Transsexual people themselves rue the changes at Hopkins set in place by McHugh. “Hopkins’s cachet with transsexual people desperately seeking services remained, so since 1979 those poor patients who didn’t know any better were seen at Hopkins’s Sexual Behaviors Consultation Unit (SBCU), which continued to do research on them but made them pay $150 per visit for that privilege,” says Jessica Xavier, a local activist who in 2000 carried out a needs-assessment survey on transgender health care in the District of Columbia. “They also stopped referrals for sex-reassignment surgery, which McHugh was quoted as calling ‘psychosurgery’ and hoped would go the way of pre-frontal lobotomies. If seen at the SBCU, a transsexual patient would be fortunate indeed to get referred for endocrinology.”
According to Paul McHugh, the incorporation of the diagnosis of transsexuality and later “gender identity disorder” in the Diagnostic and Statistical Manual has only “sustained the misdirection” put in place by John Money and other researchers. “People were being harmed, subjected to a ferocious surgery and being encouraged in an overvalued idea that doesn’t for most of them make sense,” McHugh maintains. “Fundamentally at the root of all this is an idea that is shared by other people in the environment, that is, by other people like Dr. Money, for example—the idea that sex is socially assigned and that it could be changed. These individuals take that idea up and it becomes a ruling passion for them. They don’t think about anything else and it becomes a part of what they call their identity. They have talked themselves into this just like other people have talked themselves into the idea that they are not thin enough.”
McHugh is nonetheless willing to concede that researchers may someday find a biological explanation for at least some forms of gender variance. “If people are afflicted in fetal life by an abnormal hormonal thing, they can have all kinds of peculiar sexual attitudes when they come out,” he admits. But he is quick to distinguish between individuals who can prove that they were subject to “an abnormal hormonal thing” in prenatal life from those who, for whatever reason, choose to dress and live as members of a sex other than that dictated by their anatomy. And he remains adamantly opposed to any form of surgical intervention for the latter group. “This surgery is serious surgery and it’s a misuse of resources when I don’t think that the problem lies in the bodily structure.”
Despite the controversy surrounding sex-change surgery and his ongoing battle with adversaries within Johns Hopkins and without, John Money was continuously funded by the National Institutes of Health for more than thirty-five years, from the start of his career to its ignominious end. In June 1997, Milton Diamond and Keith Sigmund-son published an article in the Archives of Pediatrics and Adolescent Medicine that cast doubt not only on Money’s theories but also on his credibility as a researcher. Sigmundson had for many years overseen the care of Money’s most famous patient, a twin boy named David Reimer, who had been raised as a girl after his penis was accidentally severed during a circumcision. Money had long used this case (identified as “John/Joan” in the Diamond article) as proof that the sex of assignment and rearing trumped all other variables in the formation of gender identity in normatively sexed, as well as intersexual, children. Despite her XY genotype and male genital and endocrine profile at birth, “Joan” was a normal little girl, Money asserted in scientific articles, books, lectures, and interviews, who “preferred dresses to pants, enjoyed wearing her hair ribbons, bracelets and frilly blouses, and loved being her Daddy’s little sweetheart.” Sigmundson, who had witnessed firsthand the acute misery suffered by the child and his family as the boy’s masculinity asserted itself in the face of repeated efforts to convince him that he was a girl, had been contacted by Diamond, who sought information about the child for many years.
As early as 1959, Diamond had challenged Money’s view that the sex of assignment and rearing was the key to the formation of gender identity. Working in the laboratory of William C. Young at the University of Kansas as a graduate student, Diamond had participated in animal experiments that showed the awesome power of hormones on developing fetuses. Female guinea pigs treated with massive doses of testosterone in utero were masculinized, not just in anatomy but in behavior. “There was lots of older literature that clued us in so that this [data] wasn’t coming out of the blue,” Diamond told me in a 2003 interview, referring to the “chickens, the famous chickens” hormonally manipulated by Berthold in 1849. “ut people weren’t applying it to humans. Those were birds. This was the work that showed it could happen to mammals. That you could take a mammal, treat it in utero for a limited period of time, don’t touch that animal until it’s an adult, and then lo and behold it acts like a male.” Subsequent experiments by the researcher Roger Gorski and colleagues showed the same effects in female rats. “With rats, the critical period for that sort of brain differentiation is postnatally,” Diamond says. “So Gorski and others were able to give it after birth—a single injection! And that’s so remarkable to me. You give one injection, a single day, and you forever influence that individual’s life.”
Over the next thirty years, Diamond’s animal experiments and work with human intersexual patients convinced him that human beings are not psychosexually neutral at birth, as Money had attempted to prove, but are psychosexually biased at birth, although social factors play an important role in how that biological predisposition is expressed. “I think that any behavior, whether it be sexual behavior, eating behavior or religious behavior, starts off with some sort of biological predisposition,” he says. “Some behaviors are more biologically oriented than others but they are always influenced by social and cultural factors.” Diamond, who prefers the terms “androphilic” and “gynecophilic” to “homosexual,” says that a gay person who lives in a society where homosexuality is brutally suppressed, for example, will probably not act on his feelings. “If you are a homosexual in Saudi Arabia,” he says, “you keep that to yourself. So that’s why I say that there is a biological predisposition, and society decides how it gets manifested.” In the case of David Reimer, the child (known as Brenda throughout his childhood) “was socially constrained from acting as the male that he wanted to be by his parents, Money, and others who said ‘oh no, you are a girl.’”
Despite his early and repeated championing of the view that humans are not psychosexual blank slates at birth, Diamond found it difficult to gain a hearing until he and Sigmundson published the article that revealed that David Reimer had threatened suicide at age fourteen if he were not allowed to live as a male. His parents then told him the truth about his history, and he immediately began living as a male. By the time Diamond located Reimer’s former psychiatrist, Keith Sigmundson, Reimer was married and the adoptive father of three children. His life story became the basis of a best-selling book, As Nature Made Him: The Boy Who Was Raised as a Girl, a book that understandably is narrated from the point of view of David Reimer and his family. John Money is depicted as a monstrous figure, an unsavory amalgam of evil scientist and sexual pervert, a voyeur in a white lab coat. The undeniable harm that was done to David Reimer is foregrounded, and Money’s theories are presented as bizarre fantasies shorn of social and scientific context. Though it is rather unpopular these days to defend John Money, some researchers are willing to say that the Colapinto book doesn’t offer a balanced presentation of either the man or his research.