“What is it you want?”
“Tawny has androgen insensitivity syndrome, doesn’t she?”
No reply.
“The lack of menses at puberty. The height, the large breasts, the abundant head hair.”
“You seem confident in your diagnosis. Why call me?”
“I need verification.”
“I’m sorry but—”
I fired another zinger. “Tawny may have killed Pomerleau. She may be murdering children.”
A deafening quiet came down from Montreal.
“Young girls. Four so far. Maybe six.”
“Where?”
“Does that matter?”
“No.”
“Well?”
“Her medical status, which I am not confirming, would be relevant for what reason?”
“DNA was recovered from one victim, a fourteen-year-old girl. Amelogenin testing indicated it was left by a male. That finding has pointed the search for her killer in what I now suspect is the wrong direction.” I didn’t complicate the discussion by mentioning Pomerleau’s DNA.
“How does this involve me?”
“I think you know.”
“One moment.”
I heard movement, guessed Lindahl was closing a door.
“Tawny came to me following an unimaginable ordeal, as you know. I cannot divulge details of our conversations, but five years in that basement left her terribly damaged.”
“Fine.” For now.
“We dealt with her immediate issues first. As I gained her trust, Tawny opened up, eventually talked of concerns about her body.”
Lindahl paused to collect her thoughts. Or to devise a strategy for revealing only what was essential. “Tawny had never menstruated, never grown underarm or pubic hair. The doctors told her it was due to a combination of poor diet and constant stress. Advised that, with time, she would catch up.
“In many ways, she did. Tawny grew tall, grew busty, but other changes never took place. At my suggestion, she agreed to be tested. If I chose the doctor and accompanied her. Which I did.” Pause. “What do you know about androgen insensitivity syndrome?”
“The basics. It’s a condition that impacts sexual development both prenatally and at puberty. Persons with AIS can’t respond to androgens, male sex hormones. I’m sketchy on the underlying genetics.”
I regretted the last as soon as the words left my mouth. I didn’t want a lecture. Was anxious to establish only one thing.
“Androgen insensitivity syndrome is caused by mutations in the AR gene, which encodes for proteins called androgen receptors. Androgen receptors allow cells to respond to hormones that direct male sexual development.”
“Testosterone.” No matter my preference, the lecture was coming down. I wanted to hurry it along.
“And others. Androgens and their receptors function in both males and females. Mutations in the AR gene prevent the androgen receptors from working properly. Depending on the body’s level of insensitivity, an affected person’s sex characteristics can vary from mostly female to mostly male.”
I tapped my nails on the desktop, impatient to get what I needed. To confirm what was keeping my pulse in the stratosphere.
“AIS patients present across a spectrum of severity. Complete androgen insensitivity syndrome, or CAIS, refers to the body’s total inability to use androgens. CAIS individuals have the external sex characteristics of a female but abnormally shallow vaginas and sparse or absent pubic and axillary hair. Such individuals lack a uterus, fallopian tubes, and ovaries, and have undescended testes in the abdomen.”
“They can’t menstruate or become pregnant.”
“Correct. A milder form of the syndrome, PAIS, results when the body’s tissues are partially sensitive to the effects of androgens. Persons with PAIS—also called Reifenstein syndrome—have normal male or female form, virilized genitalia or a micropenis, internal testes, and sparse to normal androgenic hair.”
“With both CAIS and PAIS, the karyotype is 46,XY?” I shot to the core.
“Yes. Though outwardly female, these individuals are genetically male.”