Disorders of sexual development may be more common in newborns than what we think

Frequency of Ambiguous Genitalia in 14,177 Newborns in Turkey, 2019

According to a recent study, ambiguous genitalia in newborns may be more common than previously thought, the Endocrine Society reports.

“Our research found 18 babies with ambiguous genitalia among 14,177 newborns (1.3 in 1,000 births). This frequency is higher when compared to previous studies (1 in 4,500-5,500),”

“These findings support the hypothesis that early placental dysfunction and androgen deficiency might be important in the etiology of male genital anomalies,”

said the study’s first author, Banu Kucukemre Aydin, M.D., of Istanbul University in Turkey. Image credit Intersex Human Rights Australia.

2019 Study Abstract

Limited data are available on the exact incidence of disorders of sex development (DSD) with genital ambiguity at birth.

To determine frequency of ambiguous genitalia in newborns.

Prospective multicenter study.

Three tertiary care hospitals.

Patients or Other Participants
All 14,177 babies born during the study period were included.

Main Outcome Measures
All newborns were examined at birth; data on weeks of gestation, birth weight, and length were collected. A structured questionnaire was used for data collection. Quigley and Prader scales were used for phenotypic grading. Clinical and genetic investigations were performed.

Eighteen babies with ambiguous genitalia were found among 14,177 newborns (1.3/1000). Fifteen newborns had 46,XY DSD, one had 46,XX congenital adrenal hyperplasia, and one had 45,X/46,XY mixed gonadal dysgenesis. Karyotype analysis was not done in one baby who died in the neonatal period. The ratio of prematurity was higher in the DSD group (44% vs 11%; P < 0.001) and the ratio of small for gestational age was also higher in the DSD group (22% vs 5%; P = 0.007). Eight babies with DSD had mothers who had additional medical conditions, such as preeclampsia, depression, insulin resistance, and gestational diabetes mellitus.

The frequency of ambiguous genitalia was higher than in previous studies, but, as with any experiment, the finding should be met with caution because this study was conducted in tertiary care hospitals. In addition, lower birth weight in the DSD group supports the hypothesis that early placental dysfunction might be important in the etiology of male genital anomalies.

Related DES Studies

Intersex Awareness Day

#Intersex rights are human rights. Let’s make the world safe for intersex babies and children

“Today is #IntersexAwarenessDay, celebrated in honor of the first known intersex protest, held at a medical clinic in Boston exactly twenty years ago, on October 26th. Although we’ve made a lot of progress since then, let’s face it: we still need a lot more awareness about intersex people.”

Image credit oii-usa, OCT 26, 2016.

More Information

  • Gender identity, feminization, transsexualism, and sexual orientation in the DES-exposed studies.
  • Hugh Easton’s petition : FDA, acknowledge that hormone treatment during pregnancy can cause intersex and transgender! on change.
  • I’m David and I’m Hannah, both and yet neither. I’m just me, blog, 19/11/2015.
  • What is Androgen Insensitivity Syndrome (AIS) and what it means to be intersex? Musician Dalea talks.
  • What is it like to Be Intersex ? the video.

Increasing impact of estrogen pollution in waters and endocrine disruption in fish

Increasing impact of oestrogen pollution through climate change and population growth

Oestrogens are ‘female’ hormones that can enter the aquatic environment after excretion by humans and animals, causing ‘feminisation’ of male fish. This study carried out a risk assessment for oestrogen-like endocrine disruption in the UK in the 2050s, based on likely changes to the human population, river flows and temperature. The authors found that risk is likely to increase under future conditions and recommend further research to assess whether improving sewage treatment could reduce oestrogen pollution.


Impact of climate change and population growth on a risk assessment for endocrine disruption in fish due to steroid estrogens in England and Wales, ScienceDirect, doi:10.1016/j.envpol.2014.11.017, February 2015.

In England and Wales, steroid estrogens: estrone, estradiol and ethinylestradiol have previously been identified as the main chemicals causing endocrine disruption in male fish. A national risk assessment is already available for intersex in fish arising from estrogens under current flow conditions.

This study presents, to our knowledge, the first set of national catchment-based risk assessments for steroid estrogen under future scenarios. The river flows and temperatures were perturbed using three climate change scenarios (ranging from relatively dry to wet). The effects of demographic changes on estrogen consumption and human population served by sewage treatment works were also included.

Compared to the current situation, the results indicated increased future risk:the percentage of high risk category sites, where endocrine disruption is more likely to occur, increased. These increases were mainly caused by changes in human population. This study provides regulators with valuable information to prepare for this potential increased risk.

Increasing impact of estrogen pollution in waters and endocrine disruption in fish

The presence of both male and female characteristics within the same fish (intersex) is increasingly being observed

Endocrine-disrupting compounds can enter the aquatic environment via a number of different pathways and in particular via certain urban wastewater discharges, atmospheric deposition, etc. There, they can persist for years and bioaccumulate up the food chain. Exposure to these chemicals can disrupt several bodily systems, leading to changes in a number of wildlife species.

For example, the presence of both male and female characteristics within the same fish (intersex) is increasingly being observed, causing serious reproductive dysfunction. In humans, too, there is evidence that endocrine disruptors can have adverse effects on health. A number of concerning links have been made between endocrine-disrupting compounds and human health, including declining sperm counts, increased incidences of certain cancers and congenital malformations in children.

Increasing impact of oestrogen pollution through climate change and population growth, Science for Environment Policy News Alert, 27 May 2016.

This study focused on their effects on fish in rivers in England and Wales, where the main chemicals responsible for intersex in male fish are three steroid oestrogens: oestrone, oestradiol (natural hormones) and ethinyl oestradiol (a synthetic hormone used in oral contraceptive pills). The European Commission proposed annual average environmental quality standards for the latter two in 20121 , but instead they were placed on a watch list of substances to gather monitoring data to facilitate the determination of appropriate measures to address the risk posed by them.

Impact of climate change and population growth on a risk assessment for endocrine disruption in fish due to steroid estrogens in England and Wales, ScienceDirect, doi:10.1016/j.envpol.2014.11.017, February 2015.

In order to accurately regulate these substances, it is important to identify where and to what extent they pose risks, both under current and future circumstances. In the coming years, climate change will alter river flows and temperature, and is likely to affect the risk posed by steroid oestrogens by affecting their dilution and degradation in the aquatic environment. Increases in human populations will also increase the emission of steroid oestrogens.

This study tested the hypothesis that climate change and population changes will increase the risk of endocrine disruption in fish due to steroid oestrogens in England and Wales by 2050.

The researchers reproduced a risk assessment made in their previous study, in which risk was determined by comparing predicted environmental concentrations with threshold levels based on endpoints likely to cause a population response in fish (e.g 100% feminisation for oestradiol and reduced fertilisation effects for ethinyl oestradiol). The researchers incorporated changes in river flows, water temperatures and populations in order to assess future risk.

A model was used to predict the environmental concentrations of oestrogens in each river in England and Wales, and a combined toxic equivalent concentration was used to assess their collective biological effects. The risk of fish endocrine disruption in each river was classified as ‘no risk’, ‘at risk’ or ‘at high risk’.

To determine the potential impact of climate change, the researchers used three different scenarios based on the UK Met Office’s 2009 UK Climate Projections: average, wet and dry. These scenarios differ in average annual rainfall and river flows. The authors also accounted for differences in river temperature, which affects the rate of decay of chemical substances.

The researchers analysed the effects of human population increases using figures based on population projections for England and Wales in 2050 generated by the UK Office for National Statistics. They also accounted for ageing of the population, which for a given number of inhabitants will reduce excretion of ethinyl oestradiol due to the increase in menopausal women, and, therefore, fewer women taking the contraceptive pill.

The results suggest that risk will increase in the future, because the percentage of high risk sites increased across all three climate change scenarios. The combined percentage of river reaches at risk or at high risk was predicted to increase from 39% under the current conditions to 48%, 50% and 50%, for the wet, average and dry future scenarios, respectively.

However, climate change was not the primary driver of increased risk. The findings suggest that an increase in temperature would increase biodegradation within streams, and thus reduce concentrations of harmful compounds, and only a small fraction of the changes could be attributed to changes in river flow. By far the main driver of the increased risk was population growth.

These findings represent a warning to policymakers that current risk assessments may look much different in the future, largely driven by the increasing — and ageing — population. The pollution of the aquatic environment by oestrogens is not specifically regulated at the level of the Urban Waste Water Treatment Directive (91/271/EEC), which is essentially targeted at the removal of organic pollution in general from wastewater. However, additional treatment may be necessary to remove specific substances that could impact upon aquatic flora or fauna. This need for treatment should be determined in each Member State on a case-by-case basis in order to fulfil the requirements of other Directives such as the Water Framework Directive.

“Intersex” male bass found throughout protected Northeast US waters

Evidence of estrogenic endocrine disruption in smallmouth and largemouth bass inhabiting Northeast U.S. national wildlife refuge waters

image of Rappahannock-River
The Rappahannock River Valley National Wildlife Refuge was one of 19 refuges where intersex bass were found (USFWS).

By Brian Bienkowski,
Environmental Health News,
December 17, 2015

Eighty-five percent of male smallmouth bass tested in or nearby 19 National Wildlife Refuges in the U.S. Northeast had signs of female reproductive parts, according to a new federal study.

The study, led by the U.S. Geological Survey and U.S. Fish and Wildlife Service, also reported that 27 percent of male largemouth bass in the testing sites were intersex.

The study is the first of its kind in National Wildlife Refuges and adds to growing evidence that endocrine disrupting chemicals are getting into U.S. lakes, rivers, streams and reservoirs—no matter how protected the waters seem. And such contamination seems to affect the reproductive development of some fish species, which can lead to threatened populations.

For the bass in this study, those considered “intersex” either had a protein that is used to make egg yolk typically found in females, or immature egg cells in their testes, said co author Fred Pinkney, a biologist with the U.S. Fisheries and Wildlife.

The eggs were in the very, very early stages

But any change to fish reproductive systems could possibly threaten overall fish populations and ability to properly reproduce.

During the fall seasons of 2008 to 2010, the researchers tested a total of 118 male smallmouth bass from 12 locations and 85 percent were intersex. They tested an additional 173 male largemouth bass from 27 sampling sites and 27 percent were intersex.

It’s not entirely clear why the bass were intersex as the researchers did not test the waters for specific chemicals, said lead author Luke Iwanowicz, a research biologist with the U.S. Geological Survey.

However, the suspected culprits of the sex changes are endocrine disrupting compounds.

This includes hormones, industrial chemicals and pesticides that are or mimic estrogen hormones. These compounds enter rivers and streams via permitted effluents, stormwater and agricultural runoff, and wastewater treatment plants, where excreted birth control and natural estrogens pass through relatively un-altered.

The study is just the latest to find intersex fish in U.S. waterways and builds on a U.S. Geological Survey study in 2009 that showed intersex male fish in nine U.S. river basins, though that study didn’t include Northeast basins. The bass tested in the Northeast waterways had a higher prevalence of intersex than the fish in the 2009 study.

It seems that certain fish species may be more sensitive to estrogenic compounds than others, as evidenced by the disparity between largemouth and smallmouth bass in this study. Previous studies also have reported that smallmouth bass seem more susceptible to intersex changes.

However it’s not clear if this is actual physical sensitivity to the chemicals or if it’s due to some species spending more time in more contaminated habitats.

National Wildlife Refuges are areas protected by the U.S. Fish and Wildlife Service. There are more than 560 such refuges nationally.

The U.S. Fish and Wildlife Service encourages management actions that reduce runoff into streams, ponds and lakes—both on and off of refuge lands

The national refuges tested spanned from eastern Ohio up to Maine and included: the Patuxent Research, Susquehanna, Montezuma, Great Swamp, Wallkill River, Great Meadows, Assabet River, Rappahannock River Valley, Mason Neck, Back Bay, John Heinz, Erie, Cherry Valley, Great Bay, Lake Umbagog, Sunkhaze Meadows, Missisquoi, Moosehorn and Ohio River Islands refuges.

Pinkney said the bass indicate that many aquatic species in Northeast U.S. refuges may be exposed to estrogenic chemicals.

I’m David and I’m Hannah, both and yet neither. I’m just me

“This is who I am. I have survived these events and hope others can use the information to make their lives better”

intersex painting
Phycologicaly I feel both male and female. This is my normal, my world.” Luminis Kanto

I had most every one of those symptoms indicated and even more on your chart. In addition I came very close to death from chemotherapy on a number occasions during treatment. After eighteen years I have recovered from most effects accept the nerve damage to my extremities and some other problems.
This whole situation stems from fetal sexual development (Intersex) (DSD) resulting in one of my testis remaining as a fetal ovary until it became malignant as an adult. This could be from exposure to DES. In addition to all of these issue I also have gender issues that some people believe falls under the category of transgender. I on the other had believe this is purely an Intersex health issue caused by an EDC.
I did marry and been so for almost forty three years. We even managed to have two children over fiveteen year period of marriage. One of my testis did develop to about half of normal adult size as compared to the other totally undeveloped right testis.
Phycologicaly I feel both male and female. In addition I have hypogonadism, no surprise there. This is my normal, my world.

This is who I am. I have survived these events and hope others can use the information to make their lives better.
I was never told anything by the medical community ever as a child. I’m sure this all stems from their ignorance on the subject. There was also a sense that the medical community was in denial that people could be something other than just purely male and female. As a young child I saw first hand a very young boy with ambiguous genitila being subjected to sex change surgery. This was very confusing for me as a child and this was something I’ve carried with me my whole life. The thought I had as a ten year old child was that he was being punished for some abstract crime. I never spoke of this to anyone until I was an adult. Even when I did tell people I really don’t think most people can absorb that such things could happen or that some peoples sexual development wasn’t alway binary.
I really do not know for sure if I was exposed to DES or other EDC but my Intersex body development is consistent with such exposure. genedic blood tests have been done to see if what I have is an inherited this condition and nothing tested so far suggests that was the case.
I may never know for sure the root cause of my Intersex but doesn’t mean I haven’t accepted who I am.
I’m David and I’m Hannah, both and yet neither. I’m just me.

Some Intersex Resources

Ni Homme, ni Femme: le “Troisième Genre”

“Sexe neutre” : le “troisième genre” enfin reconnu en France?

Personne intersexuée: “Je suis la preuve indubitable que l’on peut vivre avec deux sexes“.

Une personne intersexuée – née avec des organes génitaux masculins et féminins – a été reconnue de “sexe neutre” par le tribunal de grande instance (TGI) de Tours (Indre-et-Loire) dans un jugement rendu le 20 août 2015.

En savoir plus

Intersex Friendly Resources

Happy #IntersexAwarenessDay ! #IAD #interACT

intersex-awareness banner
Media continues to play a vital role in spreading intersex awareness.

The Gay Straight Alliance Network, in collaboration with Inter/Act Youth, published a resource guide on How to Make Your GSA Intersex Friendly.

The work of the InterACT Youth Program continues to help spread awareness for the intersex movement. The most recent installment in the series of resource brochures published by the InterACT Youth Program, What We Wish Our Friends Knew, is referenced in the GSA Network Intersex resource.

The informative document includes a viewing guide to facilitate dialogue after GSA members watch the Buzzfeed video “What it’s like to be Intersex”.

Friendly Resources

  • PDF How to Make Your GSA Intersex Friendly.
  • PDF What we WISH our friends KNEW.
  • Video What it’s Like to Be Intersex.

More information

To Be Intersex explained on Video

What is it like to Be Intersex ?

A great video by Advocates for Informed Choice published on 23 June 2015, to share in celebration of ‪#‎IntersexAwarenessDay!.

More information
  • Featuring Alice Alvarez (AIC Board Member), Emily Quinn (Inter/Act Youth Leadership Coordinator) Pidgeon Pagonis (former AIC staffer), and Sean Saifa Wall (AIC Board President).
  • All our posts tagged intersex.
  • Read DES studies on fertility and gender identity.

The Parents who sued Doctors over their Toddler’s Sexual Assignment Surgery

Parents Sue Doctors For Deciding Their Kid Is A Girl

We just hate that there were choices made that could have a significant impact on his being able to be a man” said the parents who accuse hospital of negligence and medical malpractice for not getting the patient’s informed consent before surgery.

In 2013, in a first of its kind lawsuit, Greenville, S.C., residents Pam and Mark Crawford decided to sue the doctors who gave their adopted son sex assignment surgery while in foster care. MC, who had been deemed a female by doctors, had surgery at 16 months to “correct” his status as intersex (having both male and female genitalia), but is struggling with this assigned identity now at 10 years old. His parents are grieving that such a decision was made for him before he was able to make it himself.

Sources and more information