As Nature Made Him (6 page)

The first complete transexual surgery at Johns Hopkins was performed by Dr. Jones on 1 June 1965, when a New Yorker named Phillip Wilson became Phyllis Avon Wilson. But it still remained for Johns Hopkins to sell the idea to the American public. While some members of the sex change committee argued for keeping the existence of the clinic quiet, Money pushed for a preemptive strike and argued in favor of creating a press release that would circumvent leaked rumors about what the team had done. Money’s argument prevailed, and he helped concoct a press release with the hospital’s public relations department. The statement was issued on 21 November 1966. Money later revealed that a strategic decision had been made to issue the press release to the
New York Times
alone. The prestige of the
Times
, the Johns Hopkins team hoped, would set the tone for all other media coverage. “The plans,” Money later wrote, “worked out exactly as hoped.”

The
Times
treated the revelations with none of the scandalized outrage that had greeted the Jorgensen case in 1951. The front-page story used verbatim quotations from Gender Identity Clinic chairman John Hoopes, culled directly from the Johns Hopkins press release, and presented the procedure as a humane and effective solution to an intractable psychosexual problem. Similarly approving stories followed in all three news weeklies,
Time
,
Newsweek
, and
U.S. News & World Report
. In April 1967 Esquire magazine published an exhaustive feature on the Johns Hopkins clinic, in which Money was admiringly quoted. Indeed, of all the coverage in late 1966 and early 1967 of Johns Hopkins’ pioneering foray into transexual surgery, by far the hardest edged was CBC’s
This Hour Has Seven Days
, in which Alvin Davis sharply challenged Money on the ethics and efficacy of switching people’s sex. Except for the single stinging rejoinder (“Would
you
like to argue on God’s side?”), Money had refused to rise to the bait, and thus, for his fellow Gender Identity Clinic committee members, set the standard for how to handle direct attacks. Money’s calm, judicious performance was a masterpiece of public relations, and all the more impressive to those who knew the ferocity with which, in ordinary life, he responded to even the mildest opposition to his opinions.

As Money himself would admit in an essay written in 1990, “In the practice of my psychohormonal research, I do not suffer fools gladly.” This was an understatement. The psychologist’s violent reactions to intellectual challenge were legendary. “John was unusually brilliant,” says Dr. Donald Laub, a pioneer in adult transexual surgical techniques who has known Money for thirty years. “He may be the smartest person I’ve ever met. He was so smart that it was a
problem
—because he knew everybody else was dumb.” By all accounts, Money had no compunction about letting others know his low opinion of their intellectual firepower. “Even when John asked for feedback, what he was looking for was agreement,” says Dr. Howard Devore, a psychologist who earned his Ph.D. under Money in the Psychohormonal Research Unit in the mid-1980s. Should that agreement fail to be forthcoming, Money was never afraid to let his displeasure be known. As early as the mid-1950s, Money had a reputation for tantrums among his coworkers, underlings, and students that preceded him throughout the academic world.

“Every center that I trained at after [Johns Hopkins],” says Devore, “when people saw on my résumé that I had worked with John Money, they would ask me to comment, off the record, what it was like working with him and was he ‘as bad as people say?’ I was just amazed at how consistent his worldwide reputation actually was. And frankly, John didn’t do that much to hide it. I once saw him stand up at an academic meeting and shout a presenter down because he didn’t agree with what she was saying.”

By February 1967—when Ron and Janet Reimer first saw John Money on television—his reputation was for all intents and purposes unassailable. Dr. Benjamin Rosenberg, himself a leading psychologist who specialized in sexual identity, says that Money was “the leader—the front-runner on everything having to do with mixed sex and hermaphrodites and the implications for homosexuality and on and on and on.”

Money’s reach and influence throughout the academic and scientific world would help to define the scientific landscape for decades to come—indeed, to the present day: many of his students and protégés, trained in his theories of psychosexual differentiation, have gone on to occupy the top positions at some of the most respected universities, research institutions, and scientific journals in the country. His former students include Dr. Anke Ehrhardt, now a senior professor at Columbia University; Dr. Richard Green, director of the Gender Identity Clinic in London, England; Dr. June Reinisch, who for years was head of the famed Kinsey Institute; and Dr. Mark Schwartz, director of the influential Masters and Johnson Clinic.

On the clinical side, Money’s influence was perhaps even more remarkable. His theories on the psychosexual flexibility at birth of humans form the cornerstone of an entire medical specialty—pediatric endocrinology. Professor Suzanne Kessler, in her 1998 book,
Lessons from the Intersexed
, suggests that Money’s views and their implications for the treatment of ambiguously sexed babies form among physicians “a consensus that is rarely encountered in science.”

There was, however, at least one researcher in the mid-1960s who was willing to question John Money. He was a young graduate student fresh from the University of Kansas.

The son of struggling Ukrainian Jewish immigrant parents, Milton Diamond, whom friends called Mickey, was raised in the Bronx, where he had sidestepped membership in the local street gangs for the life of a scholar. As an undergraduate majoring in biophysics at the City College of New York, Diamond had become fascinated by the role hormones played in human behavior. Seeking a place to do graduate work, he chose Kansas, where anatomist William C. Young (famous for his hallmark studies of the 1930s on the role of hormones in the estrus cycle) ran a laboratory. In a stroke of serendipity, Diamond’s arrival in Kansas in the fall of 1958 coincided with the time when a trio of researchers on Young’s staff—Charles Phoenix, Robert Goy, and Arnold Gerall—stood on the brink of a discovery about the sex-differentiating role of hormones that would change the science and study of sexual development forever.

Disillusionment with earlier hormone studies had led many sex researchers, including Young’s team, to shift their focus from the role played by hormones in the mature organism to the role played by hormones in the womb. Working from guinea pig studies done two decades earlier by Soviet sex researcher Vera Dantchakoff, the Kansas team sought to learn the role played by the hormones that bathe a developing fetus’s brain and nervous system. Earlier researchers had shown that, in humans, in the early stages of gestation, the male and female fetus’s internal and external sex organs are identical to one another. Between six and eight weeks, however, changes start to take place. If the fetus’s cells bear the male (XY) chromosome, the fetal gonads differentiate as testicles, which begin to pump out testosterone. This prenatal androgen is the agent that masculinizes the developing fetus’s external genitals—turning the undifferentiated genital tubercle into a penis, causing the open genital sinus to fuse along the midline and form the scrotum, into which the testicles descend—and at the same time masculinizes the internal reproductive system by spurring the growth of the seminal ducts (another testicular secretion suppresses growth of the rudimentary female internal structures). If, on the other hand, the fetus bears the female (XX) chromosome, the gonads develop as ovaries, no testosterone is produced, in the absence of which the external genitals and internal anatomy differentiate as female, the genital tubercle develops as a clitoris, the genital sinus remains open and becomes the entrance to the vagina, and the internal structures develop as fallopian tubes and uterus.

The question for the Kansas team was whether these prenatal hormonal effects on the anatomy were mirrored in the brain. To find out, they set about creating a cohort of hermaphrodite guinea pigs by injecting large doses of testosterone into the wombs of pregnant mothers. When exposed to testosterone at a critical stage in fetal development, the female guinea pigs were born, as expected, with clitorises enlarged to the size of penises. The researchers then set out to learn if the masculinization of a treated female’s anatomy was matched by a corresponding masculinization of her sexual behavior.

In observing the treated females as they grew from childhood to maturity, the team noticed something extraordinary. Not only did the treated females demonstrate an increased physical activity distinct from that of their untreated sisters, they also did not, in the presence of normal males, present their hindquarters for sexual penetration in the normal female in-heat posture known as lordosis. Instead, the testosterone-treated females (even those that showed no clitoral enlargement) attempted to mount their untreated sisters.

I spoke with team member Robert Goy, shortly before his death in 1999, about the breakthrough moment of his research career. His voice was charged with an excitement that suggested he had just made the discovery the night before. “We couldn’t schedule tests fast enough,” he told me. “We were testing every night—night after night after night—and getting data, and analyzing it, and reanalyzing it.”

Milton Diamond was in the thick of the research, performing adjunct experiments on the pregnant mothers to learn what, if any, influence the testosterone had on their functioning. Having come to Kansas hoping to learn something new and interesting about the action of hormones on behavior, Diamond found himself present at one of the most significant biological breakthroughs in sex research of the twentieth century.

There was concern among members of the team about how their professor, William Young, would react to the results. They knew him to be an adherent of the theories of psychosexual neutrality advanced just four years earlier by John Money’s team at Johns Hopkins. “Young was a great follower of John Money and the Hampsons,” Goy told me. “He had been thinking all this time that the organizing principle for sexual behavior was experience. So his world was shaken by these results. But he was wonderfully adaptable, and the truth was more important to him than anything else. It’s very unusual in a scientist. Most scientists fall in love with their own ideas and theories, and you can’t shake them out of it. Will Young wasn’t like that.”

In fact it was Young who settled the debate that flared among the research team members when it came time to write up the results. Unsure precisely how to label the behavior of the treated female guinea pigs—the team toyed with calling it “masculine mimicry” or “pseudodifferentiation”—they were overruled by Young, who told them they had discovered not the role played by prenatal testosterone in creating a
simulation
of masculine behavior, but masculine behavior itself. Accordingly, Young advised the team to state unequivocally that they had discovered, in the fetal guinea pig, the
organizing principle
for adult masculine sexual behavior.

“Young was an anatomist,” Goy explained, “and if you understand the way anatomists use the term
organization
, it makes that choice of word inevitable. Anatomists believe that the organs of the body are organized by a set of tissues that are differentiated in a special way and combined so that they carry out a definite function or malfunction of that organ. And that’s the way he used the word
organization
. He meant that all of the tissues underlying sexual behavior—whether peripheral structures, brain tissues, blood, or muscles—are organized into a whole; and that that organization is imposed by exposure to hormones before birth; and that that organization is either masculine or feminine. And he believed that we had discovered the principle that organizes the tissues in a masculine form.”

Still, when the team came to write up their results, which would appear in a 1959 issue of the journal
Endocrinology
, Young urged caution in how directly they should extrapolate their experimental animal work to sexual differentiation in humans—largely out of Young’s respect for Money’s work with the Hampsons. The team agreed to soften their statements on the applicability of their research to humans. “We said there may be some way that the guinea pig picture will ‘complement’ or ‘supplement’ the human picture by accounting for ‘discrepancies,’ ” Goy said.

Not everyone in the lab was satisfied with that decision. The youngest member, Mickey Diamond, felt that Young and the others were being too cautious in failing to link their animal findings directly to the human situation. “I believe in evolution,” Diamond says, chuckling. “I didn’t see any reason that human beings would be different from other mammals in that regard.” He felt so strongly that when he was applying for a research grant in his final year at Kansas and was required to submit an original paper, he decided to write an essay taking on Money and the Hampsons’ theory of psychosexual neutrality at birth.

In that paper, entitled “A Critical Evaluation of the Ontogeny of Human Sexual Behavior,” Diamond rejected outright the Johns Hopkins team’s theory. Citing the guinea pig findings, Diamond described as “specious” a theory that said man is “completely divested of his evolutionary heritage,” and stated that prebirth factors “set limits” on how far culture, learning, and environment can direct gender identity in humans. Marshaling evidence from biology, psychology, psychiatry, anthropology, and endocrinology to argue that gender identity is hardwired into the brain virtually from conception, the paper was an audacious challenge to Money’s authority (especially coming from an unknown graduate student at the University of Kansas).

Addressing the theory about the psychosexual flexibility of intersexes, Diamond pointed out that such individuals had experienced “a genetic or hormonal imbalance” in the womb, and he argued that even if human hermaphrodites
could
be steered into one sex or the other as newborns (as Money claimed), this was not necessarily evidence of their gender neutrality at birth. It might simply suggest that the organization of their nervous systems and brains had undergone in utero a similar ambiguous organization as their genitals. In short, they had an inborn neurological capability to go both ways—a capability, Diamond hastened to point out, that genetically normal children certainly would not share. As for transexuals, who showed no observable anatomic ambiguity of sex, Diamond postulated that they, too, might possess an as yet undiscovered biological condition that hardwired their brains to a program opposite to the evidence of their bodies—a possibility that Diamond was able to back up with evidence from no less an authority than Dr. Harry Benjamin himself, who had recently reported that in forty-seven out of eighty-seven of his patients, he “could find no evidence that childhood conditioning” was involved in their conviction that they were living in the wrong sex.