Boys will be boys…New report challenges current theories on gender permanence

Boys will be boys…New report challenges current theories on gender permanence

Josh Greenberg
The Johns Hopkins News-Letter
[Abstract] Full Text [PDF]

In 1964, after a gruesome accident, a little boy named John became a little girl named Joan in a surgical procedure which made headlines. Reported by sexologist Dr. John Money of the Johns Hopkins Medical School, the procedure known as “gender reassignment” was hailed as a marvel of modern medicine and an example of the pliability of sexual identity.

But now, more than thirty years later, a report published last month in the Archives of Pediatric and Adolescent Medicine which continues the story of John/Joan indicates that researchers may have been completely wrong, that an individual’s identification as male or female is formed before birth and is immune to both psychology and surgery.

It all started when a botched surgical procedure to repair the foreskin of eight month-old “John” (whose name has been changed to preserve his anonymity) literally destroyed his penis. His horrified parents brought him to the Johns Hopkins Hospital, where surgeons decided that, due to the difficulty of reconstructing the male genitalia, the best course of action would be a “gender reassignment.” John was castrated and sex-change surgery followed. It was decided that John would henceforth be “Joan,” and would be raised as a girl alongside his twin brother.

This was the account as published in 1973. The unfortunate case of John/Joan was widely received as proof that gender identification was pliable, that a child has no definite ties to being male or female before being socialized into the world of Barbie and G.I. Joe. Time magazine said that the 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.” It became a textbook example and was the standard procedure for similarly mangled children, as well as for children suffering from severely deformed genitals for decades.

However, the story didn’t end there. See, it seems that the gender reassignment didn’t stick.

According to last month’s report by Dr. Keith Sigmundson of the Ministry of Health in Victoria, British Columbia and Dr. Milton Diamond of the University of Hawaii – Manoa (who actually served as a consultant to the British Broadcasting Company in its coverage of the story in the late 1960’s and 1970’s), no matter how much Joan’s parents tried, she simply refused to be a girl. She rebelled at wearing dresses and preferred her brother’s toys over her own dolls. When her mother tried to get her to pretend to put on makeup, she instead imitated her father shaving. She would even insist on urinating standing up, regardless of the mechanical difficulties involved. Socially, Joan shunned girls and actively sought out male friends while her peers teased her mercilessly, calling her “cave man” and “gorilla.”

Around age 9, Joan began to suspect that something wasn’t right. “There were little things from early on,” the patient recalls in last month’s report. “I began to see how different I felt from what I was supposed to be. But I didn’t know what it meant. I thought I was a freak or something…I looked at myself and said I don’t like this type of clothing, I don’t like the types of toys I was always being given. I liked hanging around with the guys and climbing trees and stuff like that and girls don’t like any of that stuff. I looked in the mirror and [saw] my shoulders were so wide. I mean, there [was] nothing feminine about me. I was skinny, but other than that, nothing. But that was how I figured it out, but I didn’t want to admit it. I figured I didn’t want to wind up opening a can of worms.”

That can of worms was finally opened after Joan began receiving estrogen treatment and grew breasts. Her discomfort grew, and by the age of 14 she was considering suicide. After she confessed to her endocrinologist that she suspected she was a boy, the team who had been following her case decided that the best course of action might be a re-re-assignment back to male. Joan embraced the idea, and by the age of 16 had undergone a mastectomy and phallus reconstruction. Finally, in a tearful conversation with her father, Joan learned the truth about her original gender.

The family, by this time a little leery of the experts suggestions, decided to reject their suggestions that it would be easier for “John” to move and start a new life elsewhere. Suprisingly, classmates rallied around the teenager, accepting him in ways that they had never accepted Joan. Some girls who had taunted him as a child even developed crushes on him.

John took full advantage of the situation, buying a windowless van equipped with a bar and bed and embracing his new identity. By the age of 25 he had married and adopted his wife’s children (due to the castration, he is unable to father children himself), and is now a healthy and stable individual. And yes, he is capable of having intercourse and orgasm, though his wife is more interested in sex than he is. About the events of his childhood, John is “still bitter, of course, and who wouldn’t be,” Dr. Diamond said, “but he’s got a great sense of humor, and his head is on straight.”

The case holds strong implications for other children like John. In particular, for the 1 out of every 100,000 babies born with seriously deformed genitals, surgeons will now think twice before arbitrarily deciding to make the child female. According to Dr. William Reiner of the Johns Hopkins Hospital, who wrote a companion editorial to the recent report, “The question this case doesn’t answer but lends data to is: What is the origin of gender identity? How do we know we are a boy? And when do we know it?”

John, in spite of being raised as a girl and being treated with hormones and estrogen, said ‘Forget it. I’m a boy.‘”


Citation: The Johns Hopkins News-Letter; 28 March 1997 <>