As Nature Made Him: The Boy Who Was Raised as a Girl

13

KEITH SIGMUNDSON REMEMBERS his discomfort on seeing the advertisement. It appeared, he says, sometime in the 1980s in an American Psychiatric Society newsletter, and it said: “Will whoever is treating the twins please report.” Below this entreaty was a name and address: Dr. Milton Diamond, University of Hawaii-Manoa, John A. Burns School of Medicine, Honolulu.

“I saw it,” Sigmundson says, “but I couldn’t bring myself to answer.”

In the ten years that had elapsed since Brenda’s switch to David in 1980, Sigmundson had toyed with the idea of publishing the true outcome of the case. He hadn’t done it, and for a very simple reason. “I was shit-scared of John Money,” he admits. “I didn’t know what it would do to my career.” It had been one thing for Sigmundson to cooperate with the BBC documentary and appear as an unidentified psychiatrist speaking about “difficulties” in the twin’s psychological adjustment. It would be quite another to challenge a man of Money’s power directly by publishing a signed article describing how his most widely publicized and influential case had failed from the outset. Sigmundson put the idea out of his head. Diamond’s ad was an awkward reminder. At first, Sigmundson almost answered it, but he had resisted the urge.

Money himself also mastered any urge he might have felt to publicize the case’s outcome. After his encounter with the BBC reporters in October 1979, he dropped all direct references to the case from his published papers, books, and public lectures. To many in the field of sexual development, his sudden silence on the subject was perplexing.

Virginia Prince, a pioneering transvestite activist who founded the first magazine for cross-dressers, Transvestia, in 1960, was one of those curious about the fate of the case, since it had played a significant role in her own acceptance of herself and her sexuality. Born a male, Charles Prince was in his early teens when he first started dressing in women’s clothes for erotic gratification—a clandestine activity that continued even after his marriage and the birth of his son. In his forties, Prince began to live full-time in the role of a woman, divorcing his second wife and changing his name to Virginia. Though a fully “out” transvestite by the time she learned of the twins case, Prince says that the story of the sex-changed baby nevertheless had a profound impact on her.

She first learned of it at a meeting of the Society for the Scientific Study of Sex (or Quad-S), an association of sex researchers and activists for which Money served as president for two years in the early 1970s. It was at a November 1972 Quad-S meeting in Palm Springs, California, that then-president Money gave a sneak preview of the twins case—one month before its wider unveiling at the American Association for the Advancement of Science in Washington, D.C.

“John presented pictures of the twins,” Prince recalls. “One photograph was of the two kids playing. The girl had a bow in her hair and was wearing a little dress; she’s sitting in the front of a wheelbarrow, and her brother is driving her around. The other was a portrait—a snapshot, but it was posed. The little boy’s got kind of a scowl on his face, and he’s not attempting to make a good showing. But the little girl is sitting up straight and smiling and looking at the camera, just as if she’s saying, ‘I’m happy as a clam.’ That’s the picture that got stamped on everybody’s mind.”

For Prince, Money’s twins case was encouraging proof that sex and gender were not an immutably preordained biological phenomenon. At every subsequent meeting with Money, Prince asked for an update on the twins’ progress. Ordinarily Money was happy to oblige. “He was very upbeat and happy with the results and proud [of] what was done,” says Prince. At a lecture in Los Angeles a decade later, that attitude had changed, Prince recalls. It had been some time since she had heard Money comment on the case, and Diamond’s paper on the BBC’s investigation was yet to be published. “I asked him, ‘Whatever became of the twins?’” Prince says. “He wasn’t very forthcoming. He seemed to be a little bit put out that I should ask the question. He was very short about it.”

At Johns Hopkins, Money grew similarly tight-lipped about the case. Deflecting questions about the twins when the topic arose on the wards or in his classroom, Money told especially inquisitive students and colleagues that he had “lost track” of the experiment after a “media invasion” by reporters. “He said that this family had been victimized by the BBC,” says Money’s former student Howard Devore, and that “the family and the case had been irreparably damaged as a result.” Money offered a similar explanation for his silence to his protégé, Dr. June Reinisch, a psychologist who had become head of the Kinsey Institute after studying with Money in the 1960s. “[He said] he’d been cut off from the family because they had somehow blamed him for the BBC,” Reinisch says.

This interpretation of events does not accord with Janet Reimer’s recollections. She says that even after the BBC’s visit to Winnipeg, she stayed in touch with Money. “I wrote him a letter about David switching back to being a boy and about what was happening in his life,” Janet says. “David had got his [settlement money from the hospital] by then. He was already dating girls—maybe not dating, but hanging out with girls.” Janet says that Money wrote back. “He said he would like to hear from David and Ron. And I wrote him a letter stating the truth: ‘Ron and David do not wish to communicate with you.’ I said, ‘I’m telling you that as a friend; I don’t want to give you a feeling of rejection, but they just don’t want to deal with you.’” Janet says that Money retained a studious neutrality in his letters about the news that Brenda was now David. “He never let on that he was disappointed,” Janet says. They continued to exchange letters sporadically through the 1980s. Money wrote to Janet about a trip he had made to Zimbabwe; he informed her of his bout with prostate cancer; and he mentioned the removal of his Psychohormonal Research Unit from the main campus of Johns Hopkins in 1986.

Apparently forgetting this exchange of letters, Money continued to insist to his scientific, academic, and medical colleagues that the case was “lost to follow-up”—a surprising claim if for no other reason than that the Reimers continued to live in the very house that Money had visited in 1979 and with the same telephone number that he had used to contact them.

While Money refrained from mentioning the twins case directly in his public statements after 1980, he continued to lecture on the efficacy of infant sex reassignment for boys with no penis, and Johns Hopkins Hospital continued to perform the procedure, even when an alternative treatment was developed in the mid-1970s by Dr. Mel Grumbach at the University of California, San Francisco, for cases of boys born with small penises. He discovered that he could increase phallus size in babies born with micropenis by giving injections of testosterone to the organ shortly after birth. In patients whose bodies were responsive to the hormone, the penis could be made to grow to a length that permitted standing urination and conventional copulation.

Grumbach spoke about the procedure at the Seventh Annual Birth Defects Institute Symposium on Genetic Mechanisms of Sexual Development, held in November 1976 in Albany, New York. He was surprised to discover that he could not earn an endorsement for the procedure from Johns Hopkins, still the single most influential hospital for intersex treatment. The meeting’s chairman, Johns Hopkins pediatric endocrinologist Robert Blizzard (who had worked as a consultant to Money on Bruce Reimer’s conversion to Brenda back in 1966), articulated the hospital’s decision not to adopt the California team’s treatment plan. “I think that we will be able to answer the question concerning the preference of rearing of those with [micropenis] in a few years—although not immediately,” Blizzard said in his closing remarks to the symposium. “I believe that Dr. Grumbach’s group on the West Coast is going to do what they believe is correct; namely, raise these children as boys; and our group on the East Coast are going to do what they think is correct; namely, raise these children as girls.”

John Money was Johns Hopkins’s most tireless promoter of that decision in the years that followed, stating in interviews, speeches, books, and papers that sex reassignment to girlhood was the sole option for baby boys with micropenis—or boys who, like David Reimer, had lost their penis to injury. At a meeting of the National Institute of Child Health and Human Development in September 1987, Money mentioned such infant sex changes as being among his most important clinical contributions to medical science. The occasion for Money’s comments was a ceremony at which he was being honored as one of four scientists in the country who had, for twenty-five consecutive years, been funded with taxpayers’ money by the National Institutes of Health. “In syndromes of male hermaphroditism and micropenis, and in cases of ablatio penis from circumcision trauma, when there is insufficient phallic tissue for surgical reconstruction of an adequate urinary and copulatory penis, a baby may be assigned and clinically habituated as a girl,” Money told the NIH audience in his acceptance speech. “In adulthood, comparison of such cases with those living as males without a penis shows a higher prevalence of satisfactory outcome in those living as females.”

Money’s comments were curious for at least two reasons: (1) no systematic follow-up studies had ever been published by Money, or Johns Hopkins, that demonstrated the prevalence of this satisfactory outcome, nor have there been in the years since Money’s remarks; and (2) at the time that he described the ability of doctors to successfully change the sex of developmentally normal boys to girls in cases of penis loss, the only such experiment he had followed from babyhood to adulthood was that of Brenda Reimer—an experiment that had failed fully seven years earlier, when Brenda had become David.

14

MILTON DIAMOND SAYS that he cannot recall what spurred his decision to refocus his attention on the twins case at the dawn of the 1990s. He says that he had simply grown impatient with the silence around the experiment. “My thinking at that time was, This person has to be an adult now,” Diamond says. “We should be able to write an article about this.”

Further incentive for returning to the subject was soon provided by Money himself, who in 1991 published Biographies of Gender and Hermaphroditism in Paired Comparisons, a career-summing monograph on his forty years of work at the Psychohormonal Research Unit. Presenting his largest collection to date of “matched pairs” the book was Money’s latest defense of his theory that social learning overrides biological imperatives in the shaping of human sexual identity. Missing from the text was mention of the definitive test for his thesis—his ultimate matched pair: the sex-changed twin and her brother. In the book’s introduction, Money explained the mysterious absence of the case from this otherwise comprehensive volume—an absence that he insinuated owed something to the machinations of his longtime challenger, Milton Diamond.

“On the international academic scene,” Money wrote, “doctrinal rivalry regarding the origins of gender identity led to an alliance with an unscrupulous media”—here he inserted a parenthetical reference to Diamond’s 1982 paper on the troubled case—“that prematurely terminated a unique longitudinal study of identical twins. A BBC crew of television sleuths, incited by the prospect of airing a doctrinal dispute, traced the whereabouts of the twins and their family and unethically invaded their privacy for programming purposes.” Money provided no information about Brenda’s 1980 decision to become David, and this brief reference, with its hint that Diamond was somehow connected to the case’s premature termination, marked Money’s last published comment on the case.

Perhaps understandably, Diamond was disinclined to allow this innuendo-steeped passage to stand as the final historical word on the twins experiment. That the academic community at large accepted Money’s version of events was clear from yet another book published that year: John Money: A Tribute, a collection of essays written on the occasion of Money’s seventieth birthday. Replete with paeans to Money’s scholarship from longtime acolytes, including Anke Ehrhardt and June Reinisch, the volume also included a fulsome tribute from Dr. John Bancroft, a psychiatrist and clinical consultant at the Royal Edinburgh Hospital in Scotland, who is now director, of the Kinsey Institute. A behaviorist who was a believer in the primacy of rearing over biology in sexual orientation, Bancroft had taken this nurturist view to its logical conclusion in his clinical work. As a sex therapist in Great Britain, he had experimented with trying (in vain) to convert adult homosexuals to heterosexuality through aversion therapy. In his tribute to Money, Bancroft referred with tart disapproval to the “recurring attack from Diamond” and went on to cast doubts on the veracity of the information Diamond had reported from the BBC about the psychological difficulties Brenda had suffered.

“Money has reported her development at various stages, consistent with his theoretical expectations,” Bancroft wrote. “However, since the prepubertal stage, the scientific community has received no further authoritative reports, but rather rumors (not from Money) of troubled developments.” He moved on to defend Money’s decade-long silence on the case, casting it as evidence of Money’s scrupulous care for the emotional health of his research subjects. “In a case such as this,” wrote Bancroft, “when the attention of the scientific community (and in this case the media also) is focused on a particular individual, it is easy to see the need to withdraw and be silent to protect that individual; it must be extremely difficult to be the living test of a controversial theory!”

With his own academic integrity now being questioned, Milton Diamond did not have the luxury of withdrawing and being silent. Since the late 1970s and through the ’80s, he had made periodic inquiries (and placed at least one ad) seeking information from endocrinologists and psychiatrists about the case. But now he resolved to redouble his efforts to learn the fate of the twin.

Through the BBC, Diamond found the name of a psychiatrist who had worked on the case—Dr. Doreen Moggey. That spring, he called her.

It had been fourteen years since Moggey terminated therapy with Brenda. She told Diamond that she did not know the final outcome of the experiment. She did, however, offer to give Diamond a phone number for the man who had overseen Brenda’s psychiatric treatment: Keith Sigmundson.

“I remember the first words Sigmundson said to me when I called,” Diamond recalls with a chuckle. “It was to the effect of ‘I was wondering how long it would take for you to get here.’”

By that time Sigmundson was living in Victoria, British Columbia, where he had become head of the province’s Division of Child Psychiatry. “Mickey said, ‘Keith, we gotta do this,’” Sigmundson remembers. At first Sigmundson tried to beg off, but Diamond, he says, “kept on badgering me a little bit.”

As someone who had seen firsthand the results of a reportedly successful sex reassignment, Sigmundson was inclined to agree with Diamond’s thesis that the procedure of turning baby boys into girls was wrongheaded. Still, Sigmundson had been warned by colleagues that Diamond was a “fanatic” with an ax to grind. Further conversations with Diamond and a reading of his journal articles convinced Sigmundson otherwise. “I came to see that Mickey is a serious researcher and a caring guy who really believed that Money’s theory had caused—and was continuing to cause—great harm to children.” Sigmundson agreed to contact David Reimer and ask if he would be willing to cooperate with a follow-up article on his life.

“I wasn’t sure what it was all about,” David says about the call he received that spring from Sigmundson. At that time David had been married for less than a year and wanted nothing more than to put his tortured past behind him. Sigmundson was persistent, however, and David finally agreed to meet Diamond and see what happened.

Diamond flew to Winnipeg to meet David. Over lunch at a local diner, David learned for the first time about his own fame in the medical literature and how the reported success of his case stood as the precedent upon which thousands of sex reassignments had since been performed—and continued to be performed. “ ‘There are people who are going through what you’re going through every day,’” David recalls Diamond telling him, “ ‘and we’re trying to stop that.’”

David was staggered. “I figured I was the only one,” he says. “And here Diamond tells me they’re doing all these surgeries based on me. That’s why I decided to cooperate with Mickey.” And there was another reason: David sensed in Diamond one of those people whose response to his sufferings was not purely detached and clinical. “When I told him a few things about my life,” David says, “I saw that Mickey had tears on his cheeks.”

Over the course of the following year, David and his wife and mother recounted to Diamond and Sigmundson the story of David’s harrowing journey from boy to girl and back again. Using these interviews plus the detailed clinical records that had accumulated at the Child Guidance Clinic, Diamond set out, as the paper’s lead author, to write up the results. He had promised the Reimers anonymity, agreeing to obscure their location, to omit the names of the local physicians, and to refer to David by pseudonym—or rather pseudonyms, since Diamond was faced with the narrative problem of retelling David’s double life as both he and she. He settled on the solution of calling David variously Joan (for when he was Brenda) and John (following his switch back to his genetic sex). Only in a conversation with me two years later did Diamond notice that he had bestowed on John/Joan the Christian names of Money’s two most important collaborators: Drs. John and Joan Hampson—an act that Diamond assured me was purely unconscious.

Written over the winter of 1994, the paper cast David’s life as living proof of precisely the opposite of what Money had said it proved. Citing the Kansas team’s classic work from the late 1950s, Diamond wrote that David’s case was evidence that gender identity and sexual orientation are largely inborn, a result of prenatal hormone exposure and other genetic influences on the brain and nervous system, which set limits to the degree of cross-gender flexibility that any person can comfortably display. Diamond argued that while nurture may play a role in helping to shape a person’s expressed degree of masculinity or femininity, nature is by far the stronger of the two forces in the formation of a person’s private inner sense of self as man or woman, boy or girl.

Powerful as the paper was in presenting anecdotal evidence of the neurobiological basis of sexuality, it also served as a clear warning to physicians about the dangers of surgical sex reassignment for all newborns—not just those like David who are born with normal genitals and nervous system. Diamond argued that the procedure was equally misguided for intersexual newborns, since physicians have no way of predicting in which direction the infant’s gender identity has differentiated. To change such children surgically into one sex or the other, he argued, was to consign at least half of them to lives as tortured as David’s.

Accordingly, Diamond and Sigmundson offered a new set of guidelines for management of babies with ambiguous genitalia. Recognizing that a child must be raised as either a boy or a girl, they recommended that doctors continue to assign a firm sex to the baby—but only in terms of hair length, clothing, and name. Any irreversible surgical intervention, they said, must be delayed until the children were old enough to know, and be able to articulate, which gender they felt closest to. Or as Diamond put it to me, “To rear the child in a consistent gender—but keep away the knife.”

Diamond was aware that writing the paper would inevitably raise the specter of a personal vendetta against Money. To minimize this danger, he removed from David’s quoted utterances all reference to the famous psychologist. “In fact,” Diamond says, “Money’s name is only mentioned once. I didn’t want it to be an argument ad hominem. I wanted it to be a theoretical discussion.”

Nevertheless it took Diamond and Sigmundson two years to find someone willing to publish their paper.

“We were turned down by all these journals that said it was too controversial,” says Sigmundson. “The New England Journal, The Journal of the American Medical Association.” The article was finally accepted by the American Medical Association’s Archives of Pediatrics and Adolescent Medicine in September 1996, with publication set for March 1997. In the intervening months, Diamond and Sigmundson felt considerable apprehension as they waited for their bombshell to go off. “We were basically telling all these physicians that they’d been doing the wrong thing for the past thirty years,” Sigmundson says. “We knew we were going to be pissing a lot of people off.”

Some critics, as expected, attempted to dismiss the paper on the grounds that Diamond was simply using David’s history to embarrass a scientific rival, but at least one physician who saw a prepublication copy of the paper was inclined to agree strongly with its conclusions. Dr. William Reiner had two years earlier launched the first comprehensive long-term follow-up study of patients who had been sex reassigned. Trained as a pediatric urologist, Reiner had actually spent the first eighteen years of his medical career in California performing “normalizing” genital surgeries on intersexual children. It was early in his career that Reiner had his first glimmer of doubt about the Johns Hopkins treatment model. “I got babies and two-year-olds and four-year-olds and eight-year-olds and sixteen-year-olds,” he says. “So I really saw a longitudinal view of all these urological conditions—all these birth defects—and I was therefore able to visualize in a relatively short period of time the kinds of effects that these conditions have on the lives of these kids and their families.” Then, in 1986, Reiner met a patient who changed his life.

She was a fourteen-year-old girl—a Hmong immigrant—who had announced that she was dropping out of high school because she was “not a girl.” To all outward appearances an anatomically normal female, she had nevertheless always rejected girls’ play and had insisted on wearing gender-neutral clothes. At puberty she had arrived at the unshakable conviction that she wanted to change sex and live as a male. Referred to Reiner to discuss the possibility of reconstructive surgery, she was threatening suicide unless her wishes were met.

“I had a complete medical workup on the child done,” says Reiner. Tests revealed that “she” was biologically a he—a 46XY male who suffered from a rare chromosomal condition that prevents masculine differentiation of the genitals. Reiner performed sex change surgery, after which the former girl effortlessly assumed the sex written in his DNA. The case convinced Reiner of what he had suspected for years: that the biological underpinnings for psychosexual identity are not so easily overridden by social and environmental rearing as he (and every other pediatric urologist, endocrinologist, psychiatrist, and psychologist) had been taught. This further forced Reiner to the uncomfortable conclusion that he had been doing the wrong thing in his surgical career in helping to steer intersexual children into one sex or the other at birth. In a 1996 edition of the Journal of the American Academy of Child and Adolescent Psychiatry, Reiner published a paper on the Hmong case, along with a warning to his fellow physicians about the long-accepted theory that rearing prevails over biology in shaping human sexuality.

Reiner also did something else. After eighteen years as a surgeon, he put down his scalpel. He began to retrain as a child psychiatrist specializing in psychosexual development and intersexual conditions. In 1995 he was hired by Johns Hopkins as an assistant professor in psychiatry. There he launched his study on the long-term psychosexual implications of sex reassignment. Reiner set out to follow sixteen patients, focusing particularly on six genetic males who were born without penises and as a result were castrated and raised as girls. Two years into his study, he noted that all six sex-changed boys were closer to males than to females in attitudes and behavior. Two had spontaneously reverted to being boys without being told of their male (XY) chromosome status.

“These are children who did not have penises,” Reiner told me, “who had been reared as girls and yet knew they were boys. They don’t say, ‘I wish I was a boy’ or ‘I’d really rather be a boy’ or ‘I think I’m a boy.’ They say, ‘I am a boy.’” Reiner stressed the parallels between the children he was studying and David Reimer, who also “knew,” despite his rearing as Brenda, that he was not a girl. Reiner wrote a supportive editorial in Archives of Pediatrics and Adolescent Medicine to accompany Diamond and Sigmundson’s John/Joan paper.

Today Reiner says that both David’s case and the trend in his own study support the findings that have emerged on the primacy of neurobiological influences on gender identity and sexual orientation. He cites the now-classic study done at Oxford University in 1971, which showed anatomic differences between the male and female brain in rats. Six years later, at UCLA, researchers narrowed these differences to a cluster of cells in the hypothalamus. A study done in the mid-1980s in Amsterdam located the corresponding area in the human hypothalamus, noting that it is twice as large in homosexual as in heterosexual men. Further studies have supported this finding. In 1993 and again in 1995, researcher Dean Hamer announced that in two separate studies of gay male brothers, he had found a certain distinctive pattern on their X chromosomes. The finding suggested that sexual orientation may have a genetic component.

Although Hamer’s studies have failed to be replicated by other scientists, few sex researchers today dispute the mounting evidence of an inborn propensity for acting as, and inwardly identifying with, a particular sex. “It’s quite clear that the vast majority of boys born with functioning testicles have masculine, brains,” Reiner says. He endorses Diamond and Sigmundson’s recommendation to delay surgery in cases of penile loss or intersexuality and to impose only a provisional assignment that can be changed should the child voice a strong desire to live as the other sex. Reiner suggests that this treatment model is diametrically opposed to the one pioneered at Johns Hopkins by Money and his colleagues, in which a sexual identity is imposed on a child through unshakable fiat of physicians, and any doubts or confusions the child may express about the assignment are denied by caregivers. Reiner says that on the basis of David’s case and the others he has studied, the decades-old Johns Hopkins treatment model needs to be reevaluated. “We have to learn to listen to the children themselves,” he says. “They’re the ones who are going to tell us what is the right thing to do.”

Before Diamond and Sigmundson’s journal article appeared in the Archives of Pediatrics and Adolescent Medicine in March 1997, the American Medical Association’s public relations department alerted the media that something explosive was coming. On the day of the article’s publication, the New York Times ran a front-page story headlined SEXUAL IDENTITY NOT PLIABLE AFTER ALL, REPORT SAYS, in which writer Natalie Angier described David’s life as having “the force of allegory.” Twenty-four years after publishing news of the case’s success, Time magazine ran a full-page story declaring, “The experts had it all wrong.” Similar news accounts appeared around the world—and soon Diamond and Sigmundson were deluged with calls from reporters in several countries seeking an interview with the young man now known simply as John/Joan.

David agreed to appear on two television newsmagazine programs. He was shown in darkened silhouette on ABC-TV’s Primetime Live and with his face obscured in a Canadian Broadcasting Corporation documentary. It was during the latter taping, which took place in New York City in June 1997, that I was introduced to David by Diamond and Sigmundson. The researchers had passed along to David the names of the many reporters who had requested an interview with him, but David (a rock ’n’ roll fan) had chosen the reporter from Rolling Stone.

At that first meeting with me, David was nervous and guarded. He explained that his childhood had made it difficult for him to trust strangers, but later, over a beer at the Hard Rock Cafe, he grew more relaxed. He spoke about how his parents and brother had been crucial supports in a childhood that he described as “a pit of darkness.” I soon learned that a formidable sense of humor had also played a role in his survival. Describing the physical differences between himself and his heavier, slightly balding twin, he shouted over the pounding music, “I’m the young cool Elvis. He’s the fat old Elvis.”

But the strongest impression I was left with was of David’s unequivocal masculinity. His gestures, walk, attitudes, tastes, vocabulary—none of them betrayed the least hint that he had been raised as a girl. And indeed, when I asked whether he thought his extraordinary childhood had given him a special insight into women, he dismissed the question. David had apparently never been a girl—not in his mind, where it counts. He insisted that his conversion from Brenda at age fourteen marked nothing more than a superficial switch in name—as if the double mastectomy, two phalloplasties, and lifelong course of testosterone injections he needs to compensate for his castration were mere details. “I’ve changed over,” David said, “but mainly by name. The rest was all cosmetic. I just had repaired what was damaged. That’s all.”

Through the summer and fall of 1997, David’s story continued to receive media coverage. With this coverage, another set of voices in the debate over the heretofore unexamined practice of infant sex reassignment began to be heard. These were the voices of those intersexes born after the publication of Money’s 1955 protocols—people in their thirties and forties who as babies had undergone normalizing genital surgeries and sex assignments and who were now ready to speak on the record about their lives.

They had already begun to emerge as a public voice four years earlier, largely through the efforts of one person: a San Francisco–based activist named Cheryl Chase, who had been lobbying for changes in intersex treatment since the early 1990s. “I wasn’t getting very far,” admits Chase, a short-haired woman with a dry, rational manner that belies the passion driving her. “That changed overnight when the John/Joan case blew up.”

At her birth in suburban New Jersey in 1956, Chase presented a classic case of ambiguous genitalia. Instead of a penis and testicles, there was a somewhat vaginalike opening behind her urethra, and a phallic structure of a size and shape that could be described as either an enlarged clitoris (if she were assigned as a girl) or a micropenis (if a boy). After three days of deliberation, the doctors told Chase’s parents that their child should be reared as a boy. She was christened Charlie. But a year and a half later, her parents, still troubled by Charlie’s unusual appearance, consulted another team of experts. They reassigned her as a girl and told her parents that she would grow up to be a happy, healthy, normal woman. Her parents changed her name from Charlie to Cheryl, and the doctors removed her clitoris.

Like David Reimer, Chase was then raised without knowledge of her true birth status. Thus, like David, she experienced a childhood punctuated with mysterious, unexplained surgeries and regular genital and rectal exams. Also like David, she grew up confused about her sex. “I was more interested in guns and radios,” Chase says, “and if I tried to socialize with any kids, it was generally boys, and I would try to physically best my brother. I didn’t fit with boys or girls, I was stigmatized and ostracized by my peers, and picked out for teasing all the time.” At age ten, Cheryl’s parents brought her to a psychiatrist, who attempted to prepare Cheryl for her role as wife and mother. As a preadolescent, she recognized that she was erotically attracted to females.

By age nineteen, Chase had done some of her own medical sleuthing and understood that she had been subjected to a clitorectomy as a child, and she began to search for her medical history. She was thwarted by her doctors, who refused to reveal the circumstances of her birth. It took three years for her to find a physician willing to disclose her medical records. It was then that Chase read that doctors had labeled her a “true hermaphrodite”—a term that refers to people whose gonads possess both ovarian and testicular tissue. This was also when she first learned that she had spent the first eighteen months of her life as a boy named Charlie, and that her parents, doctors, aunts, uncles, grandparents, and family friends had conspired to keep this secret from her. She also learned that the operation she had undergone at age eight (to relieve “stomachaches”) had actually been to cut away the testicular part of her gonads.

Horrified and angered at the deceptions perpetrated upon her and aggrieved at the loss of her clitoris, which had rendered her incapable of orgasm, Chase began to seek out others like herself. Through letters to the editors of medical journals and magazines, news articles, listings with crisis hotlines, and ultimately on a website, she established a network of inter-sexes in cities across the country. In 1993, she dubbed the group the Intersex Society of North America, a peer support, activist, and advocacy group. By mid-1999, Chase had been contacted by nearly four hundred intersexes from around the world—many of whom told stories almost identical to her own.

To meet Chase and members of ISNA—as I did in the spring of 1997, when they held a peaceful demonstration outside Columbia Presbyterian Hospital in New York, where Chase’s clitoral amputation was performed—is to enter a world where it is impossible to think of sex with the binary boy-girl, man-woman distinction we’re accustomed to. There was Heidi Walcutt, genetically male with an XY chromosome constitution but born with a rudimentary uterus, fallopian tubes, internal sperm ducts, and a micropenis, who describes herself as a “true American patchwork quilt of gender.” There was Martha Coventry, born with an enlarged clitoris but a fully functioning female reproductive system, who is the mother of two girls. There was Kiira Triea, assigned as a boy at age two, who did not learn of her intersexuality until puberty, when she began to menstruate through her phallus. At that stage she was referred as a patient to Dr. Money at the Psychohormonal Research Unit, where she was treated from age fourteen to seventeen, in the mid-1970s, concurrent with Brenda Reimer.

Kiira and David have never met or spoken, but Kiira’s story bears striking parallels to his. She describes how Dr. Money, evidently attempting to ascertain whether she possessed a male or a female gender identity, questioned her about her sex life—in the frank language for which he is well known. “Have you ever fucked somebody?” she remembers Money asking. “Wouldn’t you like to fuck somebody?” She also describes how Money showed her a pornographic movie on a projector he kept in his office. “He wanted to know who I identified with in this movie,” she says.

Contrary to Money’s claim that an intersexual baby reared as a boy will develop an unequivocal male gender identity, Triea’s sexuality and sense of self proved to be far more complicated than that. At fourteen she agreed to undergo feminizing surgery at Johns Hopkins to simulate female genitals, but when she became sexually active for the first time at age thirty-two, her erotic orientation was toward women.

The other intersexes in Chase’s group show a similarly complex sexuality. Max Beck was first assigned and reared as a girl named Judy. Despite strong masculine thoughts, inclinations, behaviors, and attitudes, Judy tried to stick with her assignment in order to placate worried parents and relatives, even going so far as to marry in her early twenties. But at age twenty-seven Judy left the marriage and divorced. At the age of thirty-two she stopped taking estrogen, changed her name to Max, and began taking testosterone by patch. Yet even today, Max resists the simple designation of male. “I have always felt—and continue to feel myself to be—intersexed,” he recently e-mailed me. “ ‘Masculine’ is simply a more comfortable compromise, testosterone a tastier hormonal cocktail than estrogen.” Not all the intersexes who joined Chase were sex-reassigned as babies. Dr. Howard Devore, the psychologist who studied under John Money in the 1980s, was born in 1958 with acute hypospadius (a penis open from base to tip) and with undescended, underdeveloped testicles, but was raised as a boy. Beginning at age three months he endured some sixteen “normalizing” surgeries through childhood, aimed at giving him a cosmetically convincing penis. The experience, Devore says, was emotionally devastating—and wholly unnecessary. His genitals still do not resemble those of a normal male and the sole result of his constant hospitalizations is a psychological scarring far worse than he would have experienced had he been raised with counseling to accept his atypical genitals. Devore refrained from making this argument to Money. “I learned very early that if you choose to do battle with John,” he says, “you have to deal with a very, very angry man who’s going to make you feel horrible for challenging him.” (Devore says that only in the wake of the “ John/Joan” revelations has he felt emboldened to make his intersexuality public—and to openly challenge his former professor.)

Armed with her own story and those of her fellow intersexes, Chase began trying to alert the medical establishment to the dangers of the protocols for intersex management initiated by Johns Hopkins. ISNA’s stated aim was to abolish all cosmetic genital surgery on infants—not simply the castration and sex reversal of micropenis boys. While Chase did not oppose life-saving corrective surgery on genitals, she denounced as “barbaric” all medically unnecessary cosmetic treatments on newborns that could have an irreversible effect on their erotic or reproductive functioning. And ultimately, she said, she wanted to “end the idea that it’s monstrous to be different.”

Chase found it more difficult than she had anticipated to gain an audience with influential people in the field—including John Money. “I’ve written him several times, politely, asking if he would clarify his position for us,” Chase told me. “Each time he would return my letters with a note scribbled on the corner saying he doesn’t have enough time to talk to me.”

Chase also wrote to the American Academy of Pediatrics—an association with a membership of over fifty-five thousand doctors in the United States, Canada, and Latin America. The AAP has long endorsed Money’s protocols for intersex treatment. “I write to inform you that many who have been treated according to the model you outline have found that the treatment itself has rendered our lives an ordeal,” Chase wrote to the AAP in 1995. “We who are intersexual have been discussing our experiences through the Intersex Society of North America … and we find that the current model of treatment does nothing to discourage the shame and secrecy surrounding intersexuality…. We would love to open a dialog with you, and we encourage you to mention, when you teach about treatment of intersex, the existence of a vocal, organized population of intersexual former patients who oppose the current model.”

The AAP did not respond to this letter. Chase wrote to them again in 1996 and again received no response. That October, Chase and other ISNA members held a demonstration at the AAP’s national conference in Boston. Academy officials refused to meet with the protesters, but they did distribute a press release among the journalists and protestors at the demonstration. “The American Academy of Pediatrics, a voice for children for over 60 years, is aware of the concerns and sensitive to the needs of intersexuals,” the statement read. It went on to say that the AAP would not change its stance on intersex treatment and cited Money’s work from the 1950s to defend its position.

Chase also appealed to former Surgeon General Joycelyn Elders, who prior to her appointment to Clinton’s administration had practiced for over twenty years as a pediatric endocrinologist in Arkansas, where she regularly applied Money’s protocols for intersex management to ambiguously sexed newborns. Elders never acknowledged Chase’s letters.

In 1996, Chase did succeed in persuading the New York Times to write a feature article about the burgeoning intersex activist movement, but in the story members of the medical establishment refused to discuss ISNA’s complaints. Dr. John Gearhart, head of pediatric urology at Johns Hopkins, dismissed the group as “zealots.” In a conversation with me in the summer of 1997, amid the media storm generated by Diamond and Sigmundson’s article on the failed twins case, Gearhart was more politic when addressing the issues raised by ISNA and David’s case. While he insisted that sex reassignment remains a viable option for boys born with micropenis or who lose their penises to injury, he noted that advances in penile reconstruction made him more hesitant to recommend the procedure today. “If John/Joan happened today,” he told me, “I would sit down with those parents and say, ‘The child has testicles; it’s a normal male child.’ I would suggest that you could change the child’s gender, but I would not recommend that, because reconstructive genital surgery has come light-years since John/Joan’s accident.”

Gearhart also said that advances in medicine render ISNA’s concerns obsolete. “When these people in ISNA were operated on, twenty-five and thirty years ago, there weren’t really children’s reconstructive surgeons around,” he said. “So most of [these babies] had their clitoris or their penis amputated. That was wrong, OK? That was wrong. But the surgeons didn’t know any better. Nowadays, people in modern reconstructive surgery are not cutting off little babies’ clitorises or penises, or anything along those lines.” Gearhart said that modern microsurgery retains sensation.

To hear the back-and-forth exchanges of doctors like Gearhart and activists like Cheryl Chase is to be convinced that the issues involved will not be settled anytime soon. For instance, Chase flatly rejects Gearhart’s claim that surgeons maintain clitoral sensation after reducing the organ’s size. Gearhart meanwhile continues to reject ISNA’s call for change in the current treatment protocols, insisting that scores of intersexes live happily in the sex assigned to them in infancy and that Chase and the members of ISNA represent only the “disgruntled” few—a charge to which Chase and other ISNA members take particular exception. They insist that silence among intersexual adults does not reflect happiness with the decisions made for them as babies, but is instead a symptom of the shame and secrecy that are the legacy of the current treatment methods.

“It goes back to being completely isolated as children,” Heidi Walcutt told me. “Knowing that there’s this difference, but being silenced and being shamed about it. Some people never get to the point where they start looking for answers—let alone step out as an activist against what was done to them.” Chase adds that there is also a strong disincentive for intersexes to speak out, since doing so often means undergoing a traumatic confrontation with parents who authorized the surgeries in the first place. Chase points out that more than a few ISNA members find themselves estranged from their families.

It is obviously difficult for an independent investigator to verify either Gearhart’s or ISNA’s conflicting claims about the relative happiness of adult intersexes who decline to speak about their lives; they are by definition invisible. Asked to provide a satisfied patient, every pediatric specialist I contacted voiced the Catch–22 that they “lose track” of their patients after young adulthood. Gearhart added, “And the ones I do know just want to live their lives in privacy.”

I was able to locate and speak to one intersex who is not a member of ISNA or any other activist group. She is notable in her own right in that in the late 1970s she was repeatedly cited as a particularly successful example of an intersex who was sexually reassigned in infancy. Her case was featured not only on an Emmy-winning ABC-TV science series documentary, but also in the BBC’s investigative report on the twins case. She is Paula, the former John Money patient whom Peter Williams and Martin Smith included for balance in their twins case exposé. Living anonymously now in the Northeast, but located through an Internet search engine that lists census records, Paula agreed to speak with me on the condition that I not use her last name or otherwise reveal her identity.

In a series of phone conversations and a five-hour in-person interview with Paula and her mother, I learned the circumstances of Paula’s birth. They were in many respects strikingly similar to the stories I had already heard from Chase and her colleagues in ISNA. Born in September 1971, the second of three children, Paula presented ambiguous genitalia with a scrotum but no testicles inside and a small penis of mostly empty skin. The local doctors recommended assignment as a boy, saying that the penis would grow and that the testicles would descend over time. The baby was duly christened Michael Edward. But Michael’s mother remained upset by her baby’s appearance and continued to consult doctors over the first year and a half of her child’s life. When Michael was eighteen months old, a neighbor in whom Michael’s mother had confided the dilemma brought over the current issue of Time magazine, which carried a story about one of a pair of twin baby boys who had lost his penis to circumcision and was later turned into a girl on the advice of Johns Hopkins psychologist John Money. According to the Time article, the sex change had been a complete success. Michael’s mother immediately wrote to Dr. Money, who replied promptly and advised that she bring Michael to Baltimore for immediate sex reassignment as a girl. “Within two days,” Paula’s mother says, “I was on my way down there with my husband and my child.”

On 23 February 1973, Michael was operated on at Johns Hopkins by Dr. Howard Jones, who established that the baby (like Cheryl Chase) had gonads containing both ovarian and testicular cells. Jones removed the undescended gonads (to prevent spontaneous masculinization at puberty) and reconstructed the external genitalia so that they would appear more feminine. Full .excavation of a vaginal canal was to wait until the baby was in her teens. In the meantime it was arranged that Paula would return periodically to Johns Hopkins for counseling with Dr. Money. And indeed, Paula’s mother brought her daughter back to see Dr. Money several times a year throughout her childhood. Since Dr. Money had often said that Paula was one of his best patients, it came as little surprise to Paula’s mother when, shortly after her daughter’s seventh birthday, Dr. Money asked if she would be willing to put Paula on television to discuss her successful sex reassignment. “I said, ‘If it would help one other person,’” Paula’s mother recalls, “ ‘then that’s all I want from it.’”

The program was part of the ABC-TV science series The Body Human. The episode, entitled “The Sexes,” featured a scene of Paula, a freckle-faced, short-haired girl, during one of her trips to the Psychohormonal Research Unit. With the camera keeping a studious distance from the fertility sculptures arrayed around Money’s plant-festooned office, the famous psychologist was shown sitting at his desk, in shirtsleeves and tie. He asked Paula questions as she faced him from a large, afghan-covered armchair. In a flowered dress with lace collar, her fingernails painted bright red, Paula smiled warily as she haltingly answered Money’s questions about marriage and career. Meanwhile the narrator explained in voice-over, “At the Johns Hopkins Hospital, under the enlightened care of specialist Dr. John Money, careful attention is paid to nurturing Paula’s image of herself as a girl, preparing her for all the complete experiences of womanhood.”

Shortly after this program aired in May 1979, Money again asked Paula’s mother to put her daughter in front of the cameras. This time the reporters were with the BBC. Again Paula’s mother agreed, and Dr. Money made the preliminary arrangements with Williams and Smith to interview Paula’s mother. The filming took place in early October 1979. According to Paula’s mother this interview proved less gratifying than her encounter with the ABC-TV producers. Within hours of doing the interview, she received an agitated call from Dr. Money, who told her he had learned that the BBC reporters had an “ulterior motive” in making their documentary. Money wanted Paula’s mother to pull out of the interview. When he learned that the reporters had already done the interview, he was irate. “He was absolutely furious with those reporters,” she recalls. “Furious.” The imbroglio did nothing to mar the relationship between Dr. Money and Paula’s mother. She continued to bring her daughter to see Money for regular follow-up visits until Paula was eighteen years old, at which point Paula underwent the final stage of vaginal surgery and stopped going to Johns Hopkins.

Today, at twenty-seven, Paula is a slim woman with blue eyes and tawny, straight, side-parted hair that falls to her waist. Dressed in jeans, a blue shirt, and platform open-toed sandals, she passes easily as a woman, albeit a boyishly figured one. Her small breasts and hip shape are maintained only through a regular lifelong regimen of estrogen ingestion. She takes care to pitch her raspy voice in the upper part of its register, but it does at times dip into lower notes than would ordinarily be expected in even a deep-voiced woman. Paula takes assiduous care of her grooming, lavishing great attention on her long mane of hair; she pays once-weekly visits to the pedicurist and manicurist for the maintenance of her nails; and in the course of our conversation, she frequently refreshed her makeup with the skill of a trained cosmetician.

Despite these obvious outward efforts to enhance her public femininity, Paula says that privately she has no choice but to think about her medical condition every day. Like the other intersexes I spoke with, Paula’s surgically created vagina is a daily reminder that she was not born a typical woman. “I don’t look like everyone else does,” she says. “Not at all. So of course you’re always going to have a constant reminder.” Asked if her vagina carries sensation, Paula drags on her cigarette. “There’s always lack of sensation where there’s scarring,” she says. Given these realities, it comes as little surprise to hear Paula say that despite the best efforts of medical science, she has a constant sense of living “with a secret.” Asked if there are any close friends to whom she has felt comfortable divulging her secret, Paula’s face hardens and she chuckles with brittle cynicism. “You have very few friends in this world—trust me.” She takes another drag on her cigarette. “Yeah,” she continues in the same tone. “That anyone can trust. There are very few people in this world.” She says that she had a boyfriend for six years in her late teens and early twenties in whom she confided her secret, and he was understanding. Since then, however, she has preferred to keep her condition, and the circumstances of her birth, to herself.

A virgin at age twenty-seven, Paula says that she has never felt any sexual attraction to women. When I asked about this, she cut me off before I had even finished the question. “Not at all,” she said. “Never. Never, at all. Not at all.” I asked if, while growing up, she had ever thought, “Maybe I’m a boy,” but again she spoke before I could get the question out. “Never,” she said. “Never at all.”

Paula is open about her desire not to upset her mother by voicing doubts about the decisions made on her behalf as a baby. She insists that she is happy with the choice made to reassign her as a girl—or rather, she expresses the view that no other decision could have been made at the time. “I can’t see things being any other way,” she tells me. “You know?” She pauses, then resumes. “As far as anybody was concerned at the time, this was, like, the only way.”

Like the other former research subjects of John Money to whom I spoke, Paula has vivid memories of her counseling sessions with him. She was shown pictures of men and women engaged in sexual intercourse and queried about the most private aspects of her inner self. “He asked questions that a six-, seven-, nine-, ten-year-old would not ever be asked,” Paula recalls: about masturbation, her private sex fantasies, how to deflect lesbian advances from other girls. “He would press you for answers,” Paula says. “He would sit there and press you and press you and press you. It was way too much for a child. I always said to my mother, ‘I don’t know why the hell I have to go to him.’”

Appearing on network television as the world’s first openly intersexual seven-year-old was also, Paula says, “traumatic.” When she discusses this aspect of her dealings with Dr. Money, Paula’s vocabulary and tone of voice lose their quality of studious feminine poise. Her voice drops several tones lower as she spits out a stream of angry expletives. “All that TV bullshit was garbage,” she snarled. “It was bullshit, it was traumatic. I mean you have to understand, at that time of my life I was in grade school. People in my class were asking me about it the next day. I was too young to make my own decisions, but if I had had the choice I never would have done it. But that’s my mama,” she adds with a forgiving but exasperated smile. “She loves John Money. She would do anything he said. She thought she was doing good. Helping other mothers. But I think it was bullshit.”

Paula’s mother has never questioned the decisions she made on Paula’s behalf, nor has she questioned John Money’s handling of the case. To this day she refers to Money as her “savior” and speaks in only the most glowing terms about him and about her former son’s conversion to girlhood. “Everything worked out fantastic with Paula,” she told me, speaking in ecstatically upbeat tones in a phone conversation before I met her daughter. “She is full of life and full of fun. She has never confided in me of any worries. She’s a character! A real party girl. Loves life, parties, going out, oodles and oodles of friends. The phone never stops.” She described Paula as the very quintessence of femininity. “Loves being a girl. Loves to shop. Buys the most expensive clothes. And jewelry. Everything is top designer.” She said that Paula had never seemed even slightly tomboyish as a child (an observation in contrast to the recollections of one of the ABC-TV producers, whose impression of the seven-year-old Paula was “That little boy stayed a little boy, no matter what they did to him” ).

Paula’s mother does voice one small concern about Paula’s life today: her daughter’s single status. When Paula’s parents brought her to Johns Hopkins, Dr. Money had specifically explained that sex reassignment was being done to ensure that Paula could one day marry, have a normal heterosexual love life, and have children by adoption. “Dr. Money looked that far ahead,” Paula’s mother marvels. Marriage is the one area where Dr. Money’s prognostications have yet failed to materialize, but Paula’s mother has not given up hope. “For me,” she says, “closure will come when Paula gets married.” Paula, watching as her mother speaks, takes a hard drag on her cigarette, then looks away.

Paula is dubious that she will ever marry. For one thing there is the delicate circumstance of her unusual genitals—which Paula feels is a severe stumbling block to physical and emotional intimacy with a partner. There is also the fact that Paula views marriage as an outdated institution. So for now, she continues to live at home with her parents. Her father, who suffers from severe clinical depression, confines himself mostly to his room. Most of Paula’s dealings are with her mother. It is a close but emotionally complex relationship in which Paula is totally devoted to her mother, despite Paula’s spates of brittle snappishness. Having heard many times during the course of her growing up about the severe trauma her birth caused her mother, Paula lives a life dedicated to minimizing any further emotional upset or unease that her existence might cause. Paula has thus told her mother that she will live at home forever to look after her and will “never leave her.”

In the meantime Paula devotes herself to her work. Her choice of career, while not unchallenging, does not reflect her extraordinary intelligence. Tested at Johns Hopkins at age ten, Paula’s IQ was 132, placing her in the top 2.2 percent of the population. At the time, Money’s associate Gregory K. Lehne wrote in Paula’s file that her “future academic planning can include college and professional training, with every expectation of success.” And in fact Paula had once planned to become a lawyer. She set those ambitions aside in her junior year of college, after her mother mentioned her wish that Paula pursue nursing. Though Paula had always expressed an understandable aversion to all aspects of the medical profession, she nevertheless quit college and enrolled in nursing school. Currently Paula is a registered nurse and is working toward her master’s in nursing. Her mother is “ecstatic” about these developments and boasts of how Paula “has not looked back since.”

Paula seems to be a young woman determined not to look back. She says that she has no criticism of those intersex activists who are lobbying the medical profession for change, but she takes the position, for herself, that it is better just to get on with life and not stir up the past. When her mother left the house, Paula admitted quietly, “Maybe they should wait and give kids the choice about surgery.” That, however, is an opinion she is unlikely to pass on to the medical profession. She has turned down a recent request from Johns Hopkins to participate in a follow-up study on sex reassigned patients. She simply does not want to relive her childhood—which she nevertheless insists was a perfectly happy one. But that some degree of unresolved emotion around her childhood might linger is perhaps suggested by the fact that Paula chose obstetrics and gynecology as her nursing specialty. Today she helps to deliver babies in the same small hospital where she was born twenty-seven years ago, as Michael Edward.

The medical establishment’s refusal to listen to those intersexes who have elected to speak about their experiences is no surprise to Cheryl Chase. “Our position implies that they have—unwittingly at best, and through willful denial at worst—spent their careers inflicting a profound harm from which their patients will never fully recover,” Chase once wrote. She says that she does not expect the medical establishment to change its practices unless forced. Chase plans to force them. “I think a context will open up for surgeons who keep doing this to be vulnerable to lawsuits,” she told me. “But it’s going to take a while to create that context. Right now we can’t sue because it’s standard practice, and parents give permission. The first thing we want to have happen is that when they make their recommendation to parents, they tell them it’s experimental and there’s no evidence that it works and that there’s plenty of people who’ve had it done to them who are mad as hell.”

There are other needs as well. Anne Fausto-Sterling, an embryologist at Brown University, says that the medical establishment will have to provide education and emotional support to help parents with the difficult task of raising an infant whose genitals are atypical. “At the moment there is no ongoing counseling done by people skilled in psychosexual development,” Fausto-Sterling says. “If there was really a wholesale change in this, the medical profession would have to do something like what they’ve done with genetic counseling—which is to develop a specialty of people who would work with these families long term and help them resolve both emotional and practical questions. The practical questions are very real: What do I do when it comes to undressing in gym? How do I intervene with the school system? There’s a different infrastructure that needs to be built and put into place. I think it’s the responsibility of the medical profession to do it.”

Perhaps the biggest change that will have to take place is in the medical profession’s current view of what it means to be reared with ambiguous genitals, since the Money and Hopkins guidelines are predicated on the belief that such a childhood would be psychologically and psychosexually devastating. Studies that would prove the truth of this intuitive observation are hard to come by; case histories of children reared with ambiguous genitals are rare because so few intersexual newborns have avoided surgical intervention. In 1989 a study did appear in the Journal of Urology on the lives of twenty males with micropenis who were reared in their biologic sex. Drs. Justine Reilly and C. R. J. Woodhouse of St. Peter’s Hospital and The Hospital for Sick Children in London described how these patients, who ranged in age from ten to forty-three years, had all formed healthy male gender identities and “participated in normal male activities in childhood and adolescence.” They also reported that nine (75 percent) of the older patients were sexually active and that “vaginal penetration usually is possible but adjustment of position or technique may be necessary.” The researchers drew two main conclusions: “A small penis does not preclude normal male role and a micropenis or microphallus alone should not dictate a female gender assignment in infancy.”

Reilly and Woodhouse’s study, however, looked at the lives of only twenty patients, all of whom had the same syndrome. A much more exhaustive study exists on the lives of untreated intersexes who display a much wider range of conditions than micropenis alone. Written before the advent of the 1955 protocols, it is a unique and fascinating monograph that reviews over two hundred and fifty cases of intersexes who received no surgical intervention as babies. Furthermore, the study directly addresses the question of how children fare when they grow up with genitals of the sex opposite to that in which they are reared. “Do [these people], with such manifest sexual problems to contend with, break down under the strain, as psychiatric theory may lead one to believe,” asked the study’s author, “or do they make an adequate adjustment to the demands of life?”

Far from manifesting psychological traumas and mental illnesses, the study showed, the majority of patients rose above their genital handicap and not only made an “adequate adjustment” to life, but lived in a way virtually indistinguishable from people without genital difference—a result that clearly amazed the study’s author.

“One would not have been surprised had the paradox of hermaphroditism been a fertile source of psychosis and neurosis,” the investigator noted. “The evidence, however, shows that the incidence of the so-called functional psychoses in the most ambisexual of the hermaphrodites—those who could not help but be aware that they were sexually equivocal—was extraordinarily low. The incidence of neurotic psychopathology of the classic types, sufficiently severe and incapacitating to be unmistakable, was also conspicuously low.” The study pointed out that genital ambiguity led to a “disheartenment” of mood in some patients and a social “reticence” in others but went on to say of these individuals, “there was no evidence that their disheartenment or reticence ordinarily accumulated to the proportions of psychopathology, seriously impairing their ability to cope with the essential business of life”—such as completing their education, going to the office each day, and earning a living each week.

Of particular interest are the study’s in-depth interviews with ten intersexes who received no surgery or hormone treatments until they were old enough to make their own decision. Their lives only strengthened the investigator’s impression that the condition of the genitalia plays a strikingly insignificant part in the way a person develops a stable and healthy gender identity, not to mention a secure and confident self-image. One patient with an enlarged clitoris at birth did not have the organ surgically reduced until the age of twelve, yet her childhood with masculinized genitalia left no wound on her psyche and did not impair her sense of herself as a girl. “[O]ne appreciates her remarkable stamina and the self-reliant way in which she had consolidated it,” the author noted. A second girl with a similar medical history demonstrated a marked “social deftness and complete poise” and, despite her mother’s depressions, “had emerged more stable than her adult sister or brother.” About another girl whose masculinized genitals were not surgically altered until she consented to it at age twelve, “one would not be justified in saying that she is different from scores of other adolescents.” A boy with an untreated micropenis had married at age twenty-four and, the study reported, “is meeting life most successfully without any suspicion of psychopathology…. His life is an eloquent and incisive testimony to the stamina of human personality.” A “true hermaphrodite” with a micropenis, split scrotum, and breasts at puberty lived as a male with no surgery to correct these anomalies. “The youth is another living testimony … to the stamina of human personality in the face of sexual ambiguity of no mean proportions.” A seventeen-year-old boy whose micropenis went untreated through childhood and adolescence “is making a stalwart and almost heroic adjustment to life.” Likewise, a twenty-year-old born with a small, hypospadic penis that required him to sit to urinate and that went uncorrected until age nineteen; this patient “was almost a model of what the average citizen believes a healthy, well-adjusted American youth should be,” the author noted: “confident, self-reliant, and optimistic.”

Unfortunately, no experts in the debate on intersex treatment—including Milton Diamond, Bill Reiner, Anne Fausto-Sterling, or Cheryl Chase—has ever made reference to this valuable report. That such a rare and unique study has been overlooked is perhaps not surprising. Never commercially published or distributed, it can be obtained only through written application to the Widener Library at Harvard University, where it was submitted as a senior dissertation to the college’s Ph.D. program in 1951. The author was a thirty-year-old doctoral candidate named John Money.

15

JOHN MONEY HAS NEVER explained the shift that occurred in his thinking between the time he finished his Harvard thesis and the time he wrote his first papers on inter-sexes four years later, and he has never publicly commented on any aspect of his work since the revelations in Diamond and Sigmundson’s paper.

Now seventy-eight years old and in semiretirement, he has nevertheless remained a prolific and opinionated writer on the subject of sex and sexuality. His latest book, Unspeakable Monsters, was published in the spring of 1999. Through the last two decades, his books and articles have continued to appear with regularity, and in the late 1980s he enjoyed an intense courting by the media over the publication of his book Lovemaps—Money’s term for an individual’s particular constellation of erotic tastes and impulses. Profiles and interviews with Money appeared in Playboy, Cosmopolitan, Psychology Today, Omni, and the Atlantic Monthly. In Rolling Stone’s 1990 “Hot Issue,” Money was celebrated as the “Hot Love Doctor,” and he appeared on various TV programs.

Meanwhile Money was negotiating a subtle shift from his earlier extreme position on the primacy of rearing over biology in the making of boys and girls. In a May 1988 magazine profile, he seemed at some pains to characterize himself as a longtime champion of the role of biology in psychological sex differentiation, saying that when he was publishing papers on the behavioral influence of prenatal sex hormones in the 1950s, “many people in various branches of the social sciences were just enraged at the idea that hormones in the bloodstream before you were born could have a sex differentiating influence on you.” In the same article, however, Money reiterated his claim that infant boys can, with surgery and hormone treatments, be turned into heterosexual women.

If the last two decades have seen the consolidation of Money’s international reputation as one of the single most influential sexologists of the twentieth century, his career at Johns Hopkins has not been without its setbacks. The seeds for Money’s problems were sown as early as 1975, when Dr. Joel Elkes, chairman of the Psychiatry Department and Money’s longtime protector within the institution, was replaced by Dr. Paul McHugh.

By almost any measure, McHugh, a practicing Catholic and a sworn enemy of all fashions and fads in psychiatry, was John Money’s diametrical opposite—save for the forcefulness of his opinions and his determination to put them into action. Today McHugh is famed as psychiatry’s most outspoken scourge. In referring to McHugh’s “ceaseless campaign to restore sanity to his own profession,” a 1997 Baltimore Sun profile dubbed him “Dr. Iconoclast” and listed his “annihilating opinions on everything from doctor-assisted suicide (utterly wrong) to multiple personality disorder (it doesn’t exist).” The profile also highlighted his excoriating disdain for “dubious practices—and practitioners—in the medical profession,” including Dr. Jack Kevorkian, whom McHugh was quoted as calling “insane,” and Dr. Bruno Bettelheim, the famous expert on children, whom McHugh called “a habitual liar, thankless friend, vicious bully, and brazen plagiarist.”

McHugh has always reserved special scorn for the practice of sex-change surgery on adult transexuals. Classifying transexualism as merely one symptom in a larger complex of personality disorders, McHugh had long believed that psychiatrists should treat such patients with the talking cure, not radical, irreversible surgeries. In a 1992 article in the American Scholar, McHugh lambasted transexual surgery as “the most radical therapy ever encouraged by twentieth century psychiatrists” and likened its popularity to the once widespread practice of frontal lobotomy. “Johns Hopkins was one of the places in the United States where [transexual surgery] was given its start,” McHugh pointed out in this article. “It was part of my intention, when I arrived in Baltimore in 1975, to help end it.”

Two years after McHugh arrived at Johns Hopkins, Dr. Jon Meyer, a Hopkins psychiatrist and former director of the Gender Identity Clinic, produced a long-term follow-up of fifty postoperative and preoperative adult transexuals treated at Johns Hopkins since the clinic was founded in 1966. Meyer reported that none showed any measurable improvement in their lives and concluded that “sex reassignment surgery confers no objective advantage in terms of social rehabilitation.” Presented at the American Psychiatric Association’s Annual Convention in May 1977, the paper was published two years later in the Archives of General Psychiatry. The transgendered community reacted with outrage to the paper’s alleged nonscientific methods and aims. To no avail. Its publication was heralded by an October 1979 press conference at Johns Hopkins, where it was announced to the assembled reporters that the Gender Identity Clinic was now closed. John Money was not notified about the press conference and was not consulted about the clinic’s closing—an ignominious position for the man who had—virtually singlehanded—spearheaded the movement to open it.

McHugh’s tenure at Johns Hopkins also coincided with a sudden dramatic erosion in Money’s once secure status as the institution’s resident sexual revolutionary. In 1983, Money was informed that his controversial evening course in human sexology was being summarily dropped. Three years later, when Money turned sixty-five, he was notified that he would not be allowed to keep his Johns Hopkins office space—a privilege conferred upon some other retirement-age professors—but must remove himself from the campus. He was relocated to a shabby medical arts building four blocks from the hospital and university, across from an empty lot where the local homeless and addicts congregate. There, Money installed himself in one of the building’s low-ceilinged basement offices. With a staff now reduced to a single graduate student, Money affixed to the cheap plywood door of his new space the sign he had removed from his former office door. It reads: JOHNS HOPKINS PSYCHO-HORMONAL RESEARCH UNIT.

Even after his physical removal from the institution, Money’s problems with Johns Hopkins were not over. In the early 1990s one of his former research subjects raised a complaint against him and against Johns Hopkins. This patient, who wishes to remain anonymous, has asked me to refer to him as “Charlie Gordon”—a pseudonym that he did not choose randomly. It is the name of the protagonist in the 1960s Daniel Keyes novel Flowers for Algernon, which was later turned into the Cliff Robertson movie Charly. The fictional story of a retarded man who, as an experimental research subject, was turned into a genius, Charly bears striking parallels to the life of the man I have agreed to call Charlie Gordon.

Born in 1947, Gordon showed early signs of hypothyroidism, a congenital endocrine disorder whose symptoms include severely stunted growth and retarded intellectual development—syndromes then classified as the condition “cretinism.” At age two, Gordon was referred to Lawson Wilkins’s pediatric endocrine clinic at Johns Hopkins where he underwent experimental treatments of hormone replacement by ingesting cow thyroid glands in pill form. The treatment increased not only his physical stature, but also his intellectual powers. At age five he became a psychological research subject in the newly created Psychohormonal Research Unit, where John Money would, for the next twenty-five years, conduct adjunct studies on Gordon’s adaptation to his changing bodily and intellectual stature. In an article published in the Journal of Pediatrics in September 1978, Money singled out Gordon as having demonstrated the largest increase in intelligence of all the research subjects. According to Money, he had gone from an IQ of 84 at age five to an IQ of 127 in adulthood: a 43-point gain that had taken him from low average to superior range—what Money called “a remarkable upgrading.”

Over the course of their association, Gordon became one of Money’s favorite research subjects and agreed to Money’s request that he appear at medical school grand rounds, in which he was studied by scores of Johns Hopkins student doctors. At the same time, Gordon was making regular annual visits to the clinic for in-depth interviews with Money. Gordon found the encounters unsettling. “He was always saying ‘fuck,’ all the time,” Gordon recalls. “ ‘Fuck this,’ and ‘fuck that.’ As a kid I was raised in somewhat a religious background. When I’d do church things, he’d say, ‘Oh, what do you do that shit for?’”

Money also questioned Gordon closely about sex. Believing that Dr. Money’s interest in his erotic life was intended to help him cope with the difficulties associated with his condition, Gordon opened up without reserve, detailing the content of his sexual fantasies, describing his masturbation techniques, and recounting his experimental forays into ménage à trois and his childhood experiences of “playing doctor” with a neighborhood girl. Later, in his twenties, Gordon confessed to the insecurities that had gone along with his small stature, admitting that he had once sought relationships with girls many years his junior—some as young as fourteen. Only several years after he stopped treatment with Money did Gordon learn that Money’s interest in his sex life was not simply therapeutic in nature.

This realization was brought home to him with particular force on a day in December 1989 when he was browsing in a bookstore and happened upon a copy of Money’s latest volume, Vandalized Lovemaps. The book detailed Money’s theory of how people develop sexual fetishes, perversions, and disorders, and it featured a number of case histories. The first one, entitled “Pedophilia in a Male with a History of Hypothyroidism,” caught Gordon’s eye. He began to scan the opening sentences and realized with amazement and horror that the case history being detailed was his own. He saw his sexual life laid out with extensive verbatim quotations culled from his taped interviews with Money and saw himself diagnosed as a pedophile on the evidence of his interest in teenage girls. More shocking still, says Gordon, was information published about his parents, which included a statement by Gordon’s father, who had allegedly told Money that Gordon’s mother had had an incestuous affair with her brother. Though Gordon and his family were not mentioned by name, he felt that the details of the case would be unmistakable to anyone who knew him or his family. Stricken, Gordon phoned Money, but he could not reach him. “He wouldn’t return my calls,” Gordon says. “His associate said, ‘He’s busy.’”

In the spring of 1990, Gordon brought a formal complaint against Money and Johns Hopkins through the federal Department of Health and Human Services Office for Protection from Research Risks—a division of the National Institutes of Health. Gordon learned that scientists operating under federal research grants must adhere to stringent rules, which include gaining informed, signed consent from patients and research subjects about whom a researcher wishes to publish. Money had never secured consent from Gordon for the publication of the deeply private material in Vandalized Lovemaps. The Department of Health and Human Services launched an investigation and concluded that “given the nature of [the] information [disclosed by Money], the complainant could be identifiable by persons acquainted with [him].” That fall, DHHS cited the Johns Hopkins University School of Medicine for “serious noncompliance” with federal regulations for the protection of human research subjects. Calling for “strong corrective action,” DHHS required that the Johns Hopkins Psychiatry Department “republish departmental guidelines for safeguarding the identity of patients” and allow patients who did provide informed consent to review manuscripts before publication, and it demanded that Gordon receive an apology from Money in person and in the presence of his department chairperson, in this case Money’s nemesis, Dr. Paul McHugh. Gordon says that this apology was never given, but he felt vindicated by the other sanctions. In a statement that Gordon prepared for an October 1997 meeting of President Clinton’s National Bioethics Advisory Commission on human research subjects, he outlined his unhappy history with Dr. John Money and drew a parallel between his experiences as a research subject and those of the famous “John/Joan” whose story had broken in the press just eight months earlier.

Despite this string of professional reversals, embarrassments, and punishments, Money remained defiant, combative, and uncowed. Indeed the setbacks seemed only to fuel his contentious spirit. Increasingly his published work appeared to be as much an opportunity for Money to settle scores and air grievances as it was to elucidate the subject of human sexuality. His preface to the 1987 book Gay, Straight and In Between, a volume ostensibly about the origins of sexual orientation, included an unusual digression into his then-recent ouster from Johns Hopkins. “In the spring of 1986,” he wrote, “I was delivered an edict: the space allotted to the Psychohormonal Research Unit … would be reallocated. The new space would be away from the hospital campus in a commercial building. No further explanation would be given. There would be no appeal…. My response was to write this book.”

In a 1991 autobiographical essay included in the anthology The History of Clinical Psychology in Autobiography, Money continually veered from the subject of his contributions to sexology to revisit his battles with the Johns Hopkins administration. Angrily evoking the termination of his human sexology course, Money wrote, “What the students at Johns Hopkins have lost has become the gain of students around the world. For them I now have more time to write.” In the same essay, Money excoriated the (unnamed) Paul McHugh as “the most contentiously destructive person I have ever known” and gloated that “[h]is clandestine efforts to get rid of me failed.” Money portrayed his current diminished status in the grim and dangerous basement setting of the Psychohormonal Research Unit with not untypical grandiloquence. “Working as an off-campus exile,” he wrote, “in a green subterranean jungle that flourishes under artificial light, I have a sense of kinship with dissidents like Galileo, who by order of the Vatican lived as an exile under house arrest.”

Inevitably, perhaps, in the same essay Money addressed those in the field of sexual development who had challenged his scientific theories over the years. Though he did not mention Milton Diamond by name, there was little doubt that the University of Hawaii professor was high on the list of those whom Money now castigated for “shamelessly” attacking him. Yet after lambasting these critics, Money segued into a tone of lofty Olympian remove, finally dismissing his academic disputants as beneath his notice. “My personal impression,” he wrote, “is that they are lacking in the special talent for original thinking, for formulating new concepts and hypotheses, and for making new discoveries.” Of his continued academic survival, Money wrote, “I have survived by putting into practice my own maxim and have not been lured into declaring a war that I had no possible chance of winning. Instead of mounting a direct counterattack, I would adopt a policy of disengagement and redirect my energies into an alternative channel of achievement.”

Money put into effect just such a strategy of disengagement six years later, in the spring of 1997, when his career and reputation suffered their greatest blow to date, from the worldwide media response to Diamond and Sigmundson’s paper on the twins case. To the many news organizations that requested comment from him about the now-infamous case, the psychologist refused to speak, citing confidentiality laws. I was among the raft of reporters who sought an interview with Money (for the article I was preparing for Rolling Stone). In a letter, I urged him to speak with me, and assured him that I would treat the story with scrupulous objectivity. He declined, but over the ensuing weeks and months, we exchanged a number of e-mails in which he eventually offered to work with me as a kind of silent collaborator on what he called “a piece of investigative journalism.” He offered to supply me with the requisite reprints from his published work and to vet my unpublished article to “check the accuracy of some data.”

This invitation was withdrawn in late August. Having returned from a second trip to Winnipeg, I notified Money for the first time that I had located and interviewed the patient and his family and had furthermore secured David’s promise of a signed confidentiality waiver freeing Money to speak to me about the case. Money’s tone changed abruptly. From would-be silent collaborator, he now grew ice-cold. “Thank you for your e-mail of August 24th, to which my reply is that my position has not changed and will not change,” he wrote. “I am not under any circumstances available for an interview regarding the Reimer case, and have no further comments to make. So please desist.”

I did desist for the next two months while I wrote my Rolling Stone story. In early November, with the article going to press, I phoned Money’s office to check some facts with his assistant, William Wang. I was surprised when Money got on the line. Although he refused to discuss David Reimer’s case directly, he claimed that the media’s reporting of it reflected nothing more than a conservative political bias. He was particularly incensed by the New York Times front-page story. “It’s part of the antifeminist movement,” he said. “They say masculinity and femininity are built into the genes so women should get back to the mattress and the kitchen.” As to his failure to report the outcome of the case, Money was unapologetic, repeating his claim that he had lost contact with the Reimers when they did not return to Johns Hopkins and that the opportunity to conduct a follow-up had been denied to him. Money sounded affronted when I suggested to him what various of his defenders had hinted to me: that the misreporting of the case was all the Reimers’ fault and that David’s mother, in particular, in her zeal to believe in the experiment’s success—and to please Money—had given him a “rosy picture.”

“I was not being given a rosy picture,” he said irritably, as if stung by the suggestion that he would have failed to factor in any such maternal bias in his assessment of the case’s progress. “The only thing that was of importance to me was that I didn’t get any picture at all after the family simply stopped coming to Johns Hopkins.”

He stood by his original reporting of the case and dismissed my suggestion that he “misperceived” what was going on with the child in their one-on-one sessions. Furthermore, he implied that David’s reversion to his biological sex might not have been entirely his own decision. “I have no idea,” Money said, “how much he was coached in what he wanted, since I haven’t seen the person.” He also hinted that Diamond and Sigmundson’s paper had a hidden agenda. “There is no reason I should have been excluded from the follow-up, was there?” he asked. “Someone had a knife in my back. But it’s not uncommon in science. The minute you stick your head up above the grass, there’s a gunman ready to shoot you.” Told of these comments, Diamond says that he had repeatedly invited Money to share or publish information on the twins over the previous fifteen years, always to no avail.

When I asked Money about Diamond’s appeal to delay surgery on intersexual babies until they are old enough to speak for themselves, Money grew angry. Apparently forgetting the conclusions he had reached in his own Harvard thesis review of over two hundred and fifty untreated intersexes, he emphatically rejected the idea that a person could survive a childhood with ambiguous genitalia. “I’ve seen the people who were the victim of that,” he said. “I’ve heard these poor people describe how they had to sit in a locked room and not go out for fear that someone would see them.” Money insisted that surgical intervention at the earliest opportunity after birth was the only guarantee of the child’s future happiness. “You cannot be an it,” he declared, adding that Diamond’s recommendations would lead intersexes back to the days when they locked themselves away in shame and worked as “circus freaks.”

Money refused to discuss any aspect of his personal life. “You’re trying to entrap me,” he said, darkly. “Just like my patients try to entrap me.”

At this point Money seemed determined to get off the phone. Before he did so, I reminded him that his now classic text, Man & Woman, Boy & Girl, was still in print and that it reports the twins case as a success. I asked if it would not be worthwhile for him to make changes in the text for a future edition. Money said flatly, “I’ll be dead by then.”

Despite its ring of finality, this proved not to be Money’s last word on the case. After the publication of my Rolling Stone story in December 1997, he again broke his press silence when he granted an interview to a sympathetic writer and friend, Michael King, in the New Zealand magazine The Listener. There Money dismissed both Diamond and Sigmundson’s John/Joan paper and my Rolling Stone article as part of a dark conspiracy against him. The Listener article furthermore hinted that David and his family were deliberately lying about Brenda’s life for financial gain, since David had decided to collaborate on this book, and moviemakers had expressed interest in the saga. King’s article described Money as “surprisingly resilient and sanguine” despite the controversy and ended with news of the undimmed status that Money still enjoys among U.S. funding agencies. “He has recently been recommended for a grant from the National Institutes of Health for a major new project, a classification and consolidation of contemporary knowledge of paraphilias or ‘perversions,’” King reported. I checked with the NIH in the summer of 1999 and learned that Money is still supported by the same NIH research grant that he was awarded in the mid-1950s. His most recent renewal was in the amount of $135,956.

Nor does Money lack for defenders within the academic community—and in particular among professors of psychology, many of whose tenured positions and clinical appointments have been built upon the promulgation and dissemination of Money’s theories of psychosexual development. One of his more engaging and intelligent defenders is Dr. Kenneth Zucker, a psychologist at the Clarke Institute of Psychiatry in Toronto and a longtime adherent to Money’s nurturist bias in gender identity formation. (In his clinical work, Zucker has for years attempted to modify homosexuality and transexualism in boy and girl children.) Several months after the publication of Diamond and Sigmundson’s article, Zucker wrote a paper entitled “Experiment of Nurture,” which was framed as a direct response to the John/Joan revelations. Showing his environmentalist leanings, Zucker suggested that the twins case had failed not because David possessed a male biology, but because of certain “psychosocial factors”—in particular “parental ambivalence regarding the initial decision to reassign the infant as a girl.”

Efforts on the part of Money’s defenders to blame the failure of the case on Ron’s and Janet’s supposed lack of commitment were by no means exclusive to Zucker; many of Money’s acolytes have made the same charge to me in interviews. These charges might carry more weight if not for the fact that all the evidence shows that Ron and Janet were almost slavishly devoted to the experiment—not to mention that Money himself, in his reports on the case, repeatedly described Ron and Janet as particularly skilled and committed parents in the rearing of their daughter. To be sure, once news of the case’s failure emerged, rumors apparently originating with Money leaked into the scientific community that Ron and Janet were rural fundamentalists whose restricted religious and cultural values had made it impossible for them to accept their child’s sex change in the first place, and that therefore they unconsciously undermined it. In reality, Ron and Janet grew up and spent the majority of their lives in the modern metropolis of Winnipeg (except for the three teen years they spent on farms), and both had (like Money himself) thoroughly rejected the fundamentalist religion of their parents (so much so that they refused even to be married in a Mennonite church). All new claims to the contrary, neither Ron nor Janet labored under outmoded stereotypes of men’s and women’s roles which would have forbidden them from accepting a merely “tomboyish” daughter, nor was their surrounding community of 1970s Winnipeg—an eclectic, cosmopolitan mix of cultures, religions, backgrounds, races, and socioeconomic levels—predisposed to rejecting a girl who did not conform to rigid stereotypes of femininity.

Zucker’s paper, however, did not concern itself solely with unnamed “psychosocial factors” that supposedly negatively influenced the case. He also presented a long-term follow-up on a second case of a developmentally normal baby boy who had been raised as a girl. In a shocking parallel to David’s case, this child (also, coincidentally, a Canadian) had lost his penis to a bungled circumcision by electrocautery and had subsequently been castrated and reassigned as a girl at seven months of age in 1971. Now twenty-six years old, the patient was described by Zucker as still living in the female sex. “She denied any uncertainty about being a female from as far back as she could remember,” Zucker wrote, “and did not report any dysphoric feelings about being a woman.” At the same time, Zucker admitted that the case could not be deemed an unalloyed example of the efficacy of sex reassignment, for he was obliged to acknowledge that the patient, in childhood, had always enjoyed “stereotypically masculine toys and games”; that as an adult she works in a “ ‘blue collar’ job practiced almost exclusively by men”; and that she is currently living with a woman, in her third significant sexual relationship with a member of the female sex.

Nevertheless, Zucker concluded, “In this case … the experiment of nurture was successful regarding female gender identity differentiation,” and he cited the case as convincing proof that her rearing as a girl “overrode any putative influences of a normal prenatal masculine sexual biology.”

Struck by the seeming incongruity of these conclusions, I spoke with Zucker about the case at his office in Toronto in the summer of 1998. Our conversation only served to raise further doubts about the paper’s conclusions, for Zucker was unable to answer any of my specific questions about whether the patient might not have been telling the researchers what they wanted to hear when she stated that she had never harbored any doubts about her gender. By now I understood that this is a phenomenon endemic to all areas of sex research that rely on patient testimony, but particularly so in the fraught and sensitive world of sex reassignment, where as one ISNA member told me, “You feel so embarrassed and ashamed to be talking to someone that you’ll basically tell them anything so you can get the hell out of there.” Zucker agreed that such scenarios are not unfamiliar, but he couldn’t say whether such a dynamic was at work in the case in question. And for a simple reason. He had never met the patient and had based his reporting solely on information supplied to him by the people listed as coauthors of the paper. These included a gynecologist with no training in the assessment of gender identity, and a psychiatrist who had conducted only two interviews with the woman—the first when she was sixteen, the second when she was twenty-six.

There was, as well, further reason to feel uneasy about the paper’s conclusions, and this had to do with its murky provenance. It was only in the closing moments of my interview with Zucker, after I had turned off my tape recorder, that he let fall that the paper had another silent collaborator—an investigator who, when notified of the researchers’ efforts, had hastened to supply records he had gathered on the patient in her early childhood. The investigator was John Money, who had authorized and overseen the patient’s sex reassignment in infancy and who had, true to practice, conducted a number of annual follow-ups with the child until she (for reasons unspecified in Zucker’s paper) stopped returning to Johns Hopkins.

16

IT HAS BEEN TWENTY YEARS since Brenda Reimer made her transformation to David. That metamorphosis marked a turning point in the family’s fortunes. Ron, who had been struggling to get his business on its feet, began finally to build a faithful clientele of construction companies and factories. By the early 1980s he was earning forty thousand dollars a year, the best money he had made in his life. Janet continued to see her psychiatrist, and by the mid-1980s, with lithium treatment, her depressions had abated. “I found out what kind of person I really was,” she says. “And I went to my children and apologized to them. I said, ‘I know at times I was unreasonable and that you were wary of me sometimes because you didn’t know what was going to come up next, and you didn’t altogether trust me or feel you could take me into your confidence.’ I told them that I felt great remorse.”

The improvements in Ron’s finances and Janet’s emotional health brought a harmony the couple hadn’t known since the earliest days of their marriage. “I would lay down my life for Ron,” Janet told me in the summer of 1998. “Actually, I remember something Dr. Money once said to me. He said, ‘I don’t know why people always say making love; it’s making sex.’ Back then I didn’t have an answer for him. Now I do. What I have with Ron is love. We make love.”

Neither Ron nor Janet pretends that they can ever put the past behind them completely. Janet remains the more talkative on the subject of the guilt and grief that are the main emotions associated with their decision, thirty years ago, to turn their son into a daughter. Ron typically finds it more difficult to speak directly about these matters, but he communicates them nevertheless in his more spare and diffident speech.

“I wonder,” I asked him in our first interview, “if you’ve ever got to a point where you forgot this had happened?”

Ron shook his head. “No,” he said. “We never forget.” Then he said it again. “Never forget.” And once more: “Never forget.”

I remembered a notation I had seen in Dr. Ingimundson’s psychiatric notes from the spring of 1977 concerning a private meeting with Janet and Ron. Under the heading “Counter transference” (the psychoanalytic term for the emotions experienced by the therapist toward the patient), Ingimundson had written, “Have a need to protect them.” I now felt something of the same need.

“I know David doesn’t blame you at all,” I told Ron. “He attributes all the best things in his life to you and Janet.”

Ron smiled weakly and blinked away the moisture in his eyes. “I’m glad he feels that way,” Ron said. “I don’t know if I feel like that.”

Perhaps the greatest insight that Ron gave me into his emotions concerning the failed experiment came when our formal interview was over, and we repaired from the backyard to the house. Ron poured us a pair of Crown Royal rye whiskeys, then invited me to watch a tape of his favorite movie. It had been a long day, and I told him I would probably head back to my Travelodge and turn in early. Ron was strangely, and uncharacteristically, insistent. “This is a really great movie,” he said. “I got Brian to tape it for me off HBO. I’ve seen it maybe twenty times.” The movie, he said, was called Crossroads. I soon realized that it was pointless to resist; by now Janet (who also loved the movie) had joined Ron in his entreaties. So I followed them to the basement, where we settled down in front of the television set.

I vaguely registered the movie’s plot as it played on the Reimers’ TV screen. Ralph Macchio plays a cocky young blues guitarist who befriends an eighty-year-old blues player, one Blind Willie Brown. Together the pair travel from New York City to Blind Willie’s Mississippi home, where he has some “unfinished business” to take care of. As Ry Cooder’s keening blues guitar soundtrack wailed over the opening credits, Janet turned to me and said, “We love this music. I think you have to have been to hell and back to love the blues.” In its detail, and in the thorny, affectionate relationship between the older and the younger man, the movie was better than I expected; but I still found myself fighting off sleep as the saga reached its final act, which occurs at a stark, dusty crossroads in the depths of rural Mississippi—at which point I began to grow alert.

Drawing on the famous legend of blues guitarist Robert Johnson (who was said to have won his skills as a guitar player from a deal he signed with the devil at “the crossroads”), the movie now revealed that Blind Willie Brown had made a similar deal almost sixty years earlier, when he was seventeen years old. But Blind Willie had not become famous and celebrated. Instead he had ended up destitute in a Harlem old folks’ home. Now he had come for a reckoning. Standing in the shadow of a leafless tree at the crossroads, he watched as the dapper, smooth-talking, grinning man with whom he had struck his deal all those years ago materialized from nowhere. The two men face each other. Ron, who was sitting in an armchair to my right, set down his rye and 7-Up and sat forward a little, bringing his face closer to the screen.

Confronting the man who had hoodwinked him into his bum deal, Willie Brown demands that the Man in Black tear up the contract between them—“and give me some peace.”

The Man in Black laughs derisively. “Why on earth would I want to do that?” he asks.

Willie is outraged at the man’s insouciance. “You sloughed up on your end of things,” Willie shouts. “I didn’t end up where I wanted. I didn’t end up with nothing—didn’t get nothing!”

But the grinning Man in Black offers no apologies. “Ain’t nothing ever as good as we want it to be!”

Both Ron and Janet hung on every word of this dialogue—as if they expected that on this viewing, the scene might finally play out differently. When the scene ended, Ron sat back in his chair, then glanced quickly at me and away. Several times during our long interview that day, I had tried to get Ron to speak about how he now felt about John Money and the momentous decision he had convinced Ron and Janet to make. He had made a few halting, stumbling efforts to answer my question but had clearly failed to say all that was in him. Now I felt I had my answer. Along with Ron’s grief and guilt there was an obvious admixture of outraged betrayal, which lay too deep for him to express in words.

Nor were those emotions solely confined to the way Ron and Janet felt about the son they had agreed to convert into a daughter. For David was by no means the only casualty of that doomed experiment. The matched control, too, had suffered, and suffered badly, with results that were still being felt. Brian’s episode of shoplifting in the spring before the family’s flight to British Columbia proved not to be an isolated incident, but a precursor of more serious transgressions to come.

“I was thirteen when I got involved with a bad crowd,” Brian explains. “It started with drinking and smoking, and it eventually wound up into stealing cars and dope and fighting. For me, personally, I never got into armed robbery and I never really hurt anyone that bad….” Then Brian thinks for a moment and amends that. “One person I hurt pretty bad.” He is referring to a boy whose arm he broke so severely in a fight that he was called to court. Listening to the litany of Brian’s brutal and criminal acts as a teen and young adult, I was mystified. Even in adulthood he clearly demonstrated, in comparison with David’s more conventionally male attitudes, a greater aesthetic awareness and a sensitive side out of keeping with the endless tales of mayhem and brutality that filled his teens and twenties. “That’s the side I couldn’t show to people,” he says. “The sensitive guy finished last. The tough guy gets the respect, and he gets left alone. That’s bad to say, but that’s the reality of it. He gets all the girlfriends; he gets invited to all the parties.”

Being included by his friends was vitally important for Brian because of the abandonment he felt from his parents. “I had problems growing up, but they had to deal with my sister’s problems, which were so much bigger,” Brian says. “But try growing up all your life feeling that your problems are nothing.”

Brian learned about his sister’s true birth status from Janet on 14 March 1980—the same day that Ron told Brenda.

“My mother was working at the parking lot,” Brian says. “She called me and said, ‘Brian, I have to talk to you about something.’ So I visited her at work, in this booth where she sat. We were having coffee. She said, ‘It’s about Brenda.’ Then she says, ‘Brenda was really your brother.’ And I got upset.”

Brian’s reaction was typically explosive. He jumped from his chair and smashed his fist into the booth’s reinforced glass window. “I broke both panes,” Brian recalls. “I was pissed off. Then I cooled down, and mother told me everything that had happened—about the circumcision and everything. I said, ‘Now I can understand. I can put the pieces of the puzzle together. It makes sense now.’ But I felt, ‘Shit, the first fourteen years of my life was a lie.’”

And there would be other emotional hurdles for Brian to get over—which became clear later that same day, when he saw his twin for the first time since hearing the news. “Dave was wearing a suit,” Brian recalls. “He says, ‘What d’you think?’ I said, ‘Hey. You look good. I’m happy for you.” But Brian admits that David’s transformation brought mixed emotions. In the past, Brian had always had his status as the family’s only son to make him feel special. Now even that was gone. “I supported him one hundred percent,” Brian says. “I felt a sense of relief because now he finally fitted into society. At the same time, I’m not big brother anymore.”

Just how deeply affected Brian was by this swift and emotionally bewildering turn of events was clear a year later, shortly before the twins’ sixteenth birthday and two weeks before David underwent his first phalloplasty, when on 17 June 1981, Brian was taken to the emergency room of St. Boniface Hospital to have his stomach pumped. He had drunk from a bottle of drain cleaner. At the time, Brian told his family that the suicide gesture was over a girl who had broken up with him. Today Brian admits that was not the truth. “Mom was worried sick about David,” he says. “Every waking moment was David. It was ‘Brian’s OK, he can take care of himself.’ Any problem I had seemed trivial compared to David’s. So it was almost like I had to do something to get a little bit of attention.”

At sixteen, to his parents’ consternation, Brian quit school and took a job pumping gas. He moved out of the house and started living with a girlfriend. At nineteen, Brian married her, and had two children. The marriage proved tumultuous and ended in acrimony and divorce a few years later.

Brian’s life reached its nadir after the divorce. Unemployed and trying to raise his children as a single father, he began to drink to excess and suffered bouts of severe depression. His children were temporarily removed from his custody and lived for six months with Ron and Janet. During that time Brian cleaned himself up and got control of his life. In the early 1990s he landed a well-paid union job working a lathe in a metal-spinning factory. He remarried, had a daughter, and moved into a house he bought in Winnipeg’s West End. Prozac has helped with his mood swings.

Aside from his wife and children, Brian says that the person he knows best in the world is his brother. Despite the lingering rivalries that sometimes drive the twins, even in adulthood, to severe periods of feuding and dissension, they remain extraordinarily attuned to one another’s inner lives. Yet Brian admits that, like his parents, he harbors guilt about David. It is a guilt that dates back roughly to sixth grade at Agassiz Drive school, when Brian pulled away from his social pariah sister. “I had a choice,” Brian says. “I could be with my friends or with my sister. They made it quite clear—subtle but clear—that I had a choice.” He chose to have friends—a choice for which he has never fully forgiven himself. “I wanted to have a life,” he says. “I turned my back on Brenda.” Only many years later, after David had been living in his true sex for almost five years, would the brothers again grow close.

At our first meeting, in late June 1997, Brian proudly cataloged the striking similarities between them, likening David and himself to those cases of identical twins separated at birth and who, when reunited in adulthood, discover that their lives bear uncanny parallels. “Both me and Dave married in September,” he told me. “Both have one dog and one cat. Both are factory workers. Both make around the same amount of money. We both like to watch Biography, 20/20, Fifth Estate, 60 Minutes. Both love Elvis. In a way, it’s always been me and my brother against the world.”

More than two decades have passed since David Reimer had his final contact with Dr. John Money, when the famous sexologist slipped him fifteen dollars in his parents’ living room. In the intervening years, David often fantasized about what he might say or do to the psychologist if they were ever to meet face-to-face. He admits that as a younger man his fantasies ran to violence. No more. Determined to get on with his life, he refuses to dwell on a past that he cannot change. In their paper, Diamond and Sigmundson describe David as a “forward-looking person.” In conversation, Diamond calls him a true hero. And indeed, David’s life today defies the dire prognosis of the psychiatrist who thirty-three years ago declared that he would never marry and “must live apart.” At the same time, it has been impossible for him to put the past away entirely. Over the course of our interviews together, David spoke with a blunt and unvarnished honesty about his extraordinary childhood and youth. He spoke without self-pity. His sufferings were extreme, his survival almost miraculous: both lend to his unschooled speech an aura of oracular wisdom.

“I don’t blame my parents,” he told me. “A lot of people are going to be surprised by that. They’d have to put themselves in my situation and live out my life, knowing that my parents have sacrificed so much. My dad’s a very special man. He’s got a lot in his heart, and he doesn’t know how to express himself. But you know, you can see in the soul of his eyes that he’s hurting and that he cares and he loves you.

“My mother is a lot better, she’s getting help. She admits that she did wrong things. Some people wouldn’t even do that. You know, as a very little kid I had a crush on my mother. I used to pick dandelions for her. She was the most beautiful woman in the whole world to me.

“When I think of my brother as a kid, I see this little seven-year-old with a bean shave, puppy-dog eyes, asking for help. ‘Help me! Help me!’ He’d get into trouble, get into a fight, and I’d do my best to bail him out. He’d let the scrawniest guy beat the hell out of him. My brother hiding behind me! I’d look ridiculous fighting because of the way I was dressed—I didn’t look the part to bail him out. My dad gave me shit when I fought because he thought it put Brian in a position where he would have to try to protect me. ‘It’s unfair to put your brother in a position like that.’ I tried to explain: ‘This is not my brother’s fight, this is my fight.’ It didn’t do any good. I’m not going to take anything away from Brian: he had it rough because of me. But it was directed at me, not him. When they picked on him, they were making fun of me. ‘There’s your butch sister.’

“My childhood. It comes to me. I don’t go and think about it. I’m trying to sleep, and these stupid thoughts come into my head, and I shake my head and I say, ‘I’m going to think about something else,’ but it will jump right back into my head. Memories of how I used to look. Memories of being belittled by my classmates. Memories of just trying to survive.

“If I had grown up as a boy without a penis? Oh, I would still have had my problems, but they wouldn’t have been compounded the way they are now. If I was raised a boy, I would have been more accepted by other people. I would have been way better off if they had just left me alone, because when I switched back over, then I had two problems on my hands, not just one, because of them trying to brainwash me into accepting myself as a girl. So you got the psychological thing going in your head. When I’m intimate with my wife it sometimes haunts me. From time to time it gets to flashbacks of you as a kid, and it makes you— I admit, sometimes I have to get up out of the bed and go to the bathroom and throw up.

“You know, if I had lost my arms and my legs and wound up in a wheelchair where you’re moving everything with a little rod in your mouth—would that make me less of a person? It just seems that they implied that you’re nothing if your penis is gone. The second you lose that, you’re nothing, and they’ve got to do surgery and hormones to turn you into something. Like you’re a zero. It’s like your whole personality, everything about you is all directed—all pinpointed—toward what’s between the legs. And to me, that’s ignorant. I don’t have the kind of education that these scientists and doctors and psychologists have, but to me it’s very ignorant. If a woman lost her breasts, do you turn her into a guy? To make her feel ‘whole and complete’?

“I feel sorry for women. I’ve been there. ‘You’re a little lady—go into the kitchen.’ Or ‘We don’t want you to chop wood—you might hurt yourself.’ I remember when I was a kid and women were fighting like hell to get equal rights. I said, ‘Good for them.’ I kind of sensed what position women had in society. Way down there. And that’s how I was portrayed. And I didn’t want to go way down there. I felt, I can do what anybody else can! But ‘Oh, you’re a girl—you might get hurt playing ball.’

“At Agassiz Drive school there was this guy, Tubby Wayne. He was a male chauvinist pig. ‘Women are dirt; they can’t do anything men can do.’ He kept saying, ‘You don’t know anything. You’re a girl; girls don’t know anything.’ So I finally said to him, ‘You think you’re so tough? Then hit me. C’mon hit me.’ He says, ‘No, I’m not going to hit you; you’re a girl.“No. Hit me. I’m not going to put up with this.’ He wouldn’t, so I punched him—and he laughed at me. It was a good thing he didn’t hit me, I guess. But I was thinking, Don’t hide behind the ‘I don’t hit girls’ excuse.

“The guys at work don’t know about what happened to me. I mean, I work in a slaughterhouse. All men. Can you imagine?—‘There’s the freak who wore dresses as a kid.’ They give you that male chauvinist crap all the time. Like they’re always saying that they’re the boss at home. They look at me and ask me, ‘Who’s the boss?’ I say, ‘Look, man, in my home it’s a partnership. It doesn’t mean I wimp out; sometimes I get my way, and sometimes I don’t get my way. But either way, it’s a partnership.’ I mean, who wants a woman with no brains, who follows you blindly? That’s more like a slave than a wife. You don’t want a slave, you want somebody with her own opinions, somebody who puts you on the right track, someone to show you the right direction. It’s very hard to talk to somebody who’s stone-cold stupid, who follows you blindly.

“But you know, if I had had a normal life, and none of this had ever happened to me, I’d probably be one of these chauvinistic kind of guys, where the guy goes to work, breaks his back, comes home, and sucks down a beer and watches sports. And if I saw someone like me out on TV, I’d sit there saying, ‘Oh God that’s sick.’ That’s how I would be. So knowing that that person is me, you can realize how sick I feel looking back on all this. You wish to God you could switch places with anybody.

“After I tried to kill myself, they put me in one of those psycho wards. Right away they want to put you in a group meeting. You can’t even face this by yourself, and they’re going to stick you in a room full of people so you can discuss this with strangers? There was this doctor there who kept telling me that it was wrong for me to try to kill myself. Well, it’s easy for him to sit there and say, ‘Shame, shame, shame.’ This guy’s been putting himself through college, he’s got a degree, probably living in a fancy house, he’s got 2.2 kids, got a normal life. Don’t compare that to me. Not the same.

“I’m happiest when I’m alone. Doesn’t mean I’m not friendly. It’s just I’m more comfortable when I’m by myself. It’s not lonely. It’s relaxing. It’s soothing. It reminds me of my grandfather’s farm. If I go for a walk there, I’m in total peace. I’m never alone there. You always feel like you’re surrounded in a place like that. Surrounded by what, I don’t know. But you’re not alone.

“I still wonder from time to time what it would have been like to have a biological child: to see how much of me that child would have. It’s not really an ego trip. It’s just … you feel that way. But I love my kids, and they’re my children—not just my stepchildren. I’m going to want to tell my kids about what happened. I couldn’t keep something like this away from them. I’d feel very uncomfortable about that. I already told my eldest, when she was fifteen. She had that look on her face, like, ‘You wore dresses?’ But all in all, she took it well. She said, ‘I don’t love you any less, Dad.’ I know my middle child would understand, but I won’t tell her for years. I have to wait until she’s a lot older. My son? I’ll tell him when he’s about fifteen.

“I live my life through my son. Everything my son does, that’s me. When my son has a little crush on a girl, and he’s leaning on a fence, and the girl comes up and says, ‘Hi,’ and he’s got that blush thing happening; when he’s in Cub Scouts—that’s me. I live through him. When he succeeds, that’s like me succeeding. Some psychiatrist would disagree with me living my life through him, but I never had any kind of a childhood.

“It’s going to be harder to tell my son than to tell my girls. You never know with boys and their fathers. He might think differently about me. You know: ‘My father wore dresses, my father had a girl’s name, my father lived as a girl.’ I mean that’s a lot to swallow. You can tell when it’s hard for somebody to accept something or is embarrassed. And for him to look at me sideways …

“I’m sick to death of feeling ashamed of myself. That feeling will never go away. I did nothing wrong, but it’s like you’re conditioned to feel ashamed of yourself. The very thought that I was wearing a dress, having a girl’s name—the long hair and everything—I’m going to have to carry that for the rest of my life. You can’t erase memories like that. I just survive as best I can. Keep telling myself, ‘It’s not my fault. Not my fault what happened.’

“Mom and Dad wanted this to work so I’d be happy. That’s every parent’s dream for their child. But I couldn’t be happy for my parents. I had to be happy for me. You can’t be something that you’re not. You have to be you.”

Embarking on my interviews with David, I had been warned by his former psychiatrist Doreen Moggey that I was engaging in a dangerous psychological process. She feared that David could not negotiate the leap from his current life to his former one without risk of serious mental upset, and urged me to tread gingerly when guiding him back to the memories and events he had tried, for so long, to forget. I heeded her advice, but in my conversations with David—which often stretched to six hours at a sitting, going deep into the small hours of the morning—I found that he bridled at the cautious circumspection of my questioning. He seemed to want nothing more than to charge fearlessly into the past, to speak without restraint about all that had happened to him, to put his true life story on the permanent record, and thus to reclaim it as his own. I also discovered that he wished to reclaim his life not only in the abstract form of interviews with me.

In mid-January 1998 I located and spoke to his old friend Heather Legarry. She still lived in Winnipeg but was married now with a different last name, and she worked as a kindergarten teacher. As was the case in all the interviews I did with those who had known Brenda as a child (and to whom David had authorized me to tell his medical history), I did not at first tell her the truth of Brenda’s birth, so as not to color her memories and impressions of the girl; but when I did finally reveal to her that Brenda had been born a boy and now lived as a man named David, she said that she would like to see him. Recalling how David had once dodged a confrontation with Heather at the Go-Cart track fifteen years earlier, I wondered how he would greet this news. I was surprised when David said that he would like to see her, too. That Sunday they met privately and had lunch, while I stayed home with Jane and helped her nurse her mostly-mock jealousy—a jealousy that became a little more real when David failed to return home for almost four hours. When he did arrive, he (with typical thoughtfulness) bore a red rose for his wife, but he also bore an expression, on his face, that I had never seen before; it was a look of serene and somehow euphoric peacefulness. Asked by Jane what they had talked about for so long, David even got off a joke about his horrendous past. “Oh,” he said, “just girl talk!” In fact, he later said, he and Heather had discussed all aspects of his childhood, comparing notes on their shared memories, reexamining their old friendship in the light of what neither had known at the time. It was a meeting that had clearly removed from David a burden that had weighed on him for almost two decades.

None of which is to say that revisiting David’s past with him for the purposes of researching this book was not without its painful, and precarious, moments—particularly when I stumbled upon one last family secret of the Reimers’ that had never been exposed: one of the white lies that Janet had constantly been obliged to concoct for Brenda in order to quell her daughter’s suspicions about her true identity; a white lie that had, through parental oversight, never been corrected with David, and which thus lay buried for almost twenty years, like an unexploded land mine.

On my first ever trip to Winnipeg, eight months earlier, one of the first things David had ever told me about his mother was that she was a published poet. He described to me, with touching pride, how he had actually met the editors of the journal that had printed his mother’s work. I soon learned, of course, that the story of Janet as poet was a ruse. Wanting to learn from David his impressions of meeting the BBC reporters on that day in October 1979, I did not feel comfortable keeping up the fiction that they were poetry editors. I knew that I would have to explode the lie. I put it off for as long as I could, until close to the end of my monthlong stay in Winnipeg in early 1998. I tried to break the news gently, but David still reacted very badly to this jarring revelation.

“Why did I have to find out this way?” he raged. “I’m a thirty-two-year-old man!”

For the next two hours he railed against his mother’s “gutlessness” in not telling him the truth; he shouted that he had been lied to all his life, and said, “You don’t expect that from the people you trust and love!” His anger and upset were frighteningly intense, but thankfully David’s fury soon burnt itself down, and the next day he visited his mother and spoke to her about the deception. She apologized for having overlooked this final lie, and they made up over it. In the end, the exposure of that last, lingering falsehood had a positive effect, Janet said, in removing an obstacle that had persisted from David’s childhood of secrets and lies. I was glad, and relieved, of this outcome, but at the same time, glimpsing David’s apocalyptic rage made me wish, not for the first time, that he could bring himself to see a therapist, if only to vent the combustible anger that periodically built up in him over his past.

But David’s dismal experience with the mental health profession as a child has guaranteed that he will never consult a psychiatrist in adulthood—unless it were his old friend, Mary McKenty, and that is impossible, given that she, at age eighty-three, has long since retired. Still, David and she have remained friends, and he accompanied me on a visit I made to her home in June 1998, on my final trip to Winnipeg. Though now in the grip of Alzheimer’s disease, and often unable even to recognize her own children, McKenty knew David immediately. She was a tiny woman with long, gray hair and the masklike expression typical of Alzheimer’s sufferers, but her face blossomed into a delighted smile when she saw David step over the threshold of her door.

While David chatted with Mary’s live-in nurses, I retired with her to a small sitting room off the front hall. Fortunately, we had come on a day when Mary’s memory was particularly good, and her answers to my questions, though abbreviated, were spoken in a strong clear voice that left no doubt that she knew precisely what we were talking about.

I asked Mary how she had handled Brenda’s difficult case. She shrugged. “I tried to be sensitive and supportive,” she said. I asked if Brenda had ever seemed at all like a girl. “No,” she said, “not like a girl at all.” I recalled to myself Money’s claim that Brenda must have been “coached” in rejecting girlhood; no evidence for this existed anywhere in the local treatment team’s notes, and David had been unequivocal in stating that McKenty had in no way “coached” him. But I felt it was my obligation to ask. Had Mary always kept Brenda’s true birth status from her? “Yes,” she said. I asked if she had tried to steer her gently away from being a girl. “No,” McKenty said. “The things were for her to realize and for her to do.”

Impressed with what I had been able to glean about Mary’s special human touch with her patients—and especially with Brenda—I asked her about her general approach to psychiatry. In reply, she said “You have a parental attitude to your patients.” Then she glanced in the direction of the hallway, where David’s voice could be heard. “Just like a parent,” she added, “you often admire them.” I was moved by this word admire—so different from what one ordinarily expects to hear a psychiatrist say about a patient, or to hear a highly educated doctor like McKenty say about a slaughterhouse sanitation worker like David Reimer. But it was clear that her admiration for David was total.

I asked if she had ever read any of John Money’s work. Her face, which had been eerily immobile, crumpled into a scowl. “Yes,” she said with clear distaste. I asked what she thought of it. “I thought it was unusual,” she said dryly.

David came into the room. She immediately brightened. He crouched down on the carpet in front of where she sat on the sofa.

“It’s been a long time, Mary,” he said gently.

“How long has it been?”

“Ten years at least.”

“And it’s been almost twenty since Mary started treating you,” I said.

David looked sheepish. Just that morning, he and I had been looking at Mary’s therapy notes with Brenda, and David had been aghast to be reminded of the cruel tricks he had played on her in their earliest sessions. He apologized to her now. “I drew a nasty picture of you,” he said. “I took you hostage with a toy gun.”

“I didn’t mind,” she said.

“I made a Death Warrant in your name!”

Mary laughed and pretended to reach for her cane. “You’d better watch it!” she said. Then Mary grew serious and looked at David. His smile faded, too. For a moment it might have been twenty years ago, and the two might have been patient and doctor again. And indeed, Mary’s next utterance was a classic psychiatric inquiry, a question that went to the very heart of the psychotherapeutic enterprise, and to the heart, for that matter, of the universal enterprise of becoming a self-realized human being—the enterprise upon which we are all engaged.

“Is there anything you want to change?” she asked.

David looked down at his hands. He breathed a tired sigh. Then he looked at her. He smiled. “Everything I’ve wanted to do,” he said, “I’ve done.”

Among the things that David Reimer has done that give him greatest pride is his decision to speak out publicly about his ordeal, and the positive changes that have resulted from that act.

For despite the brave efforts of Cheryl Chase, despite the three decades that Milton Diamond spent trying to warn doctors about the dangers in current management of intersex conditions, despite the long-term follow-up of sex-reassigned youngsters in Bill Reiner’s study, the medical establishment remained reluctant to address the issue. But in October 1998, amid the growing controversy ignited by Diamond and Sigmundson’s “John/Joan” article, the American Academy of Pediatrics invited Diamond to address its prestigious annual meeting of urologists. Diamond spoke about the failed twins case and spelled out his and Sigmundson’s revised protocols for the treatment of children with irregular or injured genitals. His speech was met with sustained applause from the physicians—the first tangible sign that the medical establishment as a whole might be prepared to alter what, for the past four decades, has been the accepted standard of care. It was a moment of triumph that Diamond declines to accept for himself, and instead directly attributes to the willingness of David Reimer to speak out about his extraordinary life as one of medicine’s most famous, if unwitting, guinea pigs.

In speaking out, David has shaken to its foundations the clinical practice founded on John Money’s work; he has also raised profound questions about a theory that has held sway for most of the twentieth century: Freud’s theory that a child’s healthy psychological development as boy or a girl rests on the presence or absence of the penis—the ultimate reason that David was converted to girlhood in the first place. It is a notion that today is also being called into question by neurobiological research, which is leading scientists toward the conclusion that, as Dr. Reiner says, “the most important sex organ is not the genitals; it’s the brain.”

David Reimer puts it another way when he speaks of his pride in his role as husband, father, and sole breadwinner in the family he never believed he would be lucky enough to have. “From what I’ve been taught by my father,” he says, “what makes you a man is you treat your wife well, you put a roof over your family’s head, you’re a good father. Things like that add up much more to being a man than just bang-bang-bang—sex. I guess John Money would consider my children’s biological fathers to be real men. But they didn’t stick around to take care of the children. I did. That, to me, is a man.”