As Nature Made Him

by Colapinto, John

  “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 wo
rd 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.

  Had he known of it at the time, Diamond might also have drawn upon an obscure paper in the foreign literature for his critique—a paper that had questioned the Johns Hopkins team’s protocols for intersex treatment some six years earlier. In a 1959 edition of The Canadian Psychiatric Association Journal, three Toronto physicians, Dr. Daniel Cappon, Dr. Calvin Ezrin, and Dr. Patrick Lynes, had pointed out serious flaws in the Hopkins team’s statistical and research methods. “[T]hese workers,” the Canadians wrote, “failed to relate the physical and psychological wholes of the person and only compared component parts without submitting these comparisons to mathematical validation.” In conducting their own research on a cohort of seventeen intersexual patients, the Canadian doctors took precautions that the Johns Hopkins team had not. To prevent subjective tainting of their results, the Canadians split their research team in two: one to study the patients from an endocrinologic perspective, the other to study the patients from a psychological perspective. For comparative purposes, the Canadian team also carried out research on a control group of nonhermaphrodites, as well as on a series of homosexuals and transvestites.

  The team’s results showed that it was dangerous indeed to suppose that no link existed between an intersexual child’s biological makeup and its gender identity; that in fact the status of the chromosomes, gonads, or hormones might predispose a hermaphrodite child to identify more with one sex than the other in adulthood. Stating that the Johns Hopkins team had based its recommendations to surgeons on “shaky theory,” the Canadians had expressed particular unease about the recommendation that males born with tiny or nonexistent penises should, without exception, be castrated and converted into girls. Such sex-changed children, the Canadians had warned, “were liable to be brought up tragically incongruously with the main somatic sex.”

  The Canadian team’s findings would have made a strong addition to Diamond’s exhaustive theoretical critique, but he did not learn of the paper’s existence until after his own was published (at which point he began to cite it in his own papers). “The Canadian paper got lost somewhere,” Diamond says. “It just died. I think it was maybe Hopkins compared to Podunk.” But in 1965, Diamond’s paper was published in a high-profile, well-respected American journal, the Quarterly Review of Biology, where it could not be missed—least of all by John Money, considering that the Quarterly Review was at that time published out of Johns Hopkins.

  I was sitting with Diamond in his cluttered, windowless office on the campus of the University of Hawaii Medical School as he reminisced about these origins of his thirty-year-long scientific debate with John Money. It was June of 1997, just two months after Diamond and Sigmundson’s “John/Joan” paper had delivered a blow to his old rival. A mild-mannered sixty-four-year-old with frizzy graying hair and beard, Diamond was clearly exhausted from fielding the unending stream of phone calls, faxes, and letters from both reporters and fellow scientists requesting more information about, or an interview with, John/Joan. Dressed in a pale blue overlaundered T-shirt riddled with holes, a pair of jeans, and battered running shoes, Diamond told me that professors at the University of Hawaii are “paid in sunshine.” His putty-colored pallor suggested that he had not been drawing his full wages. Diamond had, in fact, spent the majority of his thirty years in Honolulu doing experiments or hunched over his computer in the tiny office he calls his “cave,” pumping out more than one hundred journal articles and eight books on sexuality. On the wall beside him was tacked a snapshot of his four daughters; on the messy desk in front of him were heaped papers, books, open journals, and boxed sets of both Robert Johnson and Bach tapes.

  Diamond insists that he bore John Money no personal animus at the time of writing his 1965 article and that his intent was not to embarrass him. He says that his paper had merely been an effort to advance the field of knowledge in the time-honored scientific tradition of assertion and challenge. Diamond points out that after the article’s publication, he actually made an overture to Money, suggesting that they collaborate on an article. Though he recognized that they stood on opposite sides of the nature-nurture debate, Diamond believed this was precisely why their collaboration would be of particular value. He shakes his head and smiles at the naïveté that compelled him, a mere graduate student, to suggest a collaboration with one of the leading scientists in the field—a scientist whom, furthermore, he had just publicly challenged in a leading journal. “I really believed that it was an intellectually good thing to do,” Diamond says. Money evidently felt otherwise. “His attitude was, Why should I do anything with you?” Diamond says. “Who knows you?” Diamond admits that he was not completely surprised by the
reaction. “I had challenged his theory, which he took as an argument against him. Which it wasn’t.”

  Yet even a scientist less thin-skinned than John Money might have been stung by the calm, relentless logic of Diamond’s critique—which, near the end, raised the most rudimentary Science 101 objection to the unquestioning acceptance of Money’s theory of psychosexual neutrality in normal children. “To support [such a] theory,” Diamond wrote, “we have been presented with no instance of a normal individual appearing as an unequivocal male and being reared successfully as a female.” And Diamond had added: “If such an individual is available he has not been referred to by proponents of a ‘neutrality-at-birth’ theory. It may be assumed that such an individual will be hard to find.”

  Hard—but not, as events transpired, impossible. For it was just one year and eight months after Diamond threw down this gauntlet in the Quarterly Review of Biology that Dr. John Money received a letter from a young mother in Winnipeg, Canada, describing the terrible circumcision accident that had befallen one of her identical twin baby boys.