The DES Sons Online Discussion Network: Critical Issues
and the Need for Further Research
by Scott Kerlin, Ph.D. and Dana Beyer, M.D.,
DES Sons' Online Discussion Network
Contacts: Scott Kerlin: skerlin@pacificcoast.net;
Dana Beyer: wbb3@cornell.edu
DRAFT Report (for reference and discussion only) Edition Update: August 2002
Introduction: Background of Available DES Research
During the 1980s and 1990s an increasing amount of public and scientific attention was paid to the health and medical problems of women whose mothers and grandmothers took diethylstilbestrol (DES). DES was the first available synthetic estrogenic drug, a sex hormone promoted by Sir E. Charles Dodds, professor of biochemistry at the University of London in 1938 (Apfel & Fisher, 1984; Orenberg, 1981). DES was prescribed by many doctors as a "wonder drug" for women, most notably for the prevention of miscarriages but also for a number of other health needs including treatment of menopausal symptoms. It was used chiefly during the years of 1941-1971 by millions of women in the U.S. and hundreds of thousands of women in other countries. At its height of popularity DES was manufactured by more than 200 companies (chief among them, Eli Lilly) under a wide variety of brand names (Martin v. Abbott Laboratories, 1984).
Though its efficacy was doubted by many researchers, DES became extremely popular during the early 1950s, when it is estimated that some medical centers in the U.S. gave the drug to as many as 5 to 7 percent of all pregnant mothers (Saunders, 1988). It remained on the market until the U.S. Food and Drug Administration (FDA) banned the drug following publication of research in the early 1970s identifying a link between DES and a rare form of vaginal cancer in females (commonly called "DES daughters") whose mothers used DES (Berkson, 2000; Braun, 2001). Tragically, some of these females died very young of the consequences of DES-induced cancer.
The discovery of the carcinogenic potential of DES in humans led to a broad public education campaign to reach individuals who had been exposed to DES, with the bulk of attention being focused on DES Daughters and mothers. It also heightened interest in the biomedical research communities about studying the short and long-term effects of DES exposure. The bulk of DES research has emphasized further study of its carcinogenic impact and its relationship to infertility and deformation of the female reproductive system in DES daughters (National Cancer Institute DES Research Update, 1999). Some effort has been made also to monitor health effects in mothers who were prescribed DES (DES mothers), including a heightened incidence of breast cancer.
Research on the continuing effects of DES has opened the door to serious study of the health and public policy implications of environmental estrogens and other toxins (Krimsky, 2000), in particular the prevalence of estrogen-mimics: substances which simulate natural estrogens. As attention to environmental health issues in the U.S. grew during the 1990s, some researchers advocated a broader investigation into the full impact of DES exposure on humans (Colborn, Dumanosky, & Myers, 1996; Cunha, et al., 1999; Solomon & Schettler, 2000). Long-time DES researcher and professor John McLachlan at the Center for Bioenvironmental Research at Tulane and Xavier Universities labeled DES as an environmental "endocrine disrupter" (McLachlan & Arnold, 1996; McLachlan, 1997; McLachlan, 2001; McLachlan et al., 2001).
Researcher D. Lindsey Berkson (2000), a DES daughter and consulting scholar at the Center for Bioenvironmental Research, describes hormone disruptors in her book Hormone Deception as "chemicals (or mixtures of chemicals) from outside the body that can interfere with the development or function of body systems in humans and wildlife, especially in their offspring, and may lead to irreversible adverse health effects" (Berkson, 2000, p. 14).
In documenting a range of issues associated with DES exposure in humans, Berkson urges others to consider fundamental questions about the impact of environmentally-produced estrogens and how they can affect not just our physical health, but also some of our most significant aspects of psychosocial human development, including the formation of gender identity, sexual orientation, and maintenance of reproductive health for both females and males. As an area of scientific inquiry, measuring the effects of endocrine disruptors tends to follow a "systems model" of thought: holistic, multifactoral, and multidisciplinary. It is rooted in investigation of developmental and evolutionary biology as well as in the medical field of endocrinology (McLachlan, 2001), and as such, provides the makings of a new paradigm for studying the workings of the human reproductive system and hormonal influences on human development.
Some of the most recent discoveries about the effects of DES have been in areas of genetics research. It has been recognized that DES suppresses the activity of particular genes which normally play a vital role in the development of the male and female reproductive tracts and in sexual differentiation (Block et al., 2000; Travis, 1999). Recent studies of male grandchildren of the women who took DES decades ago suggest they may be at greater risk for certain conditions such as hypospadias (Klip et al., 2001, 2002; Tunick, 2001).
One affected population which has received inadequate attention from the biomedical and health research community is DES-exposed males (the term "DES sons" is commonly used). It is estimated that up to 5 million mothers used DES in the U.S. (Giusti et al., 1995), and possibly as many as 2-3 million male offspring of these women were exposed in utero. Hundreds of thousands of DES sons were also born in other countries between the 1940s and 1970s.
Compared with research on DES daughters, there is a paucity of published research studies and public awareness focusing directly on the health effects of DES sons. The reasons for this remain at question, although evidence points in part to a history of inadequate commitment to male reproductive and sexual health issues by the DES-exposed victims' advocacy groups which first called for public investigation about the effects of DES in the 1970s. It is also quite possible that the level of public awareness and U.S. governmental funding for further DES research was kept deliberately narrow (i.e. focusing on "known effects" such as vaginal cancer) and other areas of potential health effects were simply not addressed by public health research funding agencies.
The research studies on DES sons that have obtained greatest public attention have involved a handful of controlled "cohort" studies comparing exposed DES sons with unexposed peers. These studies each have involved a few hundred males and limited the scope of investigation to male infertility, increased potential for testicular cancer, and predicting the likelihood of genital malformations (Gershman & Stolley, 1988; Leary et al., 1984; Strohsnitter, et al., 2001; Wilcox et al. 1995). In most cases, researchers' findings from these studies were reported as "inconclusive", leaving many unanswered questions about whether DES is directly linked to any of these health conditions. Arguably, these cohort studies raise more questions than provide sufficient answers for the entire global population of exposed males. They represent the dominant trend in much of primary DES research: you get what you're looking for, nothing else. Because DES has been outlawed for prenatal use since the 1970s, no more controlled experiments can be developed for assessing the impact on human males or females. In experimental research with DES, only animal research is allowed.
In spite of the limited availability of large sample studies of DES sons, there is other documented evidence that DES has had detrimental health effects for a significant number of prenatally exposed males (Gill, et al., 1988; Giusti, et al., 1995; Laitman et al., 1997). These include increased risk of testicular cancer and a variety of structural abnormalities of the reproductive system such as epididymal (benign) cysts, hypoplastic testes or undescended testes (chryptorchidism), microphallus or underdeveloped penis which may be associated with an intersex condition, newly-identified "testicular dyssynergia", and hypospadias (opening of the penis is on the underside rather than at the end)(Klotz, L., 1999; Koskimäki, J. et al., 1999; Sharpe, R., 2001; Strohsnitter, et al., 2001). Recent research has also examined greater incidences of hypospadias among male offspring of DES daughters (Klip & Verloop, 2002). Studies documenting the physical effects to the reproductive systems of DES exposed males are the most common, and research on this subject is continuing in the 21st century, particularly in Europe.
A few studies have documented the therapeutic benefits of using DES for treatment of advanced prostate cancer (Agency for Health Care Policy and Research, 1999; Denis, 1998; Takezawa Y., et al., 2001), a practice that was fairly common until a few years ago. The principal benefit of using DES for such treatments is the rapid diminution of testosterone production, however its use for this treatment has also been associated with elevated blood pressure, impotence, depression, and feminization in males (BC Cancer Agency, 2001).
Some research has also investigated the neurological system links between DES exposure and increases in anxiety and depression in males as well as in females (Katz, et al., 1987; Meyer-Bahlburg, et al., 1985; Pillard et al., 1993; Saunders, 1988). A few reports have investigated possible associations between DES exposure in males and testosterone deficiency or hypogonadism (Hofnagel, D., 1976; Wortsman, J., Hamidinia, A., & Winters, S. J., 1989), but this topic needs more investigation in conjunction with recent studies of male andropause (Carruthers, M., 2001; Mailhot, J., 2001).
It has been recognized by some behavioral scientists and biomedical researchers that prenatal DES exposure in males and females may affect psychosexual development, sexual orientation, and sexual differentiation in later years (Amelsvoort, Compton, and Murphy, 2001; Bem, 1996; Gill, 1988; Gorski, 1998; Hines, 1982; Kohl, 1996; Meyer-Bahlburg et al., 1995; Reinisch, et al., 1991; Rogers, 1999; Solms & Turnbull, 2002; Toppari & Skakkebaek, 1998), in part because of its potential to alter the fragile hormonal balance between testosterone and estrogen levels, particularly in exposed males. Berkson (2000) contends that in humans, "for a male to become a male and a female to become a female, male and female hormones must be present in the mother in the right amount at the right time between fertilization and birth" (p. 42).
Berkson further states,
One cheeky irony of life is that how masculine a man is as an adult is partly the result of his having had the optimal amounts of estrogen in his brain at a certain time during his stay in the womb. Amazingly minute differences---parts per trillion of a few sex hormones---literally affect the making of men or women. Most certainly this new understanding of how estrogens work together emphasizes just how fundamental estrogen signals are in directing the development of life (p. 43).Berkson notes that endocrine disruptors such as DES can have "gender bending" effects in males: "too much estrogen (or not enough androgens) will cause de-masculinization in males" (pp. 130-131). Similarly, Toppari & Skakkebaek (1998) acknowledge that estrogenic substances such as DES have demasculinizing and feminizing effects in the developing human male fetus. Hines (1998a) demonstrates that prenatal exposure to DES is an influencing factor in sexual differentiation of human behavior, introducing effects on core gender identity and sexual orientation, and also playing a role in fostering intersexed conditions (i.e. ambiguous genitalia) in males and females.
In recent years, researchers have increasingly examined developments within the brain associated with gender identity and sexual differentiation in humans (Cardoso, 1997; Hines & Collaer, 1993; Hines, 1998a and 1998b; Matsumoto, 1999; Raloff, 1994; Rogers, 1999; Zhou, et al., 1995). Some research has been identified which examines the potential association between exposure to endocrine disruptors and increased likelihood of transsexualism or intersex conditions (Cohen-Kettenis & Gooren, 1999; Michel, et al., 2001; Slabbekoorn et al., 2000). The Endocrine Society in 2000 produced a patient fact sheet that associates DES exposure and feminization in males (Endocrine Society, 2000). One question that remains is whether scientists will eventually confirm a direct causal link between prenatal DES exposure and gender identity disorders and what would be the social, legal, and medical implications of doing so.
Although there has been limited ongoing research about the psychosexual impact of DES exposure in human males, studies examining possible feminizing effects were produced as early as the 1970s (Barr, 1973; Green, 1978; Kester et al., 1980). One probable reason for the limited availability of research documenting effects of DES exposure on male sexuality and gender identity is that most males afflicted have neither known of their exposure nor been aware of its potential effects. There have been few public educational campaigns about the impact of males' prenatal exposure to DES. In addition, many men feel uncomfortable discussing their health or medical questions with professionals (Meth & Pasick, 1990; Reese, 2000). Men are often more reticent about self-disclosure with their physicians, with therapists, and with one another than are females. It has taken great efforts to convince men to openly discuss issues such as depression and infertility let alone sexually related problems. It has required the potential of a huge market for the drug Viagra to stimulate public discussion of erectile dysfunction; it even required the development of the euphemism "erectile dysfunction" to replace "impotence" before some men became comfortable with the issue.
Among many males, discussions or honest admissions of feelings about masculinity, sexual orientation, and gender identity are very sensitive and often fraught with internalized conflict (Kimmel, 1996; Nardi & Schneider, 1998; Vance, 1995). Open discussion of these issues in our culture carries inherent risks among all men (Osherson, 1992) and thus they are more commonly withheld or repressed. This is particularly true among males who identify as gay, bisexual, or transgendered or who suffer from a range of gender identity concerns. For researchers interested in the full scope of effects of DES exposure on males this lack of forthrightness can be a formidable obstacle, not unlike the obstacles faced by researchers who seek to understand the diverse dimensions of human sexuality and behavior (Abramson & Pinkerton, 1995).
Formation of the DES Sons Online Discussion Network
In July 1999, Scott Kerlin, a DES son born in 1953, organized the DES Sons online discussion network following many years of investigative research about DES and its effects on males and females. The sons' network is an Internet-based discussion community of individuals who have joined after learning about the network through postings on the DES Action website and through a variety of other networks on health issues. As an interdisciplinary social science and biomedical researcher, Kerlin has taught social science and human development research courses to university undergraduates and graduate students in the U.S. and Canada and also has considerable experience with conducting online interviews, managing online academic discussion forums, and developing qualitative and quantitative research.
The creation of the DES sons' online network was an outgrowth of nearly 20 years of examination of research about human sexuality, gender issues, and reproductive health. It was developed with a number of primary goals in mind. Most importantly, it was formed to fill the need for greater interconnectedness among DES exposed males from around the world, since no large-scale communications network among DES sons had previously existed. By comparison, DES daughters have had the opportunity to interact via the DES Daughters discussion forum for many years, and the DES Cancer Network has long existed to fill the need for female victims of DES-related cancer.
The DES sons' online network was also formed to expand awareness about the range of existing research about DES and males' health and to explore other issues affecting the physical, mental, sexual, and psychosexual health of DES sons-particularly issues which had been suggested in previous existing research studies about DES and males but which has needed further investigation. To the extent that the DES Sons list has functioned as a "research forum", it has done so through providing an avenue for DES exposed individuals to discuss personal issues that have affected them via the online environment, which is a medium that often facilitates discussions of issues people feel are too sensitive in face-to-face environments.
The tools and features of online forums like the DES Sons discussion network provide the opportunity for conducting a type of qualitative research in health care (Pope & Mays, 2000) that enables a collective engagement of issues raised by participants and fresh insights for participants and researchers (see Fetterman, 1998 for a detailed focus on ethnographic research in online environments and Murray, 1997, for a discussion of using "virtual focus groups" in qualitative health research). Thanks to the Internet, a health researcher has the ability to study patient populations which, by virtue of a low incidence rate, were never able to be "gathered" in one place before.
Through a more qualitative emphasis in the online environment, a researcher can apply what Wildemuth (1993) describes as "the interpretive approach, with its goal of understanding the social world from the viewpoint of the actors within it, [which] is oriented toward detailed description of the actors' cognitive and symbolic actions, that is, the meanings associated with observable behaviors" (p. 451). This aspect of meaning-making among list participants has enabled exploration of health and identity issues among DES sons that may have eluded past researchers who have focused solely on using experimental or "case-control" methods to prove or disprove hypotheses about DES exposure. In this sense, it exemplifies a way that holistic qualitative inquiry can be used to match the systemic research paradigm needed for assessing the full impact of environmental endocrine disruptors-allowing new issues to emerge.
What has been learned so far from the DES Sons Discussion Network?
As of July 2002, the DES Sons online network included more than 130 active members, including Dr. Beyer, who joined the forum in 2000. Many list members have also corresponded privately and extensively with Kerlin or Beyer about issues they believe are related to the impact of DES exposure but that they felt were too sensitive to disclose to other members of the forum. A number of list members have participated in one or more of three private DES issues online "chats", each lasting 2.5 hours and conducted by Kerlin with Beyer's assistance. These chats have served as online equivalents of focus groups and have featured topics based on list members' requests (testosterone deficiency, cancer, depression, and gender/sexuality issues).
Initially, the sons' network was formed with no specific topical focus intended beyond providing a network for DES-exposed males. However, prior to approving a prospective list member's subscription, Kerlin requested that each applicant provide a brief overview of health concerns and past health issues as well as a confirmation of DES exposure. Most members who joined the network indicated that they had learned of their likely DES exposure either through a parent or sibling, but a few members could only speculate about, not confirm, their exposure.
Many of the issues and conversations on the DES sons list reveal the complexity of doing research on the effects of DES exposure in males. In an effort to assess the most critical factors concerning list members, Kerlin conducted a poll in early 2001 on the chief concerns of DES sons (see APPENDIX A) and nearly all members at the time (N=40 in February 2001) participated. Over a quarter had issues relating to sexuality, gender identity and reproductive health. These include transsexualism (another issue the medical establishment is not comfortable discussing), impotence, hypogonadism (low testosterone) and infertility. Nearly 20% had primary concerns with psychological and emotional health, particularly depression and anxiety, and 20% had primary concerns regarding their overall physical health including testicular cancer, hypospadias, and various urological malformations.
APPENDIX B contains the results of a survey conducted among a larger number of network members in August 2001 and indicates which issues are of greatest priority in future network discussions. Among nearly 45 respondents, the top five areas of concern were (in rank order): (1) Physical health concerns (e.g. hormones, infertility, erectile dysfunction, cancer); (2) gender issues (including gender identity, transgenderism, and transsexualism); (3) promoting more DES research in the future; (4) sexual identity issues (including sexual orientation and intersex); and (5) psychological and mental health issues (including anxiety and depression).
APPENDIX C provides an overview of the most recent poll of members of the DES Sons' network. Members were asked (anonymously) to indicate the one term pertaining to their gender or sexual identity or sexual orientation that they felt most described how they self-defined among their closest friends.
This poll demonstrated that among the 63 sons' network members who answered the question (approximately 70% of active network members at the time of that poll), the largest number (23, or 36.5% of respondents) identified as "transsexual" (pre- or post-op), while another 15% identified as transgendered, and 13% identified as "intersexed" or "androgynous." "Straight males" represented 17.5% of respondents (the second highest response group), while 13% identified as bisexual or gay males.
After approximately one year of the sons' network existing, some members began to raise issues with regard to sexuality, sexual orientation, and gender identity. Over subsequent months, these issues became more substantial in list discussions, at times becoming the dominant themes raised by members. As a result of significant attention to gender and sexual diversity issues among some network members, a support group (DES Trans) for these members was formed in January 2002. As of July 2002, more than 100 individuals voluntarily joined DES Trans, approximately 60 are also members of the DES Sons' network. This underscores the significance of gender identity and intersex condition as major concerns among a significant portion of persons who have been exposed to DES.
Many sons' network members have discussed a psychological experience of having felt "feminine" in their inner lives and had numerous challenges in managing relationships and social lives as a result. These members have attributed their personal experiences as linked to DES exposure and its attendant psychosexual side effects. However, this "feminization phenomenon" does not seem to be universally experienced by DES-exposed males within the network.
Conclusions
The DES Sons online network has provided fresh insights about the scope of experiences in DES-exposed males. It has led to new questions about the full impact of DES exposure on the health and well-being of males, extending beyond those issues at focus in the cohort studies of DES males published by Leary et al. (1984) and Wilcox et al. (1995) and the so-called "comprehensive" published review of research on effects of DES exposure in males by Laitman et al (1997). While network members do not necessarily represent a true "cross-section" of all exposed males, their most pressing concerns are supported in the broad body of published research on endocrine disruptors and DES.
Our findings suggest that new avenues and levels of sensitivity are needed among researchers who seek to uncover the continuing mysteries of DES exposure in humans. We believe that great benefit can occur through sharing of such research insights among biomedical researchers, health and medical professionals working directly with DES exposed daughters and sons. Much more compassion and outreach are needed among researchers wishing to further understand the scope of medical as well as the social and psychological impact of DES exposure in males. This suggests a collaborative role for social researchers (particularly researchers interested in issues of gender, sexuality, and male health) working with health and medical professionals and educators. Together they can work to raise consciousness about the potential psychosocial and emotional factors in DES exposed males and females which may be more difficult to detect and assess than physical symptoms.
We also believe strongly that the need exists for further research and educational outreach for DES sons (see questions we have proposed for guiding our further inquiry, listed in APPENDIX D). Many DES exposed males with the most significant problems reproductive system failures, gender identity issues, sexuality, infertility and depression - are likely unaware of any connection with DES. It may be that such knowledge will help provide a safe channel in which DES sons can find support to confront these very challenging and perplexing conditions.
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DES-Related Information and Research Websites
I. General DES Information Sources
A Brief History of DES (Diethylstilbestrol)
This timeline is provided by the DES Cancer Network for Women (http://www.descancer.org) and includes references to the range of companies that manufactured DES. http://www.descancer.org/timeline.html
ARC Known Carcinogens: Diethylstilbestrol
A report from the National Toxicology Program of the National Institute of Environmental Health Sciences describing in detail the carcinogenic impact of DES on animals and on humans.
DES Chemical Datasheet from the National Toxicology Program of the National Institute for Environmental Health Sciences (NIEHS)
This is a comprehensive fact sheet on DES, including various product names, effects on humans, and chemical/toxic makeup. Notable for its list of likely symptoms when taken orally by adults.
DES Action U.S.A.
A national, non-profit consumer organization dedicated to informing the public about DES and helping DES-exposed individuals. They publish a quarterly newsletter, The DES Action Voice, and many publications on various aspects of DES exposure. They also claim to provide a link between DES-exposed people and researchers and the medical community. Most of the emphasis is on DES exposed females, and outreach/support for DES sons is quite limited.
DES Action Canada
The official website for the office of DES Action Canada, with many helpful resources. http://www.web.net/~desact/
DES Sons' Information Page, from DES Action Canada
This is the most comprehensive summary on DES health issues for exposed males.
DES Research Update: Current Knowledge, Future Directions, 1999
This is the official website for the 1999 conference on DES Research that was held at the headquarters of the National Institutes of Health, Bethesda, Maryland. It shows the scope and limitations of current federally-funded (U.S.) research interests about the effects of DES exposure in humans.
Modus Operandi of an Infamous Drug: Diethylstilbestrol
An article originally published in Science News Online in 1999, this full-text reproduction discusses the genetic impact of DES and provides links to additional full-text articles covering DES.
Questions and Answers about DES: Cancer Facts
From the National Cancer Institute's CancerNet website, this information focuses chiefly on the potential for cancer in DES daughters but also briefly discusses cancer potential for DES sons. http://www.meb.uni-bonn.de/cancernet/600034.html
The Story of DES: A Cautionary Tale
This revealing timeline of DES development and the discoveries (much later) of its dangerous effects is excerpted from Women and the Crisis in Sex Hormones, by Seaman and Seaman, 1971. http://www.oxford.net/~tishy/des.html
II. DES Research: Effects on Human Health, Sexuality, and Gender Development
Chemicals Linked to Declining Male Reproductive Health
A 1996 article by Jorma Toppari et al, "Male Reproductive Health and Environmental Xenoestrogens" published in Environmental Health Perspectives is discussed in this paper, which includes a focus on the impact of DES exposure on males. http://www.monitor.net/rachel/r514.html
Chemical Profile for Diethylstilbestrol
A very comprehensive fact sheet of hazardous potential of DES, produced by Environmental Defense.
Development of the Cerebral Cortex: Sexual Differentiation of the Central Nervous System, by Dr. Roger Gorski, Source: Journal of the American Academy of Child & Adolescent Psychiatry, 37(12): 1337-1339, 1998. This article contains many references to the impact DES may have on sexual differentiation in humans.
Do Environmental Estrogens Have Negative Effects on the Human Reproductive System?
This article by Jessica Spencer of the Emory University Department of Chemistry examines the chemical structure and the research covering effects of DES and other "environmental estrogens."
Effects of Estrogen Treatment on Sexual Behavior in Male-to-Female Transsexuals: Experimental and Clinical Observations, by Marie Kwan, Judy VanMaasdam, and Julian M. Davidson
This article discusses various treatments of transsexuals with hormone therapy and the resulting effects; one client is included who was given DES as a primary estrogen. http://www.transgender.at/nettext/te-effec.html
Endocrine Disruptors: The State of the Science (1997)
This report by Ted Schettler MD, MPH of the Greater Boston Physicians for Social Responsibility defines what endocrine disruption is, and contains many references to the effects of DES. http://www.psr.org/tedfs.htm
Endocrinology and Environmental Estrogens
A fact sheet from the Endocrine Society that discusses the impact of synthetic estrogens (including DES) on the endocrine system.
Endocrine active environmental chemicals and sexual differentiation of central nervous system and reproductive organs: Steroid hormone-regulated gene expression (research proposal)
This proposal is from Prof. W. Lichtensteiger and Dr. M. Schlumpf of the University of Zurich, and includes significant focus on DES and possible effects.
Environment and Health: Endocrine Disruption and Potential Human Health Implications
This study by Gina M. Solomon and Ted Schettler was published in 2000 in the Canadian Medical Association Journal and discusses the effects in humans and animals of exposure to DES and other environmental hormone system (endocrine) disruptors. http://www.cmaj.ca/cgi/content/full/163/11/1471
Environmental and Occupational Hazards and Male Infertility
A guide to various causes of male infertility, diminished libido, and other hormonal effects of environmental estrogens such as DES, sponsored by the Department of Urology of the State University of New York, Stony Brook. http://www.uhmc.sunysb.edu/urology/male_infertility/Environmental_and_Occupational_Hazards.html
Environmental Effects on Reproductive Health: The Endocrine Disruption Hypothesis
Article by Dore Hollander reproduced from the March/April 1997 issue of Family Planning Perspectives, this includes a section covering the effects of DES.
Estrogen Actions in the Brain: A Symposium to Honor the Contributions of Roger Gorski
An article from CNS Drug Reviews, Vol. 5 (1), 77-82 available in pdf format.
Evidence of Endocrine Disruptors Impact on Human Health
This paper was produced by Professor Stephen Safe, a Distinguished Professor of Veterinary Physiology & Pharmacology at Texas A&M University, and presented for the Center for Health Effects of Environmental Contamination at the University of Iowa. It contains significant discussion about the potential effects of DES exposure in humans. http://www.cheec.uiowa.edu/conferences/edc_2000/safe.html
Exotic Becomes Erotic: A Developmental Theory of Sexual Orientation, by Daryl J. Bem, Cornell University
The full text of a major research study on the impact of various factors (including the possible effects of DES exposure) on the development of sexual orientation in humans. http://www.psych.cornell.edu/dbem/ebe_theory.html
Hormonally Active Agents in the Environment, by the National Research Council and Commission on Life Sciences
This full-text reproduction of the 2000 book is available on the web as part of the National Academy Press online publications collection (www.nap.edu) and contains substantial discussion of DES and other environmental hormone disruptors. Highly-recommended for serious researchers! http://www.nap.edu/catalog/6029.html
Human (DES) Exposures and Human Health Effects
A paper by Dr. Richard Miller on the effects of DES and other hormone disruptors in humans, provided by McMaster University (Canada) Department of Biology.
Human Pheromones: Mammalian Olfactory, Genetic, Neuronal, Hormonal, and Behavioral Reciprocity and Human Sexuality
An article originally published by James Vaughn Kohl in the journal Advances in Human Behavior and Evolution, which includes refere