Act Naturally

Mother Nature Strikes Back

Saying that men talk about baseball in order to avoid talking about their feelings
is the same as saying that women talk about their feelings in order to avoid talking about baseball.

- Deborah Tannen
You Just Don't Understand

by John Colapinto

Journalist John Colapinto offers evidence that human sexual identity is not a social construct. Indeed, Tom Wolfe has said that Colapinto's shocking book, As Nature Made Him: The Boy Who Was Raised as a Girl (HarperCollins), "stands as exhibit A" against the idea that nurture is more important than nature. It is the heartbreaking story of a baby boy whom an ambitious doctor changed into a girl.

John Colopinto:

My book, As Nature Made Him: The Boy Who Was Raised as a Girl, is the story of an extraordinary and unrepeatable experiment in human sexual and gender identity. It is about a boy who was born developmentally normal in the mid-1960s and who, when he was 8 months old, underwent circumcision because of a minor problem with his foreskin. During the circumcision, the doctor used the wrong instrument, an electrocautery needle instead of a scalpel, and the penis was badly burned and eventually sloughed off. Left with a baby who had a pair of normal testicles but no penis, the parents searched everywhere for help in their community of Winnipeg, Canada.

Eventually they saw Dr John Money, a world famous sexologist from Johns Hopkins University, on television. Money was talking about his new clinic for sex changes. He had a theory that we are born psychosexually neutral, that we are, in fact, blank slates. Money believed that our gender identity is written upon us by society, by parental influences, and societal pressures. That viewpoint was popular in the 1960s, largely because of Money’s writings from the 1950s.

Like everyone who has ever heard John Money speak, the young parents were enthralled. He was charismatic. He was smooth, and he never stumbled over a word. They wrote him and asked if he could help. When Money read about this penis-less boy, he replied, "Indeed I can help. Get down here to Baltimore immediately and let's get to work." So they went to Baltimore, and Money assured them that sex easily could be reassigned up until 3 years of age.

Money had worked with hermaphroditic children, children born with anatomical anomalies of the sex organs. He had never tested his theory with a developmentally normal child. So, this was a big moment for him. And there was another amazing wrinkle: the baby in question was born an identical twin. The other twin, who had not been injured, was being raised as a boy, Brian. That meant that Money had a perfectly matched control for an experiment to show that it is nurture, as opposed to nature, that defines us sexually. At the age of 22 months, the boy's two testicles were surgically removed, and a rudimentary vagina, which was to be completed later, was fashioned; Bruce Reimer became Brenda Reimer.

When the twins were about 6 years old, Money, who was already quite famous for his theories about gender identity, said, "It's going marvelously." He continued to say that through the 1970s, and then, interestingly enough, when the child was around the age of puberty, Money mysteriously stopped writing about the twins case. One scientist, however, Dr Milton Diamond, remained interested in it. Diamond suspected puberty would be the moment when we would know for sure, but Money seemed disinclined to speak about how it was going. He put Diamond off.

Through his own investigative methods, Diamond, in the early 1990s, found the twin who had been raised as Brenda, now an adult, living in Winnipeg. He did not find Brenda living with a white picket fence and a husband and children by adoption — the picture Money had painted. Instead, he found a man, 32 at the time, married with 3 children by adoption. He was employed as a slaughterhouse sanitation worker, a really rather ghastly environment where no women worked.

Diamond wrote a scientific paper that explained that this world famous, and supposedly successful, sex change had, in fact, been an abject flop. As it turned out, Brenda had been miserable from day one. The first minute she was put in a dress, she pulled it off. She seemed to have had an instinctual aversion to frilly clothing. She refused to play with dolls and would beat up her brother and seize his toy cars and guns. She was ridiculed in the schoolyard. She had a kind of pressing, aggressive need to dominate. She was relentlessly teased for her masculine gait, tastes, and behaviors. She complained to her parents and teachers that she felt like a boy; the adults — on Dr Money's strict orders of secrecy — insisted that she was only going through a phase. Meanwhile, Brenda's guilt-ridden mother attempted suicide; her father lapsed into mute alcoholism; the neglected Brian eventually descended into drug use, pretty crime, and clinical depression.

We don’t possess good language for speaking about sex-behaviour differences. But there were indefinable things that people were picking up about Brenda, and that Brenda was picking up about herself. She had been put on a course of female hormones and had grown breasts. She was finally told the truth at the urging of a compassionate psychiatrist, who said to her parents, "You must tell her or she will kill herself."

Brenda then, at the age of 15, embarked on the remarkable journey of undergoing a sex change from girl to boy, which required a double mastectomy, a course of testosterone, and obviously a name change. He rechristened himself David, after David and Goliath. He felt he had done something similar to the biblical hero in slaying the Goliath of the medical establishment and society: the teachers, parents, psychiatrists and psychologists, the endocrinologists and surgeons, and everyone else who had been trying to press him into girlhood.

His decision and his ability to make that sexual change spoke to me more clearly and dramatically and movingly about his emphatic need to live in the gender that he felt himself to be more than any other aspect of this story. What was outrageous about the whole story was how readily Money's theories have been accepted, first of all, by the medical establishment, and then by the social sciences and the media. To hear David speak about sexuality is to feel that you're in the presence of an oracle. His words have a kind of horse sense. What I found so compelling about David's story is how incredibly stupid smart people can be.

Being Brenda

by Oliver Burkeman and Gary Younge

They were meant to show that gender was determined by nurture, not nature - one identical twin raised as a boy and the other brought up as a girl after a botched circumcision. But two years ago Brian Reimer killed himself, and last week David - formerly Brenda - took his life too. This is the tragic story of Dr Money's sex experiment...

Until a few years ago, the name David Reimer meant little to those outside his immediate circle, and by the time he killed himself last Tuesday in unknown circumstances in his hometown of Winnipeg, it was already slipping back towards obscurity - a name belonging to nobody more remarkable than a local odd-job man, a 38-year-old former slaughterhouse worker who was separated from his wife, and enjoyed shopping at flea markets and tinkering with his car.

In fact, to anyone taking an interest in the development of psychology in the 1970s and 1980s, Reimer's life story would have long been infamous, but also pseudonymous. Going by the name "John", and subsequently "Joan", David Reimer had been an unwitting guinea-pig - along with his identical twin brother Brian - in a medical experiment at first celebrated, then notorious. Masterminded by a prominent Baltimore physician, John Money, it was an attempt to settle, once and for all, the fraught nature-versus-nurture debate: to prove that gender was so fluid that by a mere change in childrearing practice, plus a little surgery, a boy could be turned into a girl, while his twin developed as a male.

It would split the world of sexual psychology in two. And after 12 years of traumatising treatment, followed by a further two decades spent attempting to repair the damage, it would drive David Reimer to his death. "It was like brainwashing," Reimer once said, having resumed his male identity after a childhood spent as Brenda. "I'd give just about anything to go to a hypnotist to black out my whole past. Because it's torture. What they did to you in the body is sometimes not near as bad as what they did to you in the mind."

The tragedy has its roots in what seemed like a routine trip to hospital in 1966 for Janet and Ron Reimer and their twin baby boys, Bruce and Brian. Doctors had recommended circumcision, a practice still routine in much of North America, but Bruce's operation went distressingly wrong. Like almost every detail of the story, what actually happened is still fiercely disputed but what is clear is that the electric cauterising machine being used by doctors caused burning to his penis so severe as to render the organ unrescuable.

Reconstructive genital surgery was still rudimentary, and medical experts could offer only pessimism. So when the despairing parents happened to catch a television show, some months later, on which John Money was propounding his radical new theories about gender formation, it seemed to offer a lifeline. "He was saying that it could be that babies are born neutral, and you could change their gender," Janet Reimer later told John Colapinto, author of a book on the experiment entitled As Nature Made Him.

In photographs taken at the time, Money - then, as now, affiliated to Johns Hopkins University in Baltimore, Maryland - looks like a parody of a progressive "sexologist", turtlenecked and moustachioed, and his writings did nothing to dispel that impression. Raised in a conservative religious family in New Zealand, he had rebelled and become a self-described "missionary of sex", revelling in shocked responses to his tireless advocacy of open marriages and - a particular favourite - bisexual group sex.

At their most extreme, Money's public statements had appeared to endorse, or at least not to condemn, incest and paedophilia, but there was no hint of that in the television show Janet and Ron Reimer saw. They wrote to him, and he wrote swiftly back. He was confident, he said, that Bruce could be successfully raised as a girl. From an experimental perspective, Brian Reimer would provide the perfect control: his genetic inheritance was identical to Bruce's. The only difference was that one would be nurtured as a girl, and the other as a boy.

Money's emphasis on nurture over nature played well with the progressive spirit of the times, and especially with the women's movement, its proponents eager to establish that women's traditional social roles were not biologically pre-ordained. "Postwar, in any case, there was a move away from people being innately, biologically, inherently anything," says Lynne Segal, professor of psychology and gender studies at Birkbeck College in London. "We'd just seen Nazism, and the emphasis had been put on the idea that certain people were innately evil - Jews and gypsies, among others - so the emphasis on culture and society fitted well with social democratic ideals." The Reimers did not engage in this kind of debate. "I looked up to [John Money] as a god," Janet said simply.

Bruce Reimer started to become Brenda on 3 July1967. Physicians at Johns Hopkins surgically castrated him, and the remaining skin was used to forge a "cosmetic vaginal cleft". Money sent the family back to Winnipeg with strict instructions. "He told us not to talk about it," Ron Reimer told John Colapinto. "Not to tell [Brenda] the whole truth, and that she shouldn't know she wasn't a girl."

Things started going wrong almost immediately. Janet Reimer recalled dressing Brenda in her first dress just before the child was due to turn two. "She was ripping at it, trying to tear it off. I remember thinking, 'Oh, my God, she knows she's a boy and she doesn't want girls' clothing." Brenda was bullied viciously at school. When she urinated standing up in the school lavatories, she was threatened with a knifing.

Whether all the blame should lie with Money remains a matter of contention. His supporters argue that reconstructive surgery techniques of the time were such that trying to turn Bruce into Brenda might genuinely have been the least worst option. In public, Money advertised the "John/Joan" study as a resounding success. "This dramatic case," Time magazine reported, picking up on his salesmanship, "provides strong support for a major contention of women's liberationists: that conventional patterns on masculine and feminine behaviour can be altered."

In private, though, things were spinning into chaos. Brenda was required to attend regular therapy sessions with Money in Baltimore, in the company of her brother. According to Colapinto's account, they soon degenerated into horrifying encounters that deeply traumatised the two children. Showing the children "explicit sexual pictures" was seemingly central to Money's theories of gender reassignment. David Reimer later recalled, as Brenda, "getting yelled at by Money ... he told me to take my clothes off, and I just did not do it. I just stood there. And he screamed 'Now!' I thought he was going to give me a whipping. So I took my clothes off and stood there, shaking."

In the children's grimmest recollection - one they found almost impossible to talk about years later - Money allegedly made "Brenda assume a position on all fours on his office sofa and make Brian come up behind her on his knees and place his crotch against her buttocks", an element of Money's theory he referred to as "sexual rehearsal play". (The author John Heidenry, who wrote a recent review defending the sexologist, calls this charge "outrageous and offensive", and says Brian, the source of the claim, may have been suffering false memory syndrome.)

By the time Brenda reached her teens she had attempted suicide at least once; she refused further surgery but consented, though irregularly, to take œstrogen supplements to encourage the development of breasts. John Money gradually drifted from the Reimers' lives, but Brenda remained under constant psychiatric treatment. It was after one such session with a Winnipeg psychiatrist in 1980 that Ron Reimer collected his daughter in the car and, instead of taking her home, drove her to an ice-cream parlour, where he told her everything.

The upturn in Reimer's fortunes lasted several years. Brenda opted for a sex change within weeks of her father telling her the truth. Thanks to developments in phalloplasty, Brenda, taking the name David, received surgery that after five years left him with a reconstructed penis resembling a real one, with limited sensation, and usable for sex. When he was 23 he met Jane, a single mother of three, and married her soon afterwards. In 2000, he went public with his story.

But his happiness didn't last. Two years ago, Brian Reimer apparently killed himself, taking an overdose of drugs he was taking for schizophrenia. David reportedly felt responsible for the death, and visited Brian's grave daily, weeding the plot and bringing fresh flowers. David was not easy to live with, given his explosive anger, his cyclical depressions, his fears of abandonment — all of which Jane weathered for almost 14 years. But with David spiraling ever deeper into sloth and despair, she told him on the weekend of May 2 that they should separate for a time. David stormed out of the house. Two days later, Jane received a call from the police, saying that they had found David but that he did not want her to know his location. Two hours after that, Jane got another call. This time the police told her that David was dead. He had retrieved a shotgun from his home while Jane was at work and taken it into the garage. There, with the terrible, methodical fixedness of the suicide, he sawed off the barrel, then drove to the nearby parking lot of a grocery store, parked, raised the gun, ended his suffering.

Despite Colapinto's claims that David made a large amount of money from the book, those who knew him said he was often hard up; at the Transcona golf club, in Winnipeg's eastern suburbs, where he did odd jobs, the members had a whip round for him so he could afford to eat. Friends say he had became particularly distraught during the last few months; Reimer had told them he had lost at least $47,500 last year in a shady pro golf shop investment. The Manitoba Securities Commission had warned potential investors last November that "your money may be at risk" if it was placed with shop owner Gary Perch.

The world of psychology learned of the failure of Money's experiment through a paper by a rival, Dr Milton Diamond, of the University of Hawaii, who eventually traced those who had taken over treatment of the twins. For Lynne Segal, the story of the experiment does not settle the nature/nurture debate one way or the other - her view, widely shared today, is that the dichotomy is false - but it shows the perils of psychologists trying to prove too much through research. "It's far too simplistic, and far too interventionist, this idea that we can control and model and shape people to prove one thing or another."

John Money remains an emeritus professor at Johns Hopkins. "He's not commenting on this story," his assistant told the Guardian yesterday. "There is no comment to make."

Source: books.guardian.co.uk The Guardian Wednesday 12 May 2004

The Self I Will Never Know

by Esther Morris

Every day throughout the world children are born who challenge social values. And every day the response has been to make those children conform. This is not about children in medical crisis, but about children who are intimately invaded because their genitals aren’t "up to standard". These kids are called intersex. Their genital or reproductive anatomy is treated as an emergency that must be corrected immediately. Genital variation is not medically threatening, but cosmetic surgery is the medical standard in most "civilised" societies. In the United States alone, genital surgeries are performed on at least 5 children every day, probably more. Many will have to have surgery repeated several times throughout their lives.

In the year 2000 the American Academy of Pediatrics issued a statement that "ambiguous genitals", the global term for intersex, constitutes an emergency. In fact, intersex includes anyone born with atypical genital or reproductive anatomy. Treating an emergency does not require parental consent even when cosmetically derived. This brings to light some curious questions about what is atypical, and who has the right to decide what acceptable genitals are. Are medical professionals standing by with rulers and stamps of approval? To some extent they are, and we are all subject to their judgement. The majority who pass are sent on their way; but, for the sacred few who don’t measure up, the silent nightmare begins.

Intersex occurs as often as once in every 1,000 to 1,500 live births. Incidence is unusual, but not rare. Treatment refers to medical intervention to make atypical genital or reproductive anatomy normal. Normal is defined by medical standards determined by anatomical dimensions. The medical criteria for genital and reproductive anatomy are: a clitoris cannot be larger than 3/8 of an inch at birth… Or… visible? The recommendation is that an "enlarged" clitoris be surgically reduced to match the medical standard. A penis is "too small" if it cannot be stretched longer than one inch at birth. The recommendation for a child with a penis considered too small is to reassign the child female, and then create typical female anatomy. An "adequate" vagina is one that will accept an average size penis. When a vagina is "inadequate" various treatments are recommended to promote heterosexual intercourse. Medical treatment is deemed successful once these intimate dimensions are met.

The caveat of current protocols is that adults who have received successful treatments claim a loss to their quality of life. Others lose sexual sensation as a result of removed, reduced, enlarged or scarred genitals, in addition to loss of self. People are generally too young or traumatized to make the immediate decisions required upon discovery, so parents and providers are left in charge. Treatment histories are not always disclosed, so children grow up in confusion. Since treatment is irreversible and permanent, discerning what is important to the child is essential for the parents or physicians who wish to do no harm. How can we ascertain what is best for the child when they are still too young to speak?

The medical community believes people will be traumatized by their atypical anatomy and need corrective treatment to lead happy and healthy, or normal, lives. Many adults argue that correction creates its own stigma that leaves them struggling with identities and loss of self. The growing number of support groups and patient advocacy groups (currently 3,012 appear in an internet search) endorse the position that corrective treatment does not resolve the issue of psychosocial adjustment. Many people believe that corrective treatment created problems they didn’t have before. Others believe that the foundation of their discontent is the treatment itself; and the values that overlook medical needs in the rush to correct intimate anatomy. Although doctors have produced a number of studies that support the current protocols, the reports contain limited definitions of physical normalcy. There is currently no data collected that includes quality of life for intersex outcomes. The intimate nature of intersex is complicated by the stigma around genital anatomy. We are not so quick to judge other parts of anatomy. We teach our children to respect diversity, yet adults create a "state of emergency" over the size and shape of genitals. The real phenomenon is that the prevalence of genital and reproductive variation is kept such a secret. Intersex variations are so quickly "disappeared" that we don’t get a chance to know about them, or how they might mature.

In no country in the world today do lesbians, gays and transgender people enjoy full and equal civil rights with heterosexuals – rights, for example, relating to employment, housing, parenting, partnership, inheritance and protection from abuse and discrimination. However, many states have made significant steps towards equality in recent years. South Africa and Ecuador have written anti-discrimination clauses relating to sexual orientation in their constitutions. In the 43 states of the Council of Europe, discrimination against sexual minorities can be challenged under the European Convention of Human Rights. And in 2003 the US Supreme Court finally overturned an anti-sodomy law which had applied in 12 states.

But steps have been made in the opposite direction too. In the past 3 years the number of countries where homosexuality is punishable by death has risen from 7 to 10. All are Muslim-majority states, with Saudi Arabia, Afghanistan and Iran especially inclined to execute. The number of countries where homosexuality is recorded as illegal has gone up from 70 to 80. Some impose prison sentences of 20 years or more. Gays and lesbians in Uganda and Russia have been tortured and forced into exile. Street violence towards lesbian, gay and transgender people is alarmingly high. In Brazil some 90 are murdered each year. Police often fail to investigate such killings – or are themselves involved. Some religious fundamentalists in the US preach that it is a Christian duty to kill gays.

We know about these things because the issue of homosexuality is being openly discussed.

For people born with intersex conditions, their struggles remain little known. While there is public outcry over the African practice of Female Genital Mutilation (FGM), Intersex Genital Mutilation is practised in the hospitals of the rich world under the name of "corrective surgery". This is usually medically unnecessary, often carried out on babies of under 18 months, and may continue throughout the patient’s life. Intersex campaigners are calling for an end to this. The child should be assigned a sex, says the Intersex Society of North America, given a name that corresponds to the sex, and raised with counselling and age-appropriate explanations of their condition.

Awareness is increasing. In 1999 the Constitutional Court of Colombia restricted the ability of parents and doctors to resort to the scalpel when children are born with atypical genitalia. It was the first time a High Court anywhere in the world had considered whether Intersex Genital Mutilation was a violation of human rights. Colombia’s court also recognises that intersex people are a minority which enjoys the constitutional protection of the State and that every individual has a right to define his or her own sexual identity.

(This information was taken from Amnesty International 2003: Intersex Society of North America www.isna.org Vanessa Baird, No-Nonsense Guide to Sexual Diversity, New Internationalist/Verso 2001; International Lesbian and Gay Association www.ilga.org)

	People whose bodies will not categorise them as male or female: 1 in every 1,000
	People with chromosome types that are NOT "normal" XX (female) or XY (male): 1 in every 1,666
	Male-defined bodies with XXY chromosomes: 1 in every 1,600
	Female-defined bodies with XXY chromosomes: 1 in every 10,000
	Vaginal agenesis (or absence): 1 in every 4,000
	Number of people who have some form of genital surgery: 1 or 2 in every 1,000

There are dozens of intersex conditions that are medically corrected. Though techniques vary, the treatment goals remain the same:

	Enlarged clitorises are surgically removed or "reduced".
	Treatment for vaginal agenesis includes a variety of vaginal reconstruction techniques to increase vaginal size and depth for penile vaginal intercourse.
	Treatment for hormone differentiation involves lifelong hormone therapy and/or genital surgery.
	Treatment for urethras that are not at the tip of a penis involves multiple surgeries to lengthen the urethra to allow urination while standing up.
	Treatment for "gender ambiguity" usually entails infant genital surgery and surgical sex assignment at birth.

Compiled by Esther Morris: information from the website of the Intersex Society of North America, www.isna.org

Source: newint.org New Internationalist 364 Jan/Feb 2004

Psychological Impact of "Assigned" Gender

by Dr Joyce Brothers

A situation once known as hermaphrodism - where a person is born with physical features not clearly male or female - has come back into the public eye as a condition called "intersexuality." The way these people are viewed and treated has changed. Are you aware of the psychological impacts of "assigned gender" and the "cosmetic" surgery that goes with it?

The condition known as intersexuality, where the genitals are. atypical and the newborn cannot be identified as definitively male or female, is so rare as to be nearly nonexistent. True ( ) False ( )
The most usual way to deal with a newborn who is intersexual is to operate within 72 hours to normalize the genitals, sometimes enabling the body to properly "finish" the right sexual designation. True ( ) False ( )
Studies have shown that those who have surgery while newborns often suffer later psychological side effects from having been raised as the "wrong" gender, due to arbitrary decisions in assigning the sex of the child at birth. True ( ) False ( )
Intersex-rights groups generally feel that it is psychologically healthier for the child to be left with the original genitalia until he or she is old enough to discern which is the proper sex for him- or herself. True ( ) False ( )
It is better for the parent to see and treat the child as an "it" - intersexed, rather than boy or girl - until the child's mind is made up about what he or she wants to be. This way, less has to be "undone" if the child's decision is contrary to the way he or she has been reared. True ( ) False ( )
While it might be more comfortable for parents, relatives and teachers to see children as macho boys or feminine girls, the intersex child should be permitted to dress and act as he or she chooses, even if that is in an androgynous way. True ( ) False ( )
Intersex-rights groups believe that parents should not decide for the child how his or her genitals should be configured when a newborn does not conform to a strictly male or female appearance, and that early surgery is designed to meet the parental needs at the expense of the child's. True ( ) False ( )

Answers:

False. A number of conditions contribute to intersex designations, and they vary in frequency. Children who are not XX and not XY account for 1 in 1,666 births; those whose bodies differ from the standard male or female in some way are approximately 1 in 100.
True. One or two out of every 1,000 newborns are "assigned" a gender by doctors and parents, and these children receive surgery to normalize the appearance of the genitals - although most such surgery is cosmetic and rarely medically necessary.
True. Medical decisions to choose a child's sex have historically been based on measurements of a penis that is considered too small or clitoris that is too big - considerations that sometimes cause the child to be assigned the opposite sex from what he or she truly is.
True. Intersex advocates argue that when there is no medical necessity for surgery, it is preferable for children to keep the genitals they were born with, thus avoiding being forced into the wrong sex or having surgery that can leave them with scars and impaired sexual feelings.
False. Most current thought gives detailed guidelines to help parents choose a path for an intersex child based on a number of criteria. Psychologically, it is better to pick a sex that the child might eventually reject than to treat the child as neither female nor male.
True. Even in cases where surgery is avoided and the child is assigned a gender temporarily until he or she is sure which sex is comfortable for him or her - parents should avoid having their child assume an overly masculine or feminine appearance. Many intersex children feel more comfortable as "just a kid" until after they hit puberty.
True. Children whose bodies were surgically altered as newboms have often shown signs of psychological distress. Those allowed to choose their own way often opt to keep their "imperfect" bodies intact and might suffer fewer psychological traumas as a result.

If you answered five of the seven questions correctly, you are among the most educated on the brave new world of the intersexed child.

Write to Dr Joyce Brothers at King Features Syndicate, 888 Seventh Avenue, New York, NY I0019.

Source: The Star-Ledger (New Jersey) 20 April 2005

Complexities of Life

by Nigel Bunce and Jim Hunt

What makes us male and female? Until now, the answer to that question has seemed relatively simple. All humans, and indeed, all mammals carry a special pair of "sex chromosomes" among the chromosome makeup of their cells. This special pair of chromosomes comes in two forms, which are distinguishable under a microscope, and which are labelled X and Y. Women have two X chromosomes; men have one X and one Y chromosome. The germ cells (sperm and ova) are formed by taking one from each pair of chromosomes; therefore all ova contain an X chromosome, which sperm contain either an X or a Y chromosome. At conception, the chromosomes of the sperm team up with those of the egg; if a sperm carrying an X chromosome is involved, the baby is XX and hence a girl, but if the sperm carries a Y chromosome, the resulting fetus is XY, and develops into a boy.

This general picture has provided the explanation of sexual identity for about 60 years. Just recently, Dr David Page, a geneticist from Boston, Massachusetts, has reported new findings, which indicate that the situation is more complicated than had been imagined hitherto. The trail began by examining patients who have abnormalities of the sex chromosomes.

For several decades, medical researchers have been aware of a variety of different abnormalities that can occur in people's sex chromosome makeup. These abnormalities are not all that rare, involving one individual in every few thousand. For example, there are men with the combination XXY; these people are male in appearance, but are sterile. There are women who have only a single X chromosome; that is, they lack the other half of the chromosome pair completely. Much harder to explain are people who are "sex-reversed". This means that their outward appearance is the opposite of their chromosome makeup. These are women who are XY, or men who are XX. Generally, these people are not capable of having children.

Dr Page's work involved studying people of the above type. Generally these people came to his clinic because they were having trouble starting a family. Suppose a man has the XX combination; where is he getting his maleness from? Dr Page proposed the theory that it is not the whole chromosome that determines sex. Instead a part of the chromosome, or gene, provided the switch that determined maleness or femaleness. Sometimes individual genes can get scrambled from one chromosome to another during the division of a cell. For example, the switch normally present on a man's Y chromosome could get scrambled on to his X. Then a sperm would be produced that had an X chromosome with the Y switch. If this sperm fertilised an egg, the offspring would be XX but yet produce male characteristics.

What is really new in this research is that last December, Page, together with colleagues from other countries, announced that they had found the switching gene, by studying the genetic makeup of thirty XX type males. One of these men had less than 1% of the Y chromosome incorporated into one of his X chromosomes, yet still was male in appearance. By studying these various chromosome fragments, Page and his collaborators have been able to discover the exact location of the switching gene on the normal Y chromosome.

College of Physical Science
University of Guelph

Source: physics.uoguelph.ca The Science Corner

I can't help but wonder if the above explains many instances of transexuality.

Carnal Knowledge: Can Men Marry if They Have Ovaries?

by Faye Flam

Recent efforts to pass amendments that define marriage as a union between a "man" and a "woman" are going to run into more than just political opposition. Scientists are contending there's no clear definition of the gender divide. There are at least 7 definitions, but not everyone qualifies as male or female across the board, says Galdino Pranzarone, a psychologist at Roanoke College who has argued against marriage amendments on the editorial pages of the Roanoke Times. Some people are born with a mix of male and female characteristics. The incidence of intersex births is between one in 1,000 to one in 2,500, says Pranzarone. "That's a lot of people."

Alice Dreger, part of the medical humanities and bioethics faculty at Northwestern University, has also written on the flaws of the "one man and one woman" equation. You could define the sexes by their sex organs, Dreger says, but those are vulnerable to birth defects, accidents or cancer. Not to mention that some people have an organ whose size fits somewhere between a small penis and a large clitoris. You might think you could get out a microscope and use chromosomes, defining men as having an X and a Y, women as having two X's. It's simple enough except some people have just a single X, or XXY, or XYY. There are XX men, XY women, and people with a "mosaic" of genetically male and female cells.

As an activist for the intersex community, Dreger often gets asked for advice and recently heard from a 19-year-old man whose medical workup revealed he had two X chromosomes and ovaries. His situation was due to congenital adrenal hyperplasia (CAH), a hormonal disorder that often causes women to become masculinised. Once in a while it will cause a genetic female to become outwardly male. Dreger said this young man wanted to know what to tell his parents and girlfriend and whether he should have surgery to become a woman. He felt like a man and liked being a man, so she advised him to stay a man.

And as Cindy Stone learned, women can sometimes get a Y chromosome. For her, it was Complete Androgen Insensitivity Syndrome (CAIS). A faulty gene on her X chromosome makes it impossible for her body to respond to her male hormones, so though she has male genetics, she developed along a female pattern. Stone, who teaches gender studies at Indiana University, said her genitalia look female on the outside, so she didn't suspect anything until she failed to menstruate. When she was 17 her doctors told her she had a birth defect and would never have children. But when she reached her 30s, she went to another doctor who had a more complete explanation. She not only had a Y chromosome, she had testicles inside her body and no ovaries or uterus. And yet, she always wanted to be female, felt female and looked female. In some ways she's more "feminine" than ordinary women, whose bodies make and respond to small amounts of testosterone. Stone has never had a zit, she says, and grows almost no body hair. She says like many intersex people, she submitted to surgery she now regrets. Doctors removed her testicles, she said, after which she lost much of her sex drive. Testicles secrete some female hormones, so once hers were gone she had to go on hormone replacement.

Other intersex people got surgery at infancy before they could let anyone know whether they felt more like girls or boys, says Stone. As for marriage reform, she wonders who her politicians think she should marry. "I have testicles and a vagina. I have an F on my birth certificate but my bloodwork says my cells are all XY."

Twenty states have already passed constitutional amendments to restrict marriage to a union between a man and a woman, and eight more will be voting on it this November, according to the National Conference of State Legislatures. But Pranzarone predicts that once lawyers start representing intersex cases, these laws will fall apart.

Contact staff writer Faye Flam at fflam@phillynews.com.

Source: philly.com Philadelphia Inquirer 9 October 2006