A BOY WITHOUT A PENIS

By Christine Gorman

He was one of a set of infant twin boys when, in 1963, his penis was damaged beyond repair by a circumcision that went awry. After seeking expert advice at Johns Hopkins Medical School, the parents decided that the child's best shot at a normal life was as an anatomically correct woman. The baby was castrated, and surgeons fashioned a kind of vagina out of the remaining tissue. When "she" grew older, hormone treatments would complete the transformation from boy to girl.

The case became a landmark in the annals of sex research, living proof of the prevailing theory of the 1960s and early 1970s that sexual identity exists in a kind of continuum and that nurture is more important than nature in determining gender roles. Babies are born gender neutral, the experts said. Catch them early enough, and you can make them anything you want. Widely cited in medical and social-science textbooks, the baby's transformation helped pediatricians confidently advise other parents facing similar circumstances to rear their wounded boys as girls.

What these doctors and parents didn't know was that the celebrated sex-change success story was, in fact, a total failure. In a follow-up study published last week in the Archives of Pediatric and Adolescent Medicine, Milton Diamond, a professor of anatomy and reproductive biology at the University of Hawaii, and Dr. Keith Sigmundson, a psychiatrist with the Canadian Ministry of Health, report that the child, whom they called "Joan," never really adjusted to her assigned gender. In fact, Joan was surgically changed back to "John" in the late 1970s, and is now the happily married father of three adopted children.

Almost from the beginning, Diamond and Sigmundson write, Joan rebelled at her treatment. Even as a toddler, she felt different. When her mother clothed her in frilly dresses, she would try to rip them off. She preferred to play with boys and stereotypical boys' toys--in one memorable instance walking into a store to buy an umbrella and walking out with a toy machine gun. By second grade, she had come to suspect she would fit in better as a boy. But her doctors insisted that these feelings were perfectly normal, that she was just a tomboy. "I thought I was a freak or something," John told Diamond and Sigmundson in interviews conducted in 1994 and 1995.

Although the other kids didn't know about Joan's surgical history, they teased her about her tomboyish looks and behavior. Public bathrooms proved to be a source of particular discomfort. Joan often insisted on urinating standing up, which usually made a mess. In junior high school, she stood so often in the stalls of the girls' rest room that the girls finally refused to let her in anymore, forcing her to use the boys' room instead.

By this time, Joan was pretty sure she was a boy. But no matter what she told her doctors and psychiatrists, they kept pressing her to act more feminine. Eventually, she gave up trying to convince them. "You can't argue with a bunch of doctors in white coats," John recalls. "You're just a little kid, and their minds are already made up. They didn't want to listen."

In 1977, when she was 14, Joan decided she had only two options: either commit suicide or live her life as a male. Finally, in a tearful confrontation, her father told her the true story of her birth and sex change. "All of a sudden everything clicked," John remembers. "For the first time things made sense, and I understood who and what I was." With the support of a new set of doctors, Joan underwent a pair of operations to reconstruct a penis--albeit a diminutive one without the sensitivity of a normal sex organ.

Following this second set of sex-change procedures, John's new doctors advised the family to move to a new town and another school and start over. This time, however, John's parents rejected the expert advice. People would find out anyway, they reasoned. It was better to stay put and be open about what had happened. Their strategy seems to have worked. After a brief transition, John was accepted by his peers in a way that Joan never was. Once, when John first began dating, he confessed to a would-be girlfriend that he was insecure about his penis, and she started telling tales in school about his condition. But Joan's old schoolmates stuck loyally by John, refusing to be drawn into the girl's malicious gossip.

At its worst, this story could be read as a lesson in scientific hubris. At its best, it's a story about the courage of one boy who claimed the right to determine his own identity.

Unfortunately, no follow-up study reporting that John had rejected his initial sex change was ever published. As a result, say Diamond and Sigmundson, dozens of other boys may have been needlessly castrated. In defense of the original team, Johns Hopkins says it wasn't able to conduct a follow-up because the family stopped coming to see its doctors.

Diamond and Sigmundson suspect that most boys-made-girls will, like John, reject their female identity by the time they reach puberty. Other experts are not so sure. "We don't have the answers," says Dr. William Reiner, a surgeon and psychiatrist at Johns Hopkins (who was not involved in the original case). "Let's listen to these kids. They eventually are going to give us the answer."

--Reported by Dick Thompson/Washington

With reporting by Dick Thompson/Washington