The Riddle of Gender

by Deborah Rudacille

  Finally—I think it was my sophomore year of college—I had some time to kill and I get off at Port Authority at Forty-second Street and I’m just walking around and I come across Lee Brewster’s Mardi Gras Boutique. Of course, I didn’t know what an important person this was at the time but I was like, “My god, there are other people like me.” But I was scared to death that I would be seen. That’s where I was introduced to the pornography, which was exciting and degrading simultaneously, as pornography is. But there was no alternative, nothing to say to me, “This is a medical condition.” Because it was considered a psychiatric condition. It still is now; we’re still fighting this fight. I thought I might be gay, and you know, the gays are still saying, “Why don’t you just admit that you want to have sex with a guy? Come on!” And then, after that, every time I came home, I’d make a side trip there.

  Q: Did you talk to anyone?’

  No, because I couldn’t be found out. Then you start thinking, “I did that. That’s me.” How do you think that makes you feel? On the one hand, you’re going to this good school, and you’re going to go to medical school and become a doctor, and on the other hand, you’re skulking around town. You get no positive reinforcement. It’s all totally negative and shame-based. Now I didn’t know that term in those days, but that’s exactly how I felt. I was living in a pool of shame. And I would run away from it. I would tell my first wife, “I can stop,” and I would count the days down but I could never stop thinking about it. I could stop wearing women’s clothes for years at a time, but I realize now that it wasn’t the clothes that was the issue, it was the being. But that was the only way to express it in those days. I couldn’t stop thinking about it. What does it mean? Who am I?

  Unbeknownst to anybody, I remembered the article about Hopkins, and I wrote to them and set up an appointment. I have a love/hate relationship with Hopkins. The love is that I do recognize that they did this. They were at the forefront in America. Harry Benjamin started it, and they picked it up academically. That’s how things work in medical culture. And they performed a service. Now, granted, it was completely twisted the way they went about it at the time. But they performed a service. Before you had to go where? To Casablanca? Thailand today is a mecca, compared to what Casablanca was like. So I appreciate that. John Money was part of it. He did the work when being a sexologist was not an easy thing to do. I can appreciate too how difficult it was for the surgeons to want to do this. The book on the history of trans-sexuality [How Sex Changed] makes that point. The terms didn’t really exist. There’s this one little group of Jewish doctors in Weimar Germany that were beginning to do this, for the first time ever in the history of civilization. And it’s not easy to go from that, through Nazism and the Holocaust, and then come to America and keep going with it. There’s so much shame in this country; we’re so puritanical. So the people who did it were pioneers, and I’m grateful to them.

  But anyway I went down there [to Baltimore]. I left school early and I went down there and I thought, “Let’s do this.” I got an intake form and stuff like that and I filled it out, but I got cold feet. I didn’t feel comfortable. I didn’t feel welcome. I felt dirty. I felt like they were making me feel like a pervert.

  Q: How old were you?

  I was twenty. I called ahead and made an appointment. I suppose my records are still there somewhere. But I just freaked out. I couldn’t do it. I did not feel welcome. It’s amazing how today, when I go to my electrolysis, my hair stylist, my surgeon, these people bend over backward to make you feel like a human being. And in those days, they did not. No matter how much they felt they were trying, it was so damn paternalistic. I’ll give them the benefit of the doubt, but they made you feel like a real freak. I couldn’t do it. So I went back to searching the stacks at school libraries, but all I could find were textbooks with the relevant pages ripped out or aversion therapy, putting electrodes on your penis. And I was thinking, “No way!”

  But there was no place else to go. I wasn’t going to a shrink. Nobody was out there saying, “We welcome gender-variant patients.”

  Q: You never heard of Harry Benjamin?’

  No, there was only Creedmore. To me, psychiatry was Creedmore. I didn’t know any different. I wasn’t in medical school at the time. Even when I went to medical school, I found nothing. Nobody talked about sex at all. I took a one-week externship in urology. DES was never mentioned. Of course, I didn’t know about the DES at that point. I didn’t know that till the end of my medical career. I first came across the book To Do No Harm in the eighties. It was only when I saw that, that I thought, “Oh, could this be?” And I asked my mother, and she just came right out and said, “Yes.” I was born in New York in 1952, there were certainly thousands of other Jewish kids exposed. I’m not the only one.

  Q: You and your mother must have a very complex relationship as a result of the DES exposure.

  She still blames herself. I told her that I’ve gotten over that. I don’t blame her anymore. She’s responsible for it, yes, but I can understand how it happened in the social context of the time. I don’t blame her.

  Seven

  FEAR OF A PINK PLANET

  Developments in the last decade have highlighted the reproductive, behavioral, and anatomical effects of endocrine disrupters on animals exposed to these chemicals. Effects due to endocnne-disrupting chemicals are observed at concentrations as low as parts per trillion for animals in the laboratory, indicating that the fetal endocnne system is more sensitive to disruption than any other known body system. These results of toxicology are significantly related to the field of gender identity and indicate a causal relationship between exposure to these chemicals and anomalies in the expression of gender identity and other disorders such as reproductive failure.

  CHRISTINE JOHNSON, “ENDOCRINE DISRUPTING CHEMICALS AND TRANSSEXUALISM,” SEATTLE, 2001

  Christine Johnson is a petite, blond transwoman, thirty-eight years old. She is an engineer, with bachelor’s and master’s degrees from Drexel University, in Philadelphia, currently living in Seattle. Her major research interest is systems theory. I sought her out online after she posted “Endocrine Disrupting Chemicals and Transsexualism” on the discussion list of the National Transgender Advocacy Coalition (NTAC). The list members, most of whom are activists focused on civil rights for transgendered people and the passing of anti-discrimination legislation, didn’t seem interested in Johnson’s article, but it hit me with the force of a depth charge.

  In 1995, I had been asked to be a coauthor an article for an environmental magazine called Garbage on the potential effects of endocrinedisrupting chemicals (EDCs). The editors of Garbage (known for tipping the sacred cows of environmentalism) had wondered if the spate of panicky articles then appearing in the popular press—articles that ominously detailed falling human sperm counts, Florida alligators with micro-penises, hermaphroditic birds and fish in the Great Lakes region—were scientifically credible. Soon after my coauthor—a friend who was then a professor in the Department of Environmental Health Sciences at the Johns Hopkins School of Public Health—and I signed the contract to write the article, the magazine went under, but by then I had downloaded two years of articles on the topic. I found the information in the newspaper and magazine articles disturbing, but as a feminist I was also deeply suspicious of the subtext, neatly summarized by the title of a BBC documentary on the topic: Assault on the Male. The media coverage of the “environmental estrogen” hypothesis seemed to me a transparent expression of male anxiety about the growing political, economic, and social power of women. All this talk of males being “feminized” and emasculated by exposure to estrogen seemed so clearly an expression of the antifeminist backlash that I was determined to call my article “Fear of a Pink Planet” (a riff on the music industry satire Fear of a Black Planet). However, Garbage sank, and as I wasn’t very far into the project, I abandoned it when the magazine ceased publication.

  When I encountered Christine Johnson’s art
icle sketching out a hypothesis between endocrine disrupters and transsexuality, I was two years into the research for this book. I had spoken to literally hundreds of transgendered and transsexual people at meetings and online. By then, it was abundantly clear to me that the people I was meeting were not mentally ill. Like the friend whose decision to transition had caused me to embark on writing this book, they seemed like regular people who had been dealt a tough hand by life, and were dealing with it as best they could. I also rejected the popular notion that gender was entirely “performative”—the newest twist of the social construction theory, most cleverly articulated in the work of the Berkeley scholar Judith Butler. Certainly, I thought, people “perform” gender in various ways, learned from their parents, community, and culture. However, most people also seem to feel comfortable basing their performance on the gender that is consistent with their anatomy. Most do not feel a disconnection between their anatomy and their “most deeply held sense of self,” as Susan Stryker phrased it, and as most of my sources describe it. So if gender-variant people weren’t mentally ill anarchists bent on bringing down the binary gender system through subversive performance, what was the source of gender variance? I searched the scientific literature and was frustrated by the paucity of hard scientific research on transsexuality, transgenderism, and gender variance. Searches on Medline (an online search engine) and PubMed (the National Library of Medicine’s search service) using those keywords brought up very few articles, and most of those were the work of researchers with whom I was already familiar. Then I encountered Christine Johnson and discovered that there was, in fact, a substantial scientific literature on anomalous sexual differentiation, but that I wouldn’t find it in journals of endocrinology or psychiatry. I would find the hard science in the last places I would have thought to look: toxicology and environmental health, the disciplines in which I had been trained as a science writer.

  I e-mailed Johnson in November 2001, introduced myself, and shared with her my questions and concerns about the environmental endocrine hypothesis and its possible relationship to our fin de siecle anxiety about masculinity threatened by female power. She responded, “Yes, there seems to be a great deal of discomfort in the media and in our society generally about gender roles and identity. But apart from the media response to these findings, in my opinion, this problem is much more serious than people are generally aware. So while the media may have reacted strongly because of existing social mores, it essentially acted correctly in raising red flags about the relationship between chemicals and sexual developmental anomalies.”

  I told Johnson that I had been asking the transgendered and transsexual people whom I was interviewing whether or not there were more gender-variant people in the world today, or whether they were simply becoming more visible as society becomes more tolerant and accepting. She answered bluntly, “I don’t think that asking transgendered people is the proper way to ask this question. This is equivalent to asking cancer patients if the rate of cancer is increasing. How can one know this? What is required is epidemiological studies, period. The fact that there is not a registry is suspicious in my view. Keeping track of the number of sexual developmental anomalies is important in gaining an understanding of the impact.”

  Johnson also rejected the notion that the growing visibility of trans-gender and transsexual people was due to greater social tolerance of gender diversity. “Ts find increased acceptance inside the T community, and to a lesser extent within the larger GLBT community, but to extend that acceptance to the general population is a bit disingenuous. Where is the evidence that society is more accepting of Ts? It seems to be that most people claim increased social benevolence, but in general are unable to identify in what tangible ways this benevolence is manifested. We have not achieved many basic civil rights, and if you ask the average (non-TG) person to name a single TG, they would be hard pressed to name anyone, because we are, in essence, the invisible ones. Also to be noted is the fact that Ts are excluded in most cases for insurance reimbursement—this is decidedly not benevolent. So while I see relatively large increases in the number of teen Ts, I see no significant increase in benevolence, at least in the U.S., towards transpeople.”

  Regarding the environmental endocrine hypothesis itself and its relationship to transsexuality, Johnson points out that the scientific literature “makes it abundantly clear that it is possible to feminize males and masculinize females by application of exogenous hormones. This is reproduced reliably in the lab on animals, so there should be little argument over the potential of hormonal compounds to alter the ‘normal’ path of development. For the last 40 years, gender researchers have been saying that hormonal variations can indeed cause altered development of the anatomy of the genitals and the brain. And so now we find endocrine disrupters all over the place, and yet we still take the incredibly naive view that somehow we develop independently from our hormonal environment? I find this view totally inconsistent with my understanding of how natural systems work.”

  We agreed to meet in the spring, to discuss these issues in more detail. In the meantime, I learned that colleagues at the Johns Hopkins

  Bloomberg School of Public Health were holding a workshop on endocrine disrupters in February 2002. The workshop would bring together scientists from industry, academia, and regulatory agencies from the United States and abroad to discuss progress in identifying and testing hormonally active substances, and ways to implement those goals that would not require a massive animal testing program. I was particularly interested to see that one of the speakers at the meeting was Dr. John McLachlan, the Tulane University researcher considered one of the primary architects of the environmental estrogen hypothesis. McLachlan has been studying the effects of endocrine-disrupting chemicals for over thirty years. I approached him after his presentation at the February 2002 meeting and asked him, with some trepidation, if it was possible for endocrine-disrupting chemicals to affect human gender identity and sexual orientation, and to increase the prevalence of intersex conditions.

  “Absolutely,” he replied, pointing out an already documented increase in the incidence of hypospadias (incompletely differentiated penis) in baby boys. Having studied the effects of endocrine-disrupting chemicals on one-celled organisms, fish, reptiles, and mammals for more than two decades, McLachlan said that he can predict with some certainty what effects endocrine-disrupting chemicals will produce when administered in sufficient doses to animals at critical stages in fetal development. But he also said that no one has yet linked these effects, which have been confirmed in laboratory animals and wildlife, to the development of gender identity or sexual orientation in humans. “You should have a look at the DES literature,” he said. Soon after the meeting, I did so. What I discovered astonished me.

  DES was first synthesized in 1938, in the laboratory of Sir Charles Dodds, a professor of biochemistry at the Middlesex Hospital Medical School at the University of London. Researchers working independently in England and Germany had succeeded in isolating natural estrogens for the first time in 1929, but natural estrogens were very expensive and difficult to produce. Further, the supply of natural estrogens could not meet the demand; Dodds’s discovery of a synthetic estrogen that could be easily and cheaply produced was hailed as a great boon. Dodds and his colleagues tested the effects of this new synthetic estrogen on female rats that had first undergone ovariectomy (removal of the ovaries). The ovariectomized rats responded to DES as though it were an endogenous estrogen produced by their own bodies—even though DES, manufactured from coal tar products, is not at all chemically similar in structure to natural estrogens. Indeed, DES appeared to be even more potent than natural estrogen, mimicking its biological effects when ingested in much smaller doses.

  Within a year, DES was being manufactured and marketed in mass quantities by drug companies in Europe and North America. Never patented, the drug was sold under more than 400 different brand names by 257 pharmaceutical companies in the United States alone
. DES was used as “hormone replacement therapy” for women, and was approved by the U.S. Food and Drug Administration for that purpose (among others) in 1941. DES was also initially prescribed to suppress lactation in the growing number of women who did not wish to breast-feed their infants, to treat amenorrhea (failure to menstruate) and vaginitis, and (surreptitiously) to prevent miscarriage, though it was not approved for the last purpose in the United States until 1947.

  The use of DES to prevent miscarriage was strongly advocated by a husband-and-wife team of researchers from the Harvard Medical School: George Smith, an obstetrician-gynecologist, and Olive Wat-kins Smith, a biochemist. In 1945, Smith and Smith asked 119 obstetricians in the United States and Europe to participate in a clinical trial on the use of DES in high-risk pregnancies. Seven published papers subsequently reported that DES not only reduced miscarriage but also produced bigger babies in high-risk pregnancies. It was later noted that three of the seven studies that reported the efficacy of DES to prevent miscarriage had used no controls at all, and none of the control participants was treated with the experimental cohort or by the same physician. A larger, controlled study at the University of Chicago in 1953 showed that DES had no beneficial effect whatsoever on the prevention of miscarriage; this finding was reinforced by six other controlled studies done in the fifties. Nonetheless, more than three million pregnant women in the United States alone were prescribed DES between 1941 and 1971. Many more mothers and fetuses were exposed to the drug in pregnancy vitamins in which DES was the active ingredient. Ads that appeared in medical journals and women’s magazines promised “a healthy pregnancy” through the use of DES. “DES became a routine part of the quality care that private practitioners gave their predominantly middle-class patients, including their own wives,” write Drs. Roberta J. Apfel and Susan M. Fisher in their 1984 history of DES, To Do No Harm: DES and the Dilemmas of Modern Medicine. “DES was considered the best possible pregnancy enhancer and it was even included in vitamin tablets for pregnant mothers.”