The theory that gender is determined by social conditioning rather than biology has been used to justify raising biological boys as girls, and vice-versa, under certain extreme circumstances. The most celebrated recent case, hailed as a great success, has now been exposed as a failure. There is good evidence that the principal characteristics of gender are biologically determined. The moving story of the recent celebrated case is told by John Colapinto in As Nature Made Him: The Boy Who Was Raised as a Girl (Quartet Books, 2000).
Whether you are biologically male or female is determined by your hereditary material (chromosomes). We each have 23 pairs of chromosomes and sex is determined by one pair. Females have a pair of X sex chromosomes, males have an X and a Y sex chromosomes.
Most babies are clearly either male or female. Male infants have a well-defined penis and testicles and females have a defined vagina and clitoris. However, a small minority of births are ambiguous. These are the hermaphrodite or "intersex" cases. For example a boy, with X and Y chromosomes, may be born with a very tiny penis, undescended testicles and a vagina-like opening. A girl, with the X chromosomes, may be born with a clitoris the size of a penis and a vaguely defined vagina.
Very often the "solution" to intersex babies has been to surgically remodel the sexual organs (e.g. remove an enlarged clitoris and surgically enhance a vaguely defined vagina), plumping for a clear male or female configuration, and to raise the child socially as appropriate to that sex. Usually this has entailed remodelling the sexual organs into the female form and raising the child as a girl, regardless of the chromosomes, because of the crude state of the art of building a new penis.
The case described by Colapinto goes beyond the intersex situation. It involves David, the identical brother of Brian. When the boys were eight months old their mother noticed they needed circumcision. Unfortunately, David's penis was accidentally burned off in this procedure.
The year was 1967; the place was Canada. If this accident happened today an artificial penis could be constructed for David using flesh harvested from elsewhere on his body. But this technique was in its infancy in 1967 and wasn't seen as an option. The solution chosen was to castrate David, to construct a shallow vagina and to raise him as a girl - Brenda. It was planned that when Brenda reached puberty she would be treated with female sex hormones and would have a proper surgical job done on her vagina. The whole plan was devised and monitored by medical psychologist Dr John Money. He believed infants remain undifferentiated as regards gender until 15 months old and that subsequent gender formation is moulded by social factors. The David/Brenda situation offered a unique chance to prove his theory. David's twin was the ideal control against whom to compare Brenda. Dr Money examined Brenda every year. He reported the case in the literature and declared that Brenda was developing happily as a girl. The David/Brenda case grabbed worldwide attention, and Dr Money became a star in his field.
Dr Money's theory was widely but not universally respected. He was challenged in 1965 by Dr Milton Diamond, who argued that gender is almost entirely biologically based, being largely determined by hormonal effects on the developing brain of the foetus. Dr Diamond continued to gather evidence that supported his theory. In the meantime reports on Brenda's progress dropped out of the literature. Dr Diamond repeatedly asked for up-to-date reports, but they were not forthcoming.
Eventually John Colapinto traced Brenda and discovered the true story. Despite the fact that she had a vagina, had no penis, and was raised as a girl, Brenda always knew she was a boy. She wanted to be with boys, she much preferred boys' games and toys and she couldn't fit in with the girls. She felt at odds with the world. When she visualised herself as an adult she saw a young man with a moustache. This was not reported by Dr Money.
When she reached teenage years, a reluctant Brenda was persuaded to take the female hormone treatment, as a result of which she developed breasts and a changed body configuration. She refused the vaginal surgery. Brenda continued to feel like a boy. She became very upset and frustrated and her father decided to reveal her true history to her.
Brenda decided to once again become David. She had a double mastectomy performed. The technique of fabricating an artificial penis had improved since 1967 and David had a penis fitted. He married a mother of three young children and he now lives happily with his family. David remains tortured by his awful history. He decided to talk to John Colapinto in order to ensure nobody would ever again have to endure such misery.
The foetus develops for nine months in the womb. During this time males are exposed to male sex hormones and females are exposed to female sex hormones and there is much evidence that, as a result, the male brain develops the characteristics of maleness and the female brain develops the characteristics of femaleness. As the case of David/Brenda shows, these characteristics cannot be overridden by social conditioning or by the obvious cues of sexual organs. Your gender is informed far more by your brain than your crotch. In this view intersex cases are largely caused by non-average exposure of the foetus to sex hormones. The best advice now in "intersex" cases is to wait until the individual acquires a secure inner knowing about their gender and only then to proceed with surgical reconstruction in that direction.
Men and women are equal. They each deserve the same civil rights; they are entitled to the same opportunities. But they are constitutionally different. We ignore or deny this fact at our peril.
William Reville is a Senior Lecturer in Biochemistry and Director of Microscopy at UCC.