In January, the New England Journal of Medicine published a study of 16 genetic males whose ages ranged from 5 to 16 years old. They were identified between 1993 and 2000 and followed for between three and eight years. All 16 boys were born with a birth defect known as cloacal exstrophy, which results in a small or absent penis, despite being genetically and hormonally male. Fourteen were surgically reassigned, dosed with hormones, and raised as females at birth, treatments their parents were warned to keep secret in the interest of their child's psychological health; the other two did not have surgery, and the parents chose to raise them as males. Of the 14 who had treatment, eight of the children later independently declared themselves as male, five labeled themselves female, and one refused to discuss the topic altogether. The two boys whose parents rejected surgery for them considered themselves male. On psychological testing, all 16 had interests, activities, and behaviors that are considered typical of males.