When I was a graduate student at UCLA, I came across this sad and tragic story in neuroscience class of a young boy who had a circumcision that went awry. In the early 1960s, identical twins were born to a Canadian couple. Bruce was born first before his identical twin brother, Brian. When the twins were 7 months old, the parents had them circumcised because they were discovered to have a condition called phimosis, a defect in the foreskin of the glans penis that makes urination difficult. During the procedure at the hospital, an accident with an electrocautery device burned and severed Bruce’s entire penis. The medical consensus conveyed to the parents by the local physicians was that the disfigured twin would be unable to live a normal and healthy heterosexual life, would be ostracized and marginalized by his peers, and would suffer in myriad ways.
Given this grim prognosis, the parents consulted an eminent sex researcher, John Money at John Hopkins University, to help them what should be done. After meeting with the family, Dr. Money recommended a sex-change operation and raise the boy as a girl. The Harvard-educated prominent sex researcher’s hypothesis was that, at birth, babies’ brain was a “tabula rasa”; their gender-neutral identity as male or female is determined by their subsequent upbringing, life experiences and identification with their genitals. Because it was not possible to give John normal-appearing male genitals, it was recommended that the boy be castrated and undergo cosmetic surgery, followed by estrogen treatment at puberty, to turn him into a girl. Faced with a terrible decision, Bruce’s parents perfunctorily consented, and at age 17 months the child’s testes were removed and his scrotum reshaped to resemble a vulva. The little boy, Bruce, became Brenda within the family and personal circle; Money’s medical records and published papers used the pseudonyms “John” and “Joan.” The parents did everything they could to raise Brenda as a normal female. Bruce’s parents were eventually convinced that surgery combined with a female upbringing gave their child the best chance at a normal life.
Dr. Money’s accounts of Bruce’s s life after his transformation was optimistic and it seemed as if the child adopted well and would become a happy normal girl. The case even made it into the popular magazine, as evidenced by a 1973 article in TIME magazine: “The dramatic case… provides strong support… that conventional patterns of masculine and feminine behavior can be altered. It also casts doubt on the theory that major sex differences, psychological as well as anatomical, are immutably set by the genes at conception.” At that time, dramatic societal changes were taking place in the roles of men and women, and the success of John as a female appeared to confirm that society created gender identity as much as, or more than, biology.
Unfortunately, a follow-up report by Milton and Sigmundson, Money’s intellectual adversaries in sex research, revealed that the child’s gender transformation was a disaster from the get-go. Subsequent interviews with the family including the child himself, indicated that the truth was far more complex, and indeed deeply problematic. In a detailed follow-up of the case, the sex researchers described the struggle that Brenda suffered from the earliest age. The child refused to wear dresses, urinated standing up, always felt that something was wrong. According to Bruce and his brother, Bruce’s behavior was much more like other boys than girls. Bruce rebelled at wearing girls’ clothing and playing with traditional girls’ toys. Despite cosmetic surgery and female indoctrination, as an adult, Bruce said that he had suspected he was a boy as early as the second grade and imagined growing up as a muscular man.
As a child, Bruce was incessantly teased and ostracized. He knew nothing about the failed circumcision and subsequent surgery, nor the fact that he was genetically a male. However, as he got older, he was more attracted to girls than boys, and he expressed the opinion that he felt like a boy trapped in a girl’s body. By the age of 14, after being on estrogen for two years, he looked increasingly like a girl, but he stopped living as one. Bruce’s father finally told him what had happened when he was young. Bruce immediately requested sex-change hormonal therapy and surgery. For years, Bruce dealt with the overwhelmingly emotional problems resulting from his past. He married, adopted his wife’s children, and happily worked a physically demanding job as a janitor in a slaughterhouse. In the 1990s, Bruce revealed his identity and real name, David Reimer, and collaborated on a book about his life. After numerous traumatic and tumultuous events in his life, including marital issues and the death of his twin brother two years prior from a drug overdose, David committed suicide in 2004 at the age of 38.
This case reaffirms the fact that, in the words of Diamond and Sigmundson, “the evidence is overwhelming that normal humans are not psychosocially neutral at birth but are, in keeping with mammalian heritage, predisposed and biased to interact with environmental, familial, and social forces in either a male or female mode.” Because there is no indication at birth how the brain has been shaped by early exposure to hormones, in many cases there is insufficient information to know with what sex the child, or the adult, will ultimately identify. In David’s case, a grievous mistake was made by failing to understand the influence on the brain of circulating androgens during early sexual development. His experiences demonstrate that, rather than being gender-neutral, he had a “male brain” from the get-go. Evidently his genetically determined gender could not be suppressed even with sex-change surgery, hormonal therapy, and a female upbringing. Clearly, gender identity involves a complex interplay and an intricate choreography of genetics, hormones, and life experiences.
Bear, M. F., Connors, B. W., and Paradiso, M. A. (2007). Neuroscience: Exploring the Brain. Philadelphia, PA. Lippincott William & Wilkins.
Colapinto, J. (2000). As Nature Made Him: The Boy Who Was Raised as a Girl. New York: Harper Collins
Diamond, M. and Sigmundson, H. K. (1997). Sex Reassignment at Birth: Long Term Review and clinical implications. Arch. Ped. Adolesc. Med. 151: 298-304.
Dreger, A. D. (1998) “Ambiguous Sex” or ambiguous medicine? Hastings Report Report 28: 24-35
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