Nick Mulcahy

May 03, 2016

After urologist Ilene Wong, MD, sold her first novel to a division of publishing giant HarperCollins, a sales representative told her that the book was a "tough sell" because of its topic — a teen who discovers that she is intersex.

"My publisher went into this with low expectations," Dr Wong told Medscape Medical News.

Dr Wong, 39, a practicing surgeon in suburban Philadelphia who writes under the pen name I.W. Gregorio, wondered herself whether the book, None of the Above, had a "glass ceiling" because intersex, which has been called hermaphroditism, is often misunderstood and stigmatized.

An estimated one in 2000 births are intersex, which refers to anyone having genitalia or chromosomes that are different from the norm, she said.

Sales worries aside, Dr Wong had no doubts about her intentions in writing the book, which was published in 2015.

Dr Ilene Wong

During her urology residency at Stanford University in California, Dr Wong was strongly affected by a patient who was 17 years old when she learned she had XY chromosomes, internal testes, and no uterus.

At about the same time, in 2009, there was major media coverage of a high-profile female athlete, runner Caster Semenya from South Africa, who turned out to be intersex. The tone and content of the reporting served as a catalyst for her novel writing.

"I watched with sickened despair as the media made her alleged intersex condition a sideshow and a punchline," Dr Wong wrote in an online forum.

But since then, people who fall outside of the "gender binary" of male and female have made social and political gains in the United States.

For example, Laverne Cox, a transgender star on the American series Orange is the New Black, has been on the cover of Newsweek. And the ubiquitous Caitlyn Jenner was recently on the cover of Vanity Fair.

A law recently passed in North Carolina that blocks cities and local governments from enacting measures that could protect gay and transgender people has been widely condemned, including by the American Academy of Pediatrics.

None of the Above sold out its initial print run of 10,000 copies and is now in its fourth printing. It has been featured positively in pop-culture outlets such as, Teen Vogue, and USA Today.

So perhaps it should not have come as a complete surprise when, last week, the Lifetime broadcast network announced that the novel has been optioned for a television series. None of the Above is part of Lifetime's new Fempire directive, which focuses on shows "for women, by women, about women," and will include tennis star Serena Williams and pop music legend Janet Jackson.

In short, Dr Wong has arrived in Hollywood, a situation she described as "crazypants" on her website.

In addition to being an artist, Dr Wong has an educational mission. She will participate in a panel later this week at the American Urological Association (AUA) 2016 Annual Meeting in San Diego, entitled Disorder of Sex Development (DSD): Evolving Role of Patient Advocacy.

Medical education has served us poorly.

She believes there is a lot of room for improvement in training for urologists and other specialists in terms of the addressing the needs of gender and sexual-orientation minorities. "Medical education has served us poorly in terms of lesbian, gay, bisexual, transgender, queer, and intersex issues," she told Medscape Medical News.

Dr Wong is a champion of the term intersex, preferring it over the term "disorder of sex development" because the word disorder suggests something is "wrong."

She pointed out that Organization Intersex International and other advocacy groups do not endorse surgery to "normalize" intersex anatomy unless a child is old enough to have formed a gender identity and consent to surgery.

While she is in San Diego attending the AUA meeting, Dr Wong will be doing a public reading at the La Mesa Branch of the San Diego County Library (8074 Allison Ave; May 6 at 6:00 pm).

Teens are much more open to gender being a spectrum rather than a binary.

None of the Above is classed as a "young adult" novel, which means that teens are the main audience. "Teens are much more open to gender being a spectrum rather than a binary," she explained.

Dr Wong was an avid reader growing up in Utica, New York, where she was raised by her grandparents and aspired to write children's books. She double-majored in English and biochemistry at the University of Pennsylvania in Philadelphia, and went on to earn a master's degree in creative nonfiction writing from Johns Hopkins in Baltimore. But less than 2 years later, she decided to go medical school and attended Yale University in New Haven, Connecticut.

Dr Wong is the mother of two young children and is married to Joseph Gregorio, a musician and composer.

Her desire to communicate with young people about the beauty of human diversity was part of her inspiration for None of the Above, which is mostly set in an American high-school environment.

"I introduce teens to these complex but vital questions. I wanted people to realize that the girl next door could be intersex — and that it wouldn't change who she was," she said in a previous interview.

The main character of the novel, Kristin Lattimer, has androgen-insensitivity syndrome, which typically consists of an XY chromosome, a high level of testosterone, no uterus, undescended testes, and a shallow vagina. She is a champion hurdler with a full scholarship to college and is in love with her boyfriend. When the young couple attempt intercourse for the first time, Kirsten realizes her anatomy is atypical and seeks medical attention.

Dr Wong has said that she was "haunted" by her Stanford patient who inspired the novel. The young woman came to the clinic alone and appeared to have no support. "What did her peers think, if she ever disclosed to them?" Dr Wong said.

Dr Wong's aspiration to provide readers with books about the vast range of human experience and identity has led her to become involved in We Need Diverse Books, a nonprofit organized by authors of young adult and children's books.

So that makes her a nonprofit volunteer, mother, surgeon, and author. "No, I don't get much sleep," she writes on her website.

American Urological Association (AUA) 2016 Annual Meeting. To be presented May 6, 2016.


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