Progestin Induced Virilization

Caused by prenatal exposure to exogenous androgens, most commonly progestin. Progestin is a drug which was administered to prevent miscarriage in the 50’s and 60’s and it is converted to an androgen (virilizing hormone) by the prenatal XX persons metabolism. If the timing is right, the genitals are virilized with effects ranging from enlarged clitoris to the development of a complete phallus and the fusing of the labia. In all cases ovaries and uterus or uterine tract are present, though in extreme cases of virilization there is no vagina or cervix, the uterine tract being connected to the upper portion of the urethra internally. The virilization only occurs prenatally and the endocrinological functionality is unchanged, ie. feminizing puberty occurs due to normally functioning ovaries.

In other words, XX people affected in-utero by virilizing hormones can be born into a continuum of sex phenotype which ranges from “female with larger clitoris” to “male with no testes”. It is noteworthy that the use of progestin is not effective in the prevention of miscarriage.

Progestin androgenized children are subjected to the same surgically enforced standards of cosmetic genital normalcy as other intersexed children… meaning that clitoridectomy and possibly more extensive procedures are often performed early in life, most often with the effect of loss of erotic sensation and ensueing psychological trauma. ISNA believes that this surgery is unneccessary, cosmetic and primarily “cultural” in its significance. It is of no benefit to the child, who suffers even more from the stigma and shame of having been surgically altered than she would have had her non-standard genitals been allowed to remain intact.

Occasionally a female neonate will be so genitally virilized that she is given a male identity at birth and raised as a boy. It is important not to hide the circumstances of her biology from such a child, in order to the avoid shame, stigma and confusion which results from secrecy. After the onset of puberty the child may want to explore the option, hopefully with the aid of loving parents and peer counseling, of having surgery to allow expression of either female or male sexuality. This is not a choice that should be forced prematurely, it is a personal choice to be made by a teenager about his/her body and about her/his choice of sexual identity and sexuality.