House asks Cameron whether she noticed that Alex had pubic hair or not during her vaginal exam. "What are you getting at?" Cameron asks, fearing something along the lines on "if there's grass on the field, play ball!" She answers that there wasn't much. House says that their patient has been described as completely docile, and has never had a period. "She's the ultimate woman," he concludes. Well, I think it's safe to say that this episode was written by a man.
Alex gets her third MRI of the episode. This time, her twitching is gone, thanks to the IV Ig. Cameron doesn't see the point of this exercise, since Wilson did an ultrasound on the area and only saw some small ovaries. House says that they aren't looking for ovarian cancer -- they're looking for "that." Whatever "that" is, it shocks the hell out of Cameron. It also has a tumor on it. You know, no one on this show ever gets, like, normal cancer. They have to have crazy cancer that hides from scans and makes the body attack itself.
House enters Alex's room. Her dad is at her side, of course. House says that they found a tumor after all. "So she has cancer?" Dad asks. "Technically, no," says House, bringing everyone's hopes up. Oh, but wait -- Alex does have cancer. She just isn't a "she." Alex is a boy, and he has testicular cancer. You see, Alex has X and Y chromosomes, but she also has a condition that makes her immune to testosterone. When you develop in the womb, you start off with gonads -- undifferentiated genitals. The Y chromosome has an SRY gene that creates testes out of the gonads. The testes then produce testosterone that signals the fetus to create male parts. If there's no signal, female parts are made by default. Complete Androgen Insensitivity Syndrome, like Alex has, makes the body immune to testosterone, so that signal is never received, and the fetus becomes phenotypically female while still being chromosomally male. Alex doesn't have a uterus, which is why she never got her period. As a consolation prize, she has those undescended testes. And now they have cancer. That's a one-two double punch of sucky news right there. "You're pure estrogen," House says, which is what made her such a great model, since it gave her that clear skin and great boobs. "The ultimate woman is a man," House concludes. This probably also made lesbian viewers cheer. Meanwhile, Dad looks horrified. He accuses House of making a sick joke. House says that if he were going to tell jokes, he would call Dad a homo for sleeping with a guy. Ha! Alex just looks shocked. Soon she'll be trying to figure out if there's a way she can fuck the cancer to make it leave. Hey, she herself admitted that she isn't very smart. Neither is Wilson, I'd say, since I find it really hard to believe that he missed those two testes Alex had sitting there in her abdomen, one of which was made even bigger by that tumor! And Wilson totally missed the fact that her uterus DIDN'T EXIST! This was really Wilson's time to shine, and he failed miserably. If he wasn't so happy to roll joints for his patients, he'd be the Worst Oncologist Ever.