique angle. 2, I am breakable after all! And 3, these hands are priceless and I have to be more careful in the future.

Patrick and the dogs finally moved our stuff up from Utah in August, 2 months after I had started residency. I had missed them so much! We are currently living in the Powderhorn Park neighborhood in a large 3 bedroom duplex that we love. We occupy the top floor of an early twentieth Century home with 12 foot ceilings, wonderful architectural details, lots of light and a large screened in balcony overlooking our front lawn. The house sits in the middle of an entirely fenced in yard that the dogs enjoy. We have lots of rabbits and squirrels which the dogs love tracking and gobbling up their turds before we can stop them. Yuk! Copper actually caught a rabbit in our yard one morning and almost wouldn’t let it go when Patrick protested. Fortunately the rabbit was not injured and bounded away when Copper finally opened his jaws. Just the other night Patrick was telling me that both dogs were asleep on the couch and whimpering in their sleep. They must have been picking up on each other because apparently they started whimpering at each other louder and louder. Patrick tried to videotape it but unfortunately failed. That surely would have been a contender for $10,000 in America’s Funniest Home Videos.

Patrick continues to look for work and takes of the house, dogs and me in the meantime. His big news is that he will be getting a cochlear implant in the next few weeks. His hearing has digressed to the point where he can no longer hear on the phone even with state-of-the-art hearing aids and he is now legally deaf, no longer just hard-of-hearing. Technology is now available however to insert sound-sensing electrodes deep within his inner ear to stimulate his auditory nerve replacing the function of inner ear hair cells. Patrick is a bit nervous about the procedure because the insertion of the electrodes into his cochlea will effectively destroy what little natural hearing ability he still has and he states that he is grieving this loss. On the other hand he is excited to go bionic (or Borg if you’re a Trekkie) and to hear probably better than he has ever heard in his life.

JD and Kayla have yet to visit but will be here for 2 weeks during the winter break. And they are growing like weeds! JD is enjoying junior high – I can’t believe I’m old enough to have a kid in junior high! – except all the homework. Kayla seems less interested in school though she is just as bright; she’d just rather play or read on her own.

Fall is now gone with all the vibrant colors that go with it. In its place are the monochromatic tones of winter with blinding sunlight, lengthening shadows and sleepy landscapes. The temperature is still bearable usually in the 30s to 40s and I continue to mentally brace myself for the arctic blast that I’m told is right around the corner. I am however looking forward to ice skating outside on one of the many lakes like so many faded holiday images of a not so distant past.

Although I am much less communicative than I have been in the past I hope you all know that you are often in my thoughts and I wish you happiness, peace and light.

Let go and go UP!

For those of you who have not seen the new Disney Pixar movie UP, I highly recommend it. UP is the story of an elderly man, Carl Fredricksen, a Wilderness Explorer, Russell, and their accidental adventure in Carl’s flying house. Carl eventually discovers that the adventures we dream of are not necessarily the most thrilling or fulfilling and that sometimes the things we cling to are the very things that hold us down. The movie is both entertaining and gives much food for thought. What do you need to let go of to go up?

Land of 10,000 Lakes

Actually there are 11,842 lakes in Minnesota and let me tell ya, it is one beautiful state! I have now been living in Minneapolis for one week. I flew in with only four bags and am currently subletting a room within walking distance of the U of MN. Today really was my first day to do some exploring though as I was in orientation all week long. One of my classmates was kind enough to lend me a bike to get around so that I can take my time to consider my options before purchasing my own. I rode out to the hospital where I will have my first rotation as a brand new doctor (I graduated 6/4/09) and enjoyed the Greenway (a paved biking/running trail) and the beautiful scenery as I passed the northern rim of Lake Calhoun. I had to stop at the Freewheel Bike shop on the way however to buy some padded bike shorts and a new squishy bike seat — I have not cycled for many years and while my legs are definitely burning I must say that it is my tush that is hurting the most. Yikes! As my commute is 7 miles (14 round trip), I should definitely get some great exercise and start burning off all the extra poundage I added during medical school.

On Monday I begin my first rotation — obstetrics at a hospital that has over 4000 deliveries each year. During my five weeks there I should deliver 50-80 myself. Given that I only had the opportunity to deliver a few placentas during medical school, I am very excited. My other 8 classmates are all starting on different rotations at the four hospitals we will work at this year. I am sure that I will have much to write about as I move forward in my career. I just hope that residency does not age me as much as medical school!

People of the Mountains

I finished my last rotation of medical school on 4/24 and will receive my diploma on 6/4. Rather than staying put in Portland for the interim, Patrick and I decided to move to Utah for the month of May and are staying with his mother in her beautiful historic home. It is so nice to be in a totally different environment and let myself recharge my battery for residency, which I will begin 6/8 at the U of M in Minneapolis.

The move, while physically exhausting as Patrick and I did it all by ourselves, was also an enlightening experience. We decided to try to get rid of as much of our stuff as possible before the move and advertised our moving sale on Craig’s List and at OHSU. Only a few people responded and we sold a couple of items at greatly reduced prices. I was glad that the items were no longer in our possession nor our responsibility but I also felt rather empty from the transactions; the few dollars we earned from the sale did not make up for the psychological drain of trading personal items for money. We were still determined to downsize our possessions however and decided to donate them instead of selling them. We loaded up our rental truck with almost all of our possessions and took them over to a Portland charity for people with AIDS. We even donated our only vehicle to another charity that serves the homeless. The difference of experience between selling and donating was night and day. Feelings of emptiness and exhaustion were replaced with joy and contentment. I also was able to feel the freedom of letting go that I had been longing for. Giving is so much more satisfying than selling.

Today I helped Patrick in the garden and mowed a GIANT yard until I had blisters on my palms and my muscles quivered. We ate fish and chips and drank fresh lime soda from the local Daley Freez and enjoyed soaking up the sun and watching our dogs bound about the yard. While doing chores in a small town may not seem like much of a vacation to some, for me it is exactly what the doctor ordered. I feel tired but stress-free and happy. I’m also very glad to have this opportunity to get to know my mother-in-law better as we’ve spent little time together over the past 7 years Patrick and I have been together. Our kids will also be visiting us here and they will get a chance to spend time with their grandma for the first extended time period. Family time in the top of the mountains.

Mahatma Gandhi

I just finished watching the 1982 movie Gandhi for the first time and was thoroughly impressed. His message of noncooperation with injustice is every bit as relevant in the 21st century as it was in the 20th. It was also interesting to see that the idea of buying local products and supporting local businesses is not new; Gandhi taught that buying English clothes contributed to their poverty and they created huge bonfires with their imported garments. He was humble enough to clean latrines, the work of the Untouchables, and wise enough to see everyone as his equal. I am truly inspired by his legacy and will continue to reflect on it as I tread my own path.