Changing Sex Is Hard to Do

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Science  21 Mar 1997:
Vol. 275, Issue 5307, pp. 1745
DOI: 10.1126/science.275.5307.1745a

Boys will be boys. That's the message from a unique, long-term follow-up of a male who, after losing his penis, was subjected to intensive efforts on the part of psychiatrists, surgeons, and his parents to feminize him. Now in his 30s, he is living as a man and happily married, scientists report in the March Archives of Pediatric Adolescent Medicine.

Sexologist Milton Diamond, of the University of Hawaii, Honolulu, has followed the case since the 1970s. He says the story of “John” and “Joan” has long been presented in textbooks as the “classic” demonstration that environmental forces can override biology in shaping gender identity. John's penis was accidentally burned off in 1963 during his circumcision at the age of 8 months. He was brought to Johns Hopkins University in Baltimore, where, under the guidance of sex researcher John Money, a decision was made to turn him into a girl—removing testicles, structuring a vagina, and giving him female sex hormones later.

Despite years of being treated as a girl, “Joan” was never comfortable and finally rebelled at 14, after 2 years of estrogen therapy. “I['ve] suspected I was a boy since the second grade,” he told his doctor. He eventually got a mastectomy and doses of male hormones. At 25, he married a woman who already had children.

“It's big news,” says psychologist Michael Bailey of Northwestern University in Chicago. “This case was heralded by many as the pinnacle of proof that psychosocial factors can override biological factors.” Some textbooks have continued to cite the case, he says, despite John's reversion to maleness and much research showing that many aspects of sexual differentiation are biologically influenced. He and others believe that whether you think you're a boy or girl probably is determined before birth.

Diamond says the case has major implications for the treatment of babies born with ambiguous genitalia. The textbooks tell you, “If you can't make a good penis out of it, make a vagina.” Now it's clear that the policy should be, “Keep your knife away. Let the kids make a decision when they get older.”

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