James Coplan, M.D., Neurodevelopmental Pediatrician, Author and Speaker

We are all Trans

April 26th, 2016 by drcoplan

[NOTE: I will return to my previous thread on the subject of prenatal diagnosis of disability shortly. But due to the topical nature of this subject, I thought I should publish it at this time.]
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Fetal genital tract. Image from Wikipedia Commons

We are all Trans

Ted Cruz and Pat McCrory may not want to hear this, but the human embryo starts out with two sets of reproductive structures: one male and one female. In fetuses that receive a Y chromosome (genetic makeup: 46 XY), the fetal gonads become testes (notice the term “bipotential gonads” in the diagram above), and begin cranking out male hormones (androgens) such as testosterone, that cause the phallus to enlarge, and a substance known as Anti-Mullerian Hormone (AMH), which forces the female genital structures (“Mullerian ducts” in the diagram) to regress . The opposite occurs in female (46 XX) fetuses: the gonads become ovaries and begin cranking out estrogen; female genital structures develop and male genital structures (“Wolffian ducts” in the diagram) are forced to regress.

In simple English, we all start out with the potential to go either way.

Every guy has a prostate gland, which (unfortunately) completely encircles his urethra (Not a shining example of intelligent design). As guys get older the prostate gland enlarges, compressing the urethra and making it harder to pass urine. Just ask any guy over 50, or eavesdrop in a Men’s Room and listen for the guy who produces only a few drops at a time, then stops, and restarts once more. But I digress… We were talking about sexuality, right? I mention Men’s Rooms primarily to remind male lawmakers that each of you is the proud owner of a prostate gland. And if you could take a look inside your prostate gland, you would find – get ready for this – a miniature UTERUS – the remnant of your Mullerian ducts that was destined to become your full-fledged uterus, but was shut down by AMH during fetal life. Don’t just take my word for it. You can look it up (And let’s not forget the obvious fact that men have breasts – another remnant of our gender equipotentiality. To the best of my knowledge, breasts serve no purpose in men – although they do carry risks. My first breast cancer patient in med school was a man. Talk about irony and bad luck.) Read the rest of this entry »

Life is Complicated – Part 2

April 21st, 2016 by drcoplan

Rodin’s “The Thinker”

What qualities are you looking for when you go to a physician for advice?

Last time, I raised the issue of fetal sexing as a possible way to reduce the risk of having a child with ASD. I described a family who asked me to write a letter to the mother’s OB-GYN in support of their plan, and closed with the question “What would you have done, if you had been in my shoes?”

I received several thoughtful replies. It was clear that the writers put a good deal of heart and soul into their responses, which drew deeply on their own experiences – both as parents of children on the spectrum, and as persons who place high value on acting ethically. One particularly articulate mom wrote the following:

“I’m pro-choice, but when we were pregnant with our third child, we declined gender testing and all genetic testing, even though I was then 37 and of advanced maternal age. … I think that when you choose to become a parent, you choose the path no matter what. I have much compassion for women who find themselves pregnant and unable or unwilling to become mothers yet because of a million life circumstances that are theirs and theirs alone. Aborting due to disability has always felt trickier to me. Of all people, I know the strain of living with a nonverbal teenager who is bigger and stronger than me and whose behaviors are only mostly controlled.” Read the rest of this entry »