I thought for a long time that being male had to do with testosterone levels, and I still suspect that it does. But then we also have women who have higher testosterone levels, and I view them generally as expressing male energy. I don’t think it’s about genitalia at all. And that brings us back to those transgendered beings who say, “I don’t want to mutilate my body.” I thought it was being very clever when I said [in the book], “There was nothing wrong with my body, except that it had a penis attached to it.” I like that, but I think there is a lot going on beneath that statement. It didn’t work for me, but that would have been like wearing a green hair ribbon when everything else was blue. It clashed. I think that’s true. But it’s just another bit of baggage. Each one of these choices has its own baggage.
Four
MEN AND WOMEN, BOYS AND GIRLS
When I got to the carnival in Stroud, I walked around for a long while just looking at the exhibitions and trying to build up enough courage to ask someone for a job. Finally, I went to the freak sideshow and started a conversation with the barker. I told him that I was looking for a job and he said he’d see what he could do. He went inside the tent to talk with the show’s owner and, after about five minutes, came out. “We’ve got a spot for a half-man, half woman person, “ he said, with a laugh. “Do you think you can do it?”
Two years after Christine Jorgensen became an international celebrity, a Johns Hopkins psychologist named John Money began publishing a series of papers that were to have large consequences for intersexual and transsexual people, and for American society in general. Early in his career, Money’s investigations into the psychology of intersexual patients convinced him that a person’s deeply rooted sense of self as either male or female was largely formed not before but after birth, by a combination of factors, the primary one being “the sex of assignment and rearing”—the way that one is raised. “To use the Pygmalion allegory, one may begin with the same clay and fashion a god or a goddess … if certain conditions are met,” he asserted. This theory was adopted not only by scientists and physicians, who used it to justify extensive surgical and hormonal manipulation of intersexual infants and children, but also by second-wave feminists who saw in Money’s theory proof that women were socialized to be a “second sex,” weaker, more dependent, more emotional. “Femininity” and “masculinity” were defined as roles adopted by essentially androgynous beings. Before we don the socially constructed personae of male and female, advocates of Money’s theory asserted, we are all the same. However, Money himself was no proponent of androgyny—quite the contrary. In Money’s view, psychological health was entirely dependent on the development of an unambiguous identity as either a man or a woman. Money’s research thus combined radicalism (the theory ofpsychosex-ual neutrality at birth) with a profound conservatism (emphasis on sexual dimorphism). We are still grappling with the effects of this paradoxical theory, which so deeply penetrated our culture, today.
The research question that Money began to explore as a graduate student appeared simple, and unlikely to initiate sweeping social changes. What could or should be done to help those individuals born in bodies that defied traditional definitions of sex, such as the long-deceased and forgotten Herculine Barbin? Children born with genital anomalies presented a clinical riddle. To the eighteenth-century doctors who examined Barbin, the presence of undescended testicles was proof that the girl was really a boy. But by the middle of the twentieth century, the medical determination of sex had become decidedly more complex, no longer visible to the eye or the palpating hand of the physician.
In 1948, Murray Llewellyn Barr, a Canadian geneticist, made the discovery for which he would later be nominated for a Nobel Prize. While carrying out experiments on nervous system cells of various mammals, Barr and a graduate student named Ewart George Bertram noticed that some of the cells contained small dark masses. Attempting to identify the masses, Barr discovered that they were present only in the cells of female animals. Later investigators would discover that these “Barr bodies” were in fact inactivated X chromosomes, switched off to prevent an overload of genetic information in the cell. Initially, Barr bodies were identified in biopsies of skin tissue, but in 1956, scientists realized that simply scraping some cells from the mucosa of the mouth would produce accurate results. Sex chromatin typing gave rise to a new science, cytogenetics, and a new method to determine sex.
Intersexual and gender-variant persons were among the first to undergo genetic testing, and certain anomalies were revealed to be genetically caused. Others were found to have no apparent genetic basis.
“It was as a graduate student in the Harvard psychological clinic that I first became directly acquainted with the phenomenon of human hermaphroditism,” Money writes in Gendermaps, published in 1995. He describes the case of a seventeen-year-old boy born with two un-descended testes and external genitalia that “resembled a vulva with a clitoridean organ instead of a penis.” The boy was suffering from a condition then called testicular feminizing syndrome, but today known as androgen insensitivity syndrome (AIS), in which cells throughout the body of an XY child fail to respond to androgens. The child thus develops a female body shape and genitals. Prior to the discovery of a test to determine chromosomal sex, such children were usually raised as girls, though as adults they were infertile. Money’s first intersexual patient “had been reared as a boy after a sex reannouncement from female to male early in infancy on the advice of a wrongly informed physician who had promised surgical and hormonal treatment in the teenage years so as to allow the boy to become a man.”
No such treatment was available, but when doctors informed the seventeen-year-old seeking the promised treatment that he could instead live as a woman, “it was an option too alien for him to contemplate,” says Money. This first experience with an intersexual person led Money to recognize the possibility that the sex of the mind could be at odds with the visible sex of the body. “It pointed clearly toward the principle of a discontinuity between the development of the body, from prenatal life through puberty, as feminized, and the development of the mental life as masculinized, despite the restrictions imposed on genital masculinity by anatomical and hormonal femininity.”
After completing his doctoral dissertation at Harvard, “Hermaphroditism: An Inquiry into the Nature of a Human Paradox,” Money joined the staff of the Pediatric Endocrinology Clinic at Johns Hopkins Hospital. A protege of Lawson Wilkins—often called the father of pediatric endocrinology—Money was recruited by Wilkins to work at Johns Hopkins as a psychoendocrinologist, a clinician/researcher whose primary goal was to develop an understanding of the mental and behavioral changes caused by treatment with hormones. At Johns Hopkins, Money’s caseload of intersexual patients expanded to sixty. His psychological evaluations of these sixty patients convinced him to “abandon the unitary definition of sex as male or female,” based on the commonly accepted criteria of either chromosomal or gonadal sex. Instead, he identified “five prenatally determined variables of sex that hermaphroditic data had shown could be independent of one another”—chromosomal sex, gonadal sex, internal and external morphologic sex, and hormonal sex—and “a sixth postnatal determinant, the sex of assignment and rearing.”