The off-label use of a steroid called dexamethasone in pregnant women has the medical community sharply divided, Time reports. The drug is being prescribed to expectant mothers who may be carrying female fetuses affected by an adrenal disorder called congenital adrenal hyperplasia (CAH). Girls affected by the condition usually have genitals that look more male than female — though their internal sex organs are normal. Dexamethasone, or dex, is prescribed to prevent this outward symptom of CAH.

While dex has been shown to prevent ambiguous genitalia in girls with CAH, it doesn’t treat the actual condition. Some doctors question if the drug, which hasn’t been approved by the FDA for treating CAH in-utero, should be used during pregnancy at all.

New York endocrinologist Maria New, the doctor at the center of the dex debate, recommends this off-label, in-utero use of the steroid based primarily on a study conducted in Sweden that was too small to be definitive. The medical and ethical quandaries surrounding this use of dexamethasone are abundant, and New has been accused of doing human research on the drug without gaining proper approval.

Dr. Walter Miller, the chief of endocrinology at University of California, San Francisco, worries that not nearly enough is known about the drug to rationalize its use in this way. Because it must be administered as early into a pregnancy as possible — usually well before doctors can identify whether the fetus is a CAH-affected female — a number of mothers and children may be unnecessarily exposed to the drug, the long-term effects of which are not known.

But New has come under fire for more than just the off-label use of a risky steroid — she’s also accused of promoting the use of dex to prevent homosexuality and bisexuality in girls. The pediatric endocrinologist and her long-time collaborator, psychologist Heino F. L. Meyer-Bahlburg, have been tracing evidence for the influence of prenatal androgens in sexual orientation. Together they’ve attempted to show that prenatal androgens have an impact on the development of sexual orientation, and that treatments with prenatal dexamethasone might cause these girls’ behavior to be closer to heterosexual norms. According to an article about homosexuality at the Bioethics Forum

"In a paper published just this year in the Annals of the New York Academy of Sciences, New and her colleague, pediatric endocrinologist Saroj Nimkarn of Weill Cornell Medical College, go further, constructing low interest in babies and men — and even interest in what they consider to be men’s occupations and games — as 'abnormal,' and potentially preventable with prenatal dex.

In the Annals article, the authors wrote: “Gender-related behaviors, namely childhood play, peer association, career and leisure time preferences in adolescence and adulthood, maternalism, aggression, and sexual orientation become masculinized in ... girls and women with 21OHD deficiency [CAH]. These abnormalities have been attributed to the effects of excessive prenatal androgen levels on the sexual differentiation of the brain and later on behavior.” 

David E. Sandberg, a University of Michigan pediatric psychologist who treats and conducts research on children with CAH, argues that normalizing gender behavior is not a reasonable goal of clinical care, while professors and philosophers in the field of bioethics worry that this view of homosexual orientation could lead to new attempts at pathologization and prevention.