Sexuality–DES Research Highlights


[This page is dedicated to Professor Milton Diamond, world-renowned clinical sexologist and a personal supporter of my ongoing research in human sexuality and psychosexual development.]

This page is an extension of my primary references page on Sexuality

Through the 25 years that I have maintained my counseling practice, my research and professional counseling interests have included human sexuality and all of its various dimensions. Many people have written to me seeking advice and support for their questions about sexuality and identity.

I am a member of the American Psychological Association Division 44: Society for the Psychology of Sexual Orientation and Gender and the American Association of Sexuality Educators, Counselors and Therapists (AASECT).

 My Academic Research Into Prenatal Hormonal Influences on Gender and Sexual Development in Men and Women, 1995 to 2020 (DES Research)

Overview: I have more than 20 years of interdisciplinary research into the effects of prenatal exposure to estrogenic and androgenic hormones on subsequent human behavioral development (including sexuality and gender identity), a field with extensive research investigation begun in the 1970s by Dr. June Reinisch, former director of the Kinsey Institute (see, for example, her 1984 journal article in Progress in Brain Research) and Dr. Dick Swaab of the Netherlands Institute for Neuroscience (see his co-authored 2010 article on Sexual Hormones and the Brain, published in the journal Pediatric Neuroendocrinology).

Evaluation of Existing Published Research on Prenatal Hormones and Gender Development:

There is prominent  literature on prenatal androgens and association with variations in gender and sexual development. Much of the existing published research on hormonal influences over gender identity development and the human brain focus only on impact of prenatal androgens and female development (for examples, see Berenbaum & Beltz, 2017, How Early Hormones Shape Gender Development, Hines, 2011, Annual Reviews on Gender Development and the Human Brain, and Hines, 2010, Sex-Related Variation in Human Behavior and the Brain from the journal Trends in Cognitive Sciences.)

There is far less long-term research on prenatal exposure to estrogens in males and psychosexual development (cite Yalom, Green and Fisk, 1973, Journal of the American Medical Association and Meyer-Bahlburg, 1978, published in the journal Pediatrics).  This is an area that I have researched in depth and which led me to launch an online research network in 1999: DES-Sons International Research Network.

DES stands for “Diethylstilbestrol“, a non-steroidal estrogenic drug that was given to millions of women in the U.S. and other countries during the 1950s to 1970s (and beyond) for management of pregnancy. An estimated 5 million “DES daughters” and “DES Sons” were born in the U.S. and many more in Canada, Europe, and Australia. DES is classified as an endocrine disruptor because of its detrimental effects on the development of the endocrine system. 

A substantial array of adverse effects of DES has been documented in mothers and their offspring. Here is an excellent, if somewhat dated research article from 2013:

Research into the possible inherited effects of prenatal DES exposure for third-generation “DES grandchildren” has also been published since 2000. An example:

History of My Research Into Human Health Effects of DES in Males: 

As a verified DES Son, I have held long-standing interest in the array of adverse effects of prenatal DES exposure in males, which I began to investigate in 1995.

Historically, DES daughters had a primary impact on the scope of research. Not long after beginning my own investigation, I immigrated to Canada, where I became involved with the advocacy group DES Action Canada as research specialist on DES sons. 

When I first created the DES Sons’ network in 1999, my aim was to document the full range of reportable adverse effects in males. It is important to note that compared with DES Daughters, there were relatively few published studies that investigated the full range of adverse health effects in males.  Here are a few examples of published research:

Within the first few months of my formation of the DES Sons’ network, I interviewed and surveyed each member to determine (1) likeliness of confirmed prenatal DES exposure; (2) health history and evidence of any documented physiological or mental health difficulties. I also conducted a series of polls of members in order to determine which issues were most prevalent in areas of concern. My own investigation revealed outcomes in many DES sons that paralleled what was documented in published research. 

Emergence of Gender-Related Concerns Among Network Members:

During conversations among network participants, several members reported a variety of issues and concerns related to gender identity, gender dysphoria, and transgenderism. The evolution of this topic is reported on DES Sons and the Significance of Gender Identity.

In the years 2002-2004 I participated as a Visiting Research Scholar in Psychology at the University of Victoria (Canada). During this period I conducted a scholarly literature investigation about hormones and human sexual behaviour, focused on the biological and psychological frames of reference for conducting scientific studies of human sexual development. My investigative research continued during 2005-06 at the University of British Columbia in Vancouver.

Highlights and Timeline of My Research Investigation:

2007 to the Present: 

The initial findings from my research, presented to international conference (International Behavioral Development Symposium in Minot, North Dakota) in 2005, provided the opportunity to explore the validity of a hypothetical correlation between prenatal DES exposure in males and females and variations in core gender identity and sexual development across the lifespan. Meanwhile, the DES Sons Research Network and its companion DES-Trans Transgender Support Group have continued to be active into 2020.

For several years subsequently, the question of whether prenatal estrogenic hormone exposure in males can be directly linked to gender dysphoria, transexualism, transgenderism, intersex, and variations in sexual orientation has been further investigated by others. Though no definitive conclusion regarding the role of prenatal DES exposure in shaping psychosexual development in males and females has been reached, there is now (2020) a much broader array of promising investigative study devoted to this question. 25 years since beginning my own research investigation, I find this truly encouraging. 

Here are some representative examples of others’ investigations and findings.

Other Published Research Into Prenatal Influences on Sexual Orientation and Gender Identity: 

2020: Newest published research into prenatally DES-exposed males and females:

Gender Identity and Sexual Orientation Identity in Women and Men Prenatally Exposed to Diethylstilbestrol (2020), by Rebecca Troisi, et al., published in the Archives of Sexual Behavior.

My Observations on this Publication:

(1) This “study” was based on a single-question methodology in 2019 for sexual orientation and gender identification, using the long-term DES Combined Cohort Study of DES Sons and DES Daughters, funded by the National Cancer Institute. Such a methodology is often used by researchers who wish to place limits on any controversial or previously unexpected findings that might interfere with their dominant research focus. In the case of the DES Combined Cohort, the NCI-funded research has always emphasized an effort to statistically measure trends in cancer prevalence in DES Sons, DES Daughers, and DES Mothers.  To the best of my knowledge, the Combined Cohorts are the only current population samples of DES Sons and DES Daughters in the U.S. that are still being monitored systematically.

(2) The timing and motivation and purpose for this “study” is intriguing to me. I believe it has been driven by politics, not science. It has come at a time (2019/20) while the U.S. is experiencing a phase of severe anti-transgender and anti-LGBTQ politics within the current Trump administration. Of special note is that the current Secretary of the U.S. Department of Health and Human Services, Alex Azar, was President of the U.S. division of Eli Lilly and Company between 2012 and 2017. Lilly was the largest producer of DES in the U.S. for many years. There is no doubt in my mind that Azar must have been aware of various stories regarding DES adverse health effects because over the years, Lilly has faced several lawsuits.

As with most research on DES Combined Cohorts, this study does not have a sophisticated foundational understanding of prenatal hormones and psychosexual development. However, I suspect it is now being used by HHS or NCI as a “definitive study” of this question, meant to “put to bed any ‘rumors’ that DES exposure might be implicated in any “controversial” adverse effects.

(4) In 2003, a time when the right-wing George W. Bush administration (the Bush family had deep financial connections with Eli Lilly going back to the administration of George H.W. Bush)  was overseeing DHHS and Bush was accused of politicizing the agency with right-wing bias, a similar NCI-funded “study” was published by long-time DES cohort  researchers Linda Titus-Ernstoff et al., Psychosexual Characteristics of Men and Women Exposed Prenatally to Diethylstilbestrol. The article’s conclusion: “our findings provide little support for the hypothesis that prenatal exposure to DES influences the psychosexual characteristics of adult men and women.” No small irony, many of the researchers in the 2003 study (based also on the DES Combined Cohorts) are cancer research specialists, and none are sexuality experts. I personally participated in the 2003 “CDC DES Update Conference” which included a call-in portion for audience participants, and I along with several other participants challenged the 2003 study for its anti-LGBTQ biases. Titus-Ernstoff and other presenters confirmed that the focus on the DES Cohort studies was to assess cancer risk and outcomes and that other subjects were just not deeply or systematically investigated. 

(5) The 2020 publication is not a reference standard on measuring the true scope of psychosexual effects of prenatal DES exposure in males and females. In my own research with DES sons, I learned that many have a history of suffering from gender dysphoria that is not easily measured by a simple question in a survey.