March 26, 2008 -- Among the important issues raised by the pregnancy of Oregonian Thomas Beatie is whether a female-to-male transgender person who becomes pregnant might be endangering the fetus, especially someone like Beatie, who has been taking testosterone for at least 10 years.
There's very little research on the subject, and experts have different opinions. Dr. Charles Garramoni, a Florida plastic surgeon who specializes in female-to-male transgender surgery (but was not involved in Beatie's case), said the chances of complications are probably slim.
"As long as he is under the strict care of a endocrinologist, as long he has hadn't just gotten the testosterone from the Internet or something, as long as the endocrinologist says everything is OK, there's no reason to think otherwise."
But Michael Bartalos -- a New York geneticist and internist who works with many transgender patients -- said that he would be concerned about the health of the eggs in Beatie's body.
Because women are born with all the eggs they will carry for life, long-time exposure to chemicals or hormones can have an adverse effect. Any possible damage done by 10 years of testosterone would be irreversible, he said.
And even if Beatie's baby is born healthy, he said, "Who knows what might happen to her in 20 years? [The baby] could be at higher risk for certain types of cancer development."
"This is uncharted waters, but as an endocrinologist I am concerned," adds Florida's Loreena Lewy-Alterbaum, who also works with transgendered patients. "Testosterone is stored in fat cells, so even after discontinuation there could be some effect on the fetus."
She says she'd be less concerned if the fetus were male because "a girl could be born with a masculine appearance, or the (residual hormone) could affect her brain development."
After ten years of taking the very high doses of testosterone necessary to suppress estrogen production, she says, even after discontinuation, the eggs could be compromised. "But do I have proof? I don't think anyone has proof," she says.
Lewy-Alterbaum thinks it would have been a safer bet for the couple to have considered other options, like donor eggs, for example.
Beatie, a small-business owner, created a stir this week after announcing he is six months pregnant. Beatie, who was born female, underwent sexual reassignment surgery 10 years ago but, like many transgender people, kept his reproductive organs intact.
Another issue is whether Beatie and others like him could be setting their children up for playground misery and years upon years on a psychiatrist's couch. But Katherine Rachlin, a psychologist who works with transgender people and their families, believes this worry is unfounded, if understandable.
"People often ask that question about transgender parents in general, but research shows that the children adjust fine," Rachlin said.
Rachlin said that she understands the reservations of people who have never been around transgender families, but said that in a case such as Beatie's, the little girl will have what appears to be an ideal life: financially stable parents who really wanted her from the start.
At any rate, it's "very likely that other children won't even know about the particulars of her birth."
Garramoni, who started changing female bodies into male bodies three years ago and has seen more than 100 patients, put it succinctly: "The kids understand. They just know that -- they say, these are my parents."
In a first-person article for The Advocate, a leading gay, lesbian, transgender magazine, Beatie said that his wife, Nancy was unable to bear children following a hysterectomy, so they made the decision that he would be artificially inseminated and carry the child.
Having children after sexual reassignment is not as unusual a decision as one might think, Garramoni said.
"It's certainly not unprecedented. Many people want to have their own child, or at least keep that option open," he said.
In many states, he added, adopting a child as a transgender person can be difficult or even unlawful.
"So when patients say they want to do that, I say 'great,'" Garramoni said. "People think trangendered are mixed-up, unstable people, but in my office we know that they are usually the most stable, grounded patients we have. They follow instructions, and the outcomes are usually positive."
Despite the possible risks, stable, grounded people -- in most expert opinion -- make good parents.
"The first five years of life sets the tone for the rest of the child's life," said Carol L.Clark, a licensed counselor and sexologist who practices in Florida
"When the first years are spent with a stable loving family the kid will probably be mentally healthy. And will probably later be able to deal with societies' conflicting values or mores."
Psychologist Rachlin agrees. "When a child has loving parents in many ways she has it all," she said. "In many ways this child will be a privileged child."