ISGI does not concur with all viewpoints of this article,
yet ISGI recognizes much of the content of this page as informational.
The following article appeared in the July 27, 1998, issue of "Alberta Report" and is
reprinted here in its entirety with the permission of "Alberta Report."
yet ISGI recognizes much of the content of this page as informational.
The following article appeared in the July 27, 1998, issue of "Alberta Report" and is
reprinted here in its entirety with the permission of "Alberta Report."
Somewhere in Canada there lives a 27-year-old blue-collar worker with a masculine genetic makeup, a B-cup bra and lesbian tendencies, according to a case study released two weeks ago in the U.S. medical journal "Pediatrics." A tragic surgical blunder turned a two-month-old baby boy into a eunuch in 1961. Through more surgery and hormone therapy, doctors transformed him, for all practical purposes, into a girl.
One of the study's authors claims it supports the idea that "gender identity," a person's sense of being male or female. is malleable and determined by how the child is raised. This study is the latest volley in the battle over what to do with "intersex" children, the estimated one in 2,000 infants born with the sex organs that are either undersized or have both male and female traits. For 40 years, doctors have been attempting to mix and match male and female biologies, gender identities and sexual orientations, in the process undermining the traditional notions of what it means to me "male" and "female"
The report describes the second of two cases where baby boys had their genitals surgically removed (both times doctors botched electrocautery circumcisions) and then had been raised as girls by their parents. The first involved a twin boy born in 1963. The accident happened at seven months. At age 21 months plastic surgery was used to make his genitals appear female. In such cases, the penis is cut down to approximate a clitoris. In adolescence he was given female hormones to complete the metamorphosis.
The lead researcher in the case was Dr. John Money of Johns Hopkins Hospital, who with his colleagues had developed a set of guidelines in the 1950s on how to handle intersex children. Dr. Money recommended that the children should be assigned a sex according to the best prognosis for reproductive and sexual function, normal appearance, and stable gender identity; that the assignment should be done as early as possible and no later than 24 months; and that parents should show no ambiguity in raising the child.
The Money guidelines presupposed that one of the strongest influences on the child's gender identity is how the child is raised. In effect, Dr. Money and his colleagues legitimized the practice of "reassigning" intersex babies, normally baby boys with under-sized penises, through surgery and hormone treatment. This became standard practice in North America. The other school advocates that intersex children should be raised according to their biological, genetic sex, and that all medical treatment should reinforce their genetic make-up.
The 1963 case, which Dr. Money reported as successful in 1973, was his proof that strong parental rearing can overcome biology, producing a female gender identity in a genetic male. However, in 1982 other researches followed up on the patient and discovered he later refused to be female. At 12 he quit the estrogen pills, went on testosterone and got a mastectomy. He later underwent phallus construction and at 25 married an older woman with children. The case then became an argument against Dr. Money's "psychosexual management," but reassignment is still the norm. Even today the American Academy of Pediatrics says that kids with ambiguous genitalia "can be raised successfully as members of either sex."
The case reported in "Pediatrics" last month supports the status quo, in that it describes a genetic male who reports being content as a woman. The accident occurred at two months of age and at seven months he was castrated and "reassigned." In interviews at age 16 and 26, while hospitalized for further genital plastic surgery, the patient denied ever wanting to be male or having any confusion about being female. Although she recalled tomboyish behaviour, her best friends were girls.
As an adult, she described herself as "bisexual," although she claimed more attraction to women. Shortly after her surgery last year, she split up with her boyfriend and moved in with a woman, bringing her total to three relationships with men and three with women. She used to think she was too tall (five-foot-ten) and skinny, and
did not like her nose, but has now accepted her body.
Intersex people are not usually so content. Normally, the tendency of any fetus is to become anatomically female. In genetic males the gonads that would have become ovaries become testes instead. The testes produce testosterone, which masculinizes the child's anatomy; tissue that would have become female organs become male
instead.
But sometimes things go wrong. True hermaphrodites have both male and female organs, often because of abnormal chromosomes. "Ferms" (female pseudohermaphrodites) are genetic females whose sex organs were masculinized through prenatal exposure to testosterone. "Merms" are genetic males who failed to produce the necessary hormones or whose tissue failed to respond to them.
The results are often bizarre and produce lives filled with emotional upheaval, depression and debilitating side effects from years of drug treatment and surgeries, according to the Intersex Society of North America ((ISNA), a group which objects to surgical reassignment of infants, At the age of 12, reports one member, "my body began to go haywire. My hips spread and my voice began to break. My breasts grew, and so did my facial hair." Some genetic females have been raised as boys because of the presence of male genitals, only to start menstruating at age 13. "When I woke up one morning with blood on my sheets, I thought I had contracted some mysterious
disease, " writes another on the ISNA website.
Dr. Kenneth Zucker of Toronto's Clarke Institute of Psychiatry, two physicians from the Hospital for Sick Children in Toronto, and a London, Ont., gynecologist wrote the latest report. Dr. Zucker, a sexual issues specialist, explains that the flexibility of gender identity implies that surgery and hormone therapy are legitimate options for would-be transsexuals. If a female gender identify is firmly established in a male body, the biology should be adjusted to match the psychology.
Dr. Zucker adds that gender identity and sexual orientation are related but separate components, The fact that the patient was more attracted to women suggests that her sexual orientation was biologically determined, whereas her gender identity was formed by her environment.
There is, however, another interpretation. Her claim to be bisexual indicates gender identity confusion despite her assertion that she never wanted be male, says Dr. Joseph Nicolosi of the National Association for the Research and Treatment of Homosexuals (NARTH) in Encino, California. Dr. Nicolosi also scoffs at the idea that gender identity is a product of the environment, with sexual orientation somehow biologically based. "Many researchers don't want to acknowledge that there is noevidence that homosexuality is genetically or prenatally determined."
He contends instead that gender identity determines sexual orientation--people raised to be male are attracted to females and vice versa--and an ambiguous upbringing produces a deviant sexual orientation. Even though it is possible to manipulate a child's gender identity, Dr. Nicolosi believes that a child should be reared according to whether it is biologically male or female. "A boy is hardwired to be a boy," he says, "but you have to have the environment to 'actualize' it."
(Article is signed by Les Sillars)
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