The Gene: An Intimate History - Siddhartha Mukherjee Page 0,169

As part of the study, Brenda and Brian visited Money’s clinic in Baltimore at frequent intervals throughout their childhood. As preadolescence approached, Money prescribed estrogen supplements to feminize Brenda. The surgical construction of an artificial vagina was scheduled to complete her anatomical transformation into a woman. Money published a steady stream of highly cited papers touting the extraordinary success of the sexual reassignment. Brenda was adjusting to her new identity with perfect equanimity, he proposed. Her twin, Brian, was a “rough and tumble” boy, while Brenda was an “active little girl.” Brenda would ease into womanhood with scarcely any hurdles, Money declared. “Gender identity is sufficiently incompletely differentiated at birth to permit successful assignment of a genetic male as a girl.”

In reality, nothing could have been further from the truth. At age four, Brenda took scissors and shredded the pink and white dresses she had been forced to wear. She lapsed into fits of fury when told to walk or talk like a girl. Pinioned to an identity that she found evidently false and discordant, she was anxious, depressed, confused, anguished, and often frankly enraged. In her school reports, Brenda was described as “tomboyish” and “dominant,” with “abundant physical energy.” She refused to play with dolls or other girls, preferring her brother’s toys (the only time she played with her sewing machine was when she sneaked a screwdriver out of her father’s toolbox and took the machine meticulously apart, screw by screw). Perhaps most confoundingly to her young classmates, Brenda went to the girl’s bathroom dutifully—but then preferred to urinate with her legs spread wide, standing up.

After fourteen years, Brenda brought this grotesque charade to an end. She refused the vaginal operation. She stopped the estrogen pills, underwent a bilateral mastectomy to excise her breast tissue, and began injecting testosterone to revert back to male. She—he—changed her name to David. He married a woman in 1990, but the relationship was tormented from the start. Bruce/Brenda/David—the boy who became a girl who became a man—continued to ricochet between devastating bouts of anxiety, anger, denial, and depression. He lost his job. The marriage failed. In 2004, shortly after a bitter altercation with his wife, David killed himself.

David Reimer’s case was not unique. In the 1970s and 1980s, several other cases of sexual reassignment—the attempted conversion of chromosomally male children into females through psychological and social conditioning—were described, each troubled and troubling in its own right. In some cases, the gender dysphoria was not as acute as David’s—but the wo/men often suffered haunting pangs of anxiety, anger, dysphoria, and disorientation well into adulthood. In one particularly revealing case, a woman—called C—came to see a psychiatrist in Rochester, Minnesota. Dressed in a frilly, floral blouse and a rough cowhide jacket—“my leather-and-lace look,” as she described it—C had no problems with some aspects of her duality, yet had trouble reconciling her “sense of herself as fundamentally female.” Born and raised as a girl in the 1940s, C recalled being a tomboy in school. She had never thought of herself as physically male, but had always felt a kinship with men (“I feel like I have the brain of a man”). She married a man in her twenties and lived with him—until a chance ménage à trois involving a woman kindled her fantasies about women. Her husband married the other woman, and C left him and entered a series of lesbian relationships. She oscillated between periods of equanimity and depression. She joined a church and discovered a nurturing spiritual community—except for a pastor who railed against her homosexuality and recommended therapy to “convert” her.

At forty-eight, goaded by guilt and fear, she finally sought psychiatric assistance. During the medical examination, her cells were sent for chromosomal analysis, and she was found to have XY chromosomes in her cells. Genetically speaking, C was male. She later discovered that s/he had been born with ambiguous, underdeveloped genitals, although chromosomally male. Her mother had consented to reconstructive surgery to transform her into a female. Sexual reassignment had begun when she was six months old, and she had been given hormones at puberty on the pretext of curing a “hormonal imbalance.” Throughout her childhood and adolescence, C did not have the faintest spasm of doubt about her gender.

C’s case illustrates the importance of thinking carefully about the link between gender and genetics. Unlike David Reimer, C was not confused about the performance of gender roles: she wore female clothes in public, maintained a heterosexual marriage (for a while, at least), and