Why we must make a stronger commitment to lesbian family health

The opinion further acknowledges that marriage has a uniquely universal dignity and recognition in our society and grants the couple access to more than 1,000 federal rights deemed important for the health of its partners and their families.⁴

ACOG Committee Opinion #385 concedes that to refer a homosexual patient seeking insemination or surrogacy services does indeed communicate the physician’s discriminatory attitude to the patient and may cause harm.³ The AMA prohibits such discrimination by requiring that physicians only offer those services that they can provide to all patients without discrimination. This would allow a physician to refuse to do any procedure that is deemed unconscionable—but any service provided to some must be provided to all.

How the first trimester may influence sexual orientation

Fetal brain circuitry is permanently organized during the first trimester of pregnancy under the influence of various hormones and hormonelike substances, conferring an innate sexual orientation and gender identity, which children gradually come to recognize.⁶ Any subtle or not-so-subtle exposure to androgenic substances during early gestation of a 46 XX fetus can influence neural patterns in the phenotypic female child. These patterns may manifest as more aggressive play activity and masculinized somatic skeletal structure, neural structure, behavioral and biophysiologic skills, or gynephilic sexual orientation, and possibly confer a male gender identity.^7-11

Congenital adrenal hyperplasia (CAH) demonstrates the biological effects of prenatal hormones on sexual orientation and gender identity. CAH is a condition in which an enzyme (21-hydroxylase) in the cortisone synthesis pathway is missing or dysfunctional, resulting in buildup of precursor androgens in the fetal blood. Female infants with CAH can be born with virilization of their external genitals or ambiguous genitalia.

Since 1968, 13 published studies have revealed that 20% to 50% of females who have CAH will identify as lesbian or bisexual in adulthood.¹⁰ A smaller percentage will come to recognize a male gender identity, particularly when their CAH is the more severe salt-wasting type.¹¹

Homosexual orientation is also more frequent among women who had prenatal exposure to the complex steroid diethylstilbestrol,¹² and among those who have polycystic ovarian syndrome (PCOS).¹³ Further evidence of the influence of prenatal androgen exposure on female sexual orientation is seen among females who gestated with a fraternal male co-twin.¹⁴ These girls are reported to have more aggressive play patterns during childhood and are more likely to identify as lesbian later in life.

Female-to-male transgender individuals have been shown to have higher adult androgen levels, a higher incidence of PCOS, and a greater likelihood of a history of CAH.^15,16

It is unclear whether all homosexual females or female-to-male transsexuals were influenced by some form of first-trimester androgen excess. There are many endogenous and exogenous sources of androgen-like substances. They include maternal adrenal steroids arising from a high level of stress, anabolic steroids ingested from poultry or beef, and subclinical variations of fetal 21-hydroxylase concentration or efficiency, for example.

Homosexuality is not a disorder

The APA backs evidence that homosexuality cannot be spread by exposure or influence, nor can it be “repaired” or eradicated by disciplinary treatment. In fact, published evidence shows that the mental health and development of children are significantly harmed by parental, familial, and school peer rejection, whereas developmental parameters are much improved by their parents’ celebration of the youth’s diversity and the school’s enforcement of its diversity policy.¹⁷ Still, recognition of one’s sexual orientation can be difficult because of legal and social proscriptions against homosexuality.

Although most homosexuals have experienced some form of discriminatory treatment in their lives—be it verbal or physical abuse, or different treatment at their school or job or by existing federal and state laws—most still report a full and rewarding life.¹⁸ Experiences of discrimination, however, are potent psychic stressors for which many seek counseling and support, and which may undermine mental and physical health.^19,20 Such discrimination may lie at the root of the documented higher rates of obesity, smoking, and alcoholism among lesbians compared with heterosexual women reported in the Women’s Health Initiative and the Nurses Health Study.^21,22

Most young people, including those who will realize that they are gay, are raised with a strong appreciation for family and cultural traditions and an anticipation of adulthood with a career and marriage.²³ Although marriage systems may differ, marriage across world cultures is a publicly acknowledged, highly respected, singular union, designed to create kinship obligations and sharing of resources between two adults and protect any children that they may produce.