Views & Reviews Outside the Box

The feminisation of nature

BMJ 2011; 343 doi: (Published 30 December 2011) Cite this as: BMJ 2011;343:d8348
  1. Trisha Greenhalgh, professor of primary health care, Barts and the London School of Medicine and Dentistry, London
  1. p.greenhalgh{at}

This year marks the 25th anniversary of the start of a scientific survey of the feminisation of fish in the River Lea in southeast England, which took several years formally to confirm what local anglers had been describing since the late 1970s: that roach living downstream of sewage effluent showed a high prevalence of intersex.

Can you recall the biochemical pathway that begins with cholesterol and progresses through progesterone and various hydroxylations to oestrogen, testosterone, and cortisol (summarised on the “steroid …

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