Tuesday, May 17, 2011

A tale of two genders

As we stumble toward the end of our endocrine/reproductive unit, I find myself even more grateful for my awesome PLACEment* with a pediatric endocrinologist. Learning about congenital adrenal hyperplasia one day and seeing a patient with it the next? Yes, please! But despite all the interesting patients I saw today (look up dysautonomia and be simultaneously shocked and intrigued), a story my preceptor told me really took the cake. For about 15 years, he's had sporadic contact with a patient who was born in a foreign country with ambiguous genitalia. Because of certain cultural issues, a surgeon was immediately called to choose a gender. The baby had testes and a phallus of sorts, but because the phallus was small and sort of clitoris-like, the surgeon elected to remove the testes and begin the process of vaginoplasty as soon as possible. With no karyotyping first. The child turned out to be 46XY, that is, genetically male with no gross chromosomal abnormalities and, unsurprisingly, has identified as male since he was old enough to express this identity (that is, age 5 or 6). The result of the surgical intervention: a transgender person who identifies as male and has female genitalia that were constructed out of the male gonads and somewhat ambiguous phallus he possessed at birth. Isn't that wild?

Oh, yeah, food! I ran out of camera battery and so didn't photograph the little mini-casseroles I made: sweet potato with sage and caramelized onions, topped with cheddar that got delightfully toasty in the oven. I also ate about half a head of broccoli with it. I may have a problem. In any case, to make a serving of this casserole, roast a large sweet potato until soft, and caramelize some onions in the meantime. Cool the potato and onions somewhat, then mash everything together with an egg, a tiny bit of milk, and some sage, salt, and pepper. Put it in muffin cups or small ramekins, top with cheddar cheese, and bake at 375 until the cheese on top is brown and bubbly.

*Refresher: Each of us is assigned a doctor to hang out with once a month as part of our PLACE program. Many people are dissatisfied with their experiences. I love mine.

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