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"Sex: Unknown"PBS Airdate: October 30, 2001 NARRATOR: In August 1965, in the small Canadian town of Winnipeg, Janet Reimer gave birth to identical twin boys. JANET REIMER: When I was a little girl I used to dream about having twins. And I always thought I would never be lucky enough to have twins. I wasn't the lucky kind. And I had twins. NARRATOR: Janet called her sons Bruce and Brian. JANET REIMER: We were so pleased and so proud and we settled right into our little one-room apartment. NARRATOR: But within eight months events would take a dramatic turn. The twins began having trouble urinating. To relieve the problem their doctor suggested circumcision. On the 27th of April, Janet left her twins at the local hospital in Winnipeg. Circumcision was a straightforward procedure and she expected to pick up her boys the next day. But early the following morning she got a call from the hospital. JANET REIMER: When we first heard that there had been an accident we thought, "Well, what kind of accident could there be?" We went to the hospital and then the doctor said, "The penis has been burnt off from circumcision." And I could not comprehend what he was talking about, because, you see, I thought they were going to use a knife. NARRATOR: Inexplicably, the physician treating her son Bruce had chosen an extremely unconventional method of circumcision. Bruce's penis had been completely destroyed. The doctors knew of no way to undo the damage. But one American psychologist by the name of John Money advised the Reimers that they could best help their son by raising him as a daughter. It was a radical and untried course of treatment. ANNE FAUSTO-STERLING (Brown University): It was high drama. It was a particularly dramatic case. Scientifically it looked beautiful because of the fact that there were twins involved. NARRATOR: This tragic situation made for a perfect case study. What does gender mean if one male twin can be raised as a boy, while the other male twin becomes a girl? But no one knew if this experiment would work. Major funding for NOVA is provided by the Park Foundation, dedicated to education and quality television. Scientific achievement is fueled by the simple desire to make things clear. Sprint PCS is proud to support NOVA. This program is funded in part by the Northwestern Mutual Foundation. Some people already know Northwestern Mutual can help plan for your children's education. Are you there yet? Northwestern Mutual Financial Network. And by the Corporation for Public Broadcasting and by contributions to your PBS station from viewers like you. Thank you. NARRATOR: In a quiet Manitoba suburb, the Reimer family was home trying to recover from a devastating accident. Just ten months earlier, their infant son's penis had been destroyed during circumcision. In shock, the Reimers shut themselves off from the rest of the world. With their own doctors bewildered by what to do, they had no where to turn. JANET REIMER: Then we saw this show on TV. We just happened to be watching TV. NARRATOR: On the screen was a young psychologist by the name of John Money, talking about the dramatic new field of sex change surgery. JANET REIMER: Dr. Money was on there and he was very charismatic. He was very...he seemed highly intelligent and very confident of what he was saying. And what he was saying was that a boy whose gender was changed could be raised as a girl, that it was nurture not nature that made the child. NARRATOR: For Janet Reimer, John Money's words offered hope, despite their shocking implications. ANNE FAUSTO-STERLING: I think she was faced with an extreme situation, that there were no resources available to her to figure out what would be the best thing to do. And so to have a well-known authority say, "I have a solution for you," must have been incredibly tempting. NARRATOR: Within weeks of the television broadcast, Janet Reimer took her infant son to Johns Hopkins University to meet with John Money. Once there, she was told by Money's team that Bruce could be made into a girl. Surgery, it was explained, would transform his body, and careful reinforcement of his new female identity would transform his mind. JANET REIMER: Dr. Money felt that it was going to be helpful to change Bruce into a female because he knew of the heartbreak and horror Bruce would have to go through living as a male when at that time there was no possibility of enhancement surgery for men. NARRATOR: John Money and the team at Johns Hopkins first developed their controversial ideas in the 1950s. They did so by studying a group of individuals once associated with side shows and carnival acts. Known as hermaphrodites, this remarkable test group offered the researchers a unique opportunity to study how gender is formed. WILLIAM REINER (Johns Hopkins Medical Center): I think it's important to understand that John Money, here at Johns Hopkins, was a pioneer in this field, and one of the very few...and probably at the beginning, almost the only person exploring these areas, and trying to understand the conditions and to understand the children and the adults with these conditions. NARRATOR: Each year, thousands of children are born with genitals that fail to develop normally. This intersex condition, as it is now called, is more common than cystic fibrosis and Down's syndrome combined. And the causes are many. All embryos start life the same. But from six weeks, if the baby is to be a boy, the genes on the Y chromosome cause the fetus to develop testicles, which then produce the male hormone testosterone. It's this testosterone that makes the male organs grow. Without it, the child develops into a female. If, however, something goes wrong with the delicate balance of hormones in the womb, the genitals can appear ambiguous. This baby girl was exposed to too much testosterone, causing her genitals to appear masculine. And infant boys who aren't exposed to enough testosterone because of a genetic defect can be born like this, with genitals that look almost feminine. Since these malformed genitals were easy to misidentify, babies like this were often raised as the opposite sex. Through his research, John Money came upon many cases of children who'd been born one sex, but raised, by mistake, as another. JOHN MONEY You find, for example—once in a while...not very often—but you do indeed find a person who is chromosomally a female, who has two ovaries inside, a uterus, who with appropriate treatment could in fact get pregnant and carry a baby, but that same person is born not with a clitoris but with a penis. And I mean a regular-type little boy's penis. NARRATOR: Money found girls with external male genitals who were raised as boys. Astonishingly, they accepted themselves as boys, even though they were genetically female. Likewise, a genetic male born with a tiny penis could be raised successfully as a girl. With research results like this, John Money came to believe that gender was susceptible to change, and that upbringing played a significant role in developing a female or male identity. The team at Johns Hopkins expanded their theory to include the notion that gender was malleable in all children, not just intersex children. And eventually they came to understand there was a critical period during the first two years of life when this could happen. MELVIN GRUMBACH (University of California, San Francisco): The theory that had emerged at...at Hopkins, was that you were really neutral at birth. You were neither male or female. And how...how you...your environment determined whether you were a boy or a girl. MILTON DIAMOND (University of Hawaii, Honolulu): To put in a nutshell what Money was saying at that early time, was that, yes, there are a lot of biological factors to be considered, but when all is said and done, the most important one is how the individual is reared. So to make it simplistic, if you put a child in a blue room, it'll become a boy, and if you put it in a pink room, it'll be a girl. NARRATOR: In the 1950s, this notion of gender neutrality at birth was not a particularly radical idea. The power of nurture was already well understood, especially among mothers. Child behavior specialists like Dr. Spock convinced parents that they held the key to their child's future happiness. So when John Money suggested that an infant's gender could be changed through upbringing people listened and believed. ANNE FAUSTO-STERLING: Money's ideas dovetailed with a lot of ideas that were being produced in the period. So in the context of the 1950s, his ideas were not crackers, they were not insane. They were pretty good scientific ideas. NARRATOR: Many doctors also embraced John Money's ideas because they offered solutions. Physicians treating intersex boys could now feel more confident changing them into girls. WILLIAM REINER: It allowed me, as a surgeon, to be able to deal with parents of a child who was a genetic male but had no penis, and feel comfortable in saying, "We have a surgical solution, because we have a psychological solution, and that surgical solution is going to coincide with the psychological solution. We can rear the child as a female. We can construct the child as a female and your child will grow up and be a successful, happy girl or woman." NARRATOR: Boys born with small or ambiguous genitals were often surgically changed into girls. ANNE FAUSTO-STERLING: In this field, sex assignment as a girl has been deemed necessary if the penis was below a certain critical size. The argument was that the penis had to be large enough for a little boy to pee standing up. And if it wasn't, then the recommendation was to assign the child as a female: to remove the penis, fashion a clitoris out of some of the penile material, to create an artificial vagina. NARRATOR: By the mid-1960s, surgeries like this had been performed on intersex infants. But this procedure had never been attempted on a child born with normal genitalia. This was not clear to Janet Reimer when she brought her infant son in to meet with John Money. JANET REIMER: I asked him at the time if this had been done before. And he said, "Yes it had been successful." He did not say it was an experiment. We were not told that it was the first one. NARRATOR: On July 3rd 1967, Bruce Reimer had his testicles removed and the beginnings of a vagina surgically created. He was almost two years old. From now on, Bruce would be Brenda. She would be raised as a girl, treated as a girl, encouraged to behave as a girl. She would receive psychological support and at puberty she would be given female hormones. The plan was that, with this combination of treatments, Brenda would grow up not only to look like a woman, but to think like a woman as well. In the 1960s, as the idea of nurture's dominance over nature gained popularity, critics began to emerge. Among the most vocal was University of Hawaii professor, Milton Diamond. He did not agree that a child's gender could be altered through upbringing. MILTON DIAMOND: My immediate reaction to the thesis was that it was simplistic. I thought humans were a lot more complicated than just being a product of their upbringing. NARRATOR: Milton Diamond is a biologist. He believes that just as animals are born with instincts to behave like males or females, so are humans. MILTON DIAMOND: I saw no reason for humans to be that different. Certainly we're influenced by our society. Certainly we're influenced by our leaning. But our basic inclinations, our basic framework, or predispositions we have, have to come from biology. NARRATOR: Using the powerful hormone testosterone, Diamond took part in a series of animal experiments designed to show the influences of this hormone in the womb. Pregnant rats were injected with testosterone, which found its way through the umbilical cord into the baby's blood stream. When they were born, the females in the litter had genitalia that looked almost male. The artificial surge of testosterone had transformed their bodies. But the big question was, "Would these masculine-looking females also behave like males?" The answer was yes. The females who had received the hormone in utero even attempted to mate as if they were male. It appeared that testosterone had re-programmed their brains, giving them the instincts and behavior of males. MILTON DIAMOND: So, in other words, here's an intervention during their embryonic life which affected their adult life. So those types of experiments showed, at least for animals, that this was possible. NARRATOR: But what affects animals does not necessarily affect humans. To prove that testosterone in the womb could also change a child's gender identity, Diamond would need far more evidence. So when he attacked John Money's theories, few people listened. MILTON DIAMOND: My view was a minority view because the Hopkins group had a great status and my ideas were relatively out of the ordinary. NARRATOR: John Money's theories about gender helped determine the treatment of hundreds of infants each year. ANNE FAUSTO-STERLING: Money's influence in the field for probably thirty years was almost monolithic. The couple of times that people challenged him in thirty years, in print, there were angry letters from Money responding to the challenge. NARRATOR: In Winnipeg, as Brenda Reimer was growing up, John Money and his ideas continued to play a big part in her life. Brenda's mother, Janet, would fill her correspondence with whatever news she thought would please him. JANET REIMER: I wrote him letters regularly. If there was anything that Brenda was trying to do to please me, then I wrote him about it—that Brenda did this and Brenda did that. NARRATOR: John Money used these letters to promote his views. By 1972, when Brenda was just six years old, Money believed that he had enough evidence to announce to the medical community that he had changed a child born a perfectly normal boy, into a perfectly normal girl. The case was published in textbooks, discussed at conferences, even reported in Time magazine. It became an international, scientific sensation. It seemed John Money was right. That nurture could override nature—that a little boy could be made to think and feel like a girl. MELVIN GRUMBACH: It was the ultimate test of John Money's hypothesis that all of these influences in prenatal life—sex chromosomes, hormones, gonadal development—could be overcome by socialization. WILLIAM REINER: I think it was certainly used as very strong evidence that children are a blank slate...newborns are a blank slate, and that we can impose a gender identity on a newborn. MELVIN GRUMBACH: The twins' case, what we knew about it, really so reinforced Money's hypothesis that it was very hard to challenge. MILTON DIAMOND: Here was an unambiguous,true-to-life, et cetera, et cetera male that was switched to be a true-to-life female. That made a significant impact on the clinical treatment then. It was like everybody was saying, "Oh wow, really? Then we can do this." NARRATOR: Surgeons in the 1970s became even more confident that the gender choices they were making for their intersex patients would work. Any hesitation they might once have had about surgically changing infant boys into girls was now all but gone. ANNE FAUSTO-STERLING: I think that the twins' case was tremendously important in solidifying Money's ideas about the treatment of intersex kids. It was the case that just drove home how correct his ideas were. And it solidified the practice of doing surgery on young infants who had unusual genitalia so that it became the only acceptable practice. WILLIAM REINER: The idea of being able to turn a genetic male into a female is a tenet of our training, a dogmatic teaching. And it was one of those that we accepted. We questioned many others and none of us seemed to question that. NARRATOR: As John Money's twins case was making headlines, work in a Los Angeles laboratory would soon cast further doubt on the whole idea of gender neutrality at birth. DR. ROGER GORSKI (University of California, Los Angeles): My interest in research is, "What's going on in the rat, in a species that we can manipulate, a species that we can understand?" NARRATOR: Building on the work done in earlier behavioral studies, Roger Gorski and his team set out to see if testosterone actually changed the structure of the brain. But before he could link behavioral differences with brain anatomy, Gorski first had to see if there were any physical differences between the brains of male and female rats. Slice by slice, millimeter by millimeter, he compared male and female brains hoping to spot even the smallest sex difference. After years of searching he found nothing. Then one of Gorski's students claimed to have found something, a tiny area of the brain that seemed to be different in males and females. ROGER GORSKI: I had a graduate student in the laboratory and he announced to the lab group that there was a marked structural sex difference. NARRATOR: The student claimed that the difference in this area of the brain was blatantly obvious. No one in the laboratory believed him. ROGER GORSKI: And so he arranged for a meeting in a conference room...had two projectors side by side, and one he put the slice of male brain and another he put the slice of the female brain. NARRATOR: Deep in the center of the brain, in an area known as the hypothalamus, Gorski's student had found what they'd been looking for. ROGER GORSKI: There was this dramatic difference that just jumped out at us. NARRATOR: The male brain on the left had a structure twice as big as the female brain on the right. ROGER GORSKI: None of us believed it until we saw it, and then we couldn't disbelieve it. NARRATOR: This is the actual part of the brain that they isolated in a male rat. They called it the sexually dimorphic nucleus, or SDN. And this is what it looks like in the female rat. Here was physical evidence showing a sex difference between a male and female brain. ROGER GORSKI: When we first discovered the sexually dimorphic nucleus of the rat, I was very much interested in, "Is it sensitive to hormones? When does it develop? What does it do?" NARRATOR: Gorski next wanted to see what could have caused this difference? Could it be the hormone testosterone? The team repeated earlier experiments by injecting a pregnant rat with testosterone. As before, females that were exposed to testosterone in the womb soon began acting like males. Gorski then examined their brains. The SDN had indeed been transformed by testosterone. Each female rat now had the SDN of a male. ROGER GORSKI: This particular area of the brain appears to be totally dependent on the hormone environment. NARRATOR: What this meant was that, in rats at least, male and female brains were physically different at the time of birth. But what did this mean for humans? ANNE FAUSTO-STERLING: There are a lot of difficulties in linking animal studies to human behaviors. And the biggest, really, is that there's tremendous variability within the animal world. The move from rats to primates is very problematic. You cannot assume that the mechanism that you study in one animal will be identical in a different species. NARRATOR: Even though Roger Gorski could not apply the results from his rat studies to human behavior, he considered it a step in that direction. ROGER GORSKI: Given the fact that the general view in the clinical world was that nurture was by far the more important, I think our demonstration that hormones played a role, at least in my mind, challenged that view. NARRATOR: Another challenge to the primacy of nurture was beginning to develop inside the Reimer home. Brenda was having difficulty at school. As the Reimer family was dealing with her problems, John Money was publishing yet another book describing the twins as dramatic proof of his theories about gender. But far away from the textbooks, Brenda's reality was much different. JANET REIMER: I could see that Brenda wasn't happy as a girl, no matter what I tried to do for her, no matter how I tried to instruct her. She was very rebellious. She was very masculine and I could not persuade her to do anything feminine. Brenda has almost no...no friends growing up. Everybody ridiculed her, called her cave woman. She was a very lonely, lonely girl. NARRATOR: It wasn't long before the local psychiatrist looking after Brenda wrote to John Money about the concerns she had with Brenda's development. She was showing signs of being deeply disturbed. Now on estrogen, Brenda began overeating in an effort to conceal her growing breasts. She even began dressing like a boy. Problems at school escalated to a point where Brenda, in fear of her own safety, finally had to leave. In 1979, a BBC series called "Open Secret" revealed some of the problems Brenda was having adjusting to her life as a young woman. Claiming the show would violate Brenda's privacy, John Money refused to appear. But one of the psychologists treating Brenda in Canada was interviewed. Milton Diamond was interviewed as well. MILTON DIAMOND: During that production it seemed to become clear to the psychiatrists that were treating the kid, the non-Hopkins psychiatrists, that the child was not developing as presented. And there was doubt expressed that the child would ever become a successful woman. NARRATOR: Many doctors and scientists continued to believe that the case was a success. John Money never published anything to suggest that Brenda Reimer had problems adjusting to her female role. MILTON DIAMOND: Unfortunately, there were few papers about the twins' case. It was just the same stuff re-reported and re-re-reported, as if, "Here is proof." And we never got more evidence. All we did was get reiteration of the first original story. And that's one of the things that convinced me I really wanted to find out what happened to the kid, and prove it, see for myself. NARRATOR: As Milton Diamond went in search of new information, evidence against John Money's theories continued to mount. In Amsterdam, work was being done to find sex differences in the brains of humans. DICK SWAAB (Netherlands Institute): It took quite some time to make the leap from Gorski's work into the human brain because, in the first place, you need the right material. Post-mortem material of human beings without brain disease is very hard to get. NARRATOR: It took five years to collect enough human brains for this research. Then the painstaking work began. Just as with the rats, slice after slice of male human brain was meticulously examined and compared to identical slices of female brain. DICK SWAAB: Ultimately, I think we measured over 100 brain samples. The difference between the male and female brain became incredibly apparent. NARRATOR: Professor Swaab found what he thought to be evidence of sexual differences in the human brain. In the slide on the left, a portion of the hypothalamus, which regulates hormones, is larger in the male than in the female brain on the right. Could this be evidence that the root of what makes us feel male or female can be traced to the brain? To answer this question the team in Amsterdam turned to a unique set of individuals. Emma Martin is a transsexual. She was born a genetically normal male, but she's spent her whole life feeling like a woman. EMMA MARTIN: When I was four years old something happened which I guess was the starting point of...of my realization that...that I was different from other people. I was playing in the back garden in my pedal car, and I suddenly realized that there was a little girl in the garden next door basically doing the same thing—just going up and down the garden on a tricycle. And I saw her through the fence and I just realized that they'd made a mistake...that... And I couldn't understand why. I couldn't understand why my parents were treating me as a boy. NARRATOR: Throughout her life, Emma was never able to accept her male gender, even though she was raised as a boy. DICK SWAAB: Transsexuals don't describe themselves as having a female brain. They describe themselves as being female. But of course this strong feeling to be a female should come from somewhere, and we are certain it's not coming from the heart. It's coming from the brain. NARRATOR: In the 1990s, Professor Swaab's team began to study the brains of transsexuals to see if there was some structural reason for their particular gender identity. He focused on the region of the hypothalamus where he had first noticed sex differences between male and female brains. After years of work, he found what he was looking for. In a tiny portion of the hypothalamus, the male transsexual brains looked similar to the female brains from his control group. It seemed clear to Swaab that this similarity between male transsexual brains and females brains could prove important in defining gender identity. DICK SWAAB: I think if we look to the entire set of data, it's clear that we are not born neutral, that our sex difference is present already very early in development. NARRATOR: Swaab's work with transsexual brains is controversial, in part because it has not yet been replicated. But some of his earlier work showing sex differences between the brains of males and females has been confirmed. But the significance of these findings remains to be seen. ANNE FAUSTO-STERLING: This established sex difference in the brain is an anatomical difference, and quite frankly no one knows what it means in terms of behavior. It might well have something to do with the different kinds of physiology involved with the production of sperm versus the production of eggs. There's no evidence that it has to do with behavior per se, which doesn't mean to say there might not be some evidence in the future. But at the moment no one really knows what that little group of cells does. NARRATOR: With the evidence incomplete, many in the medical community continued to view the nature/nurture debate through the lens John Money had provided. But this wasn't good enough for Milton Diamond. Distrustful of Money's research, Diamond was determined to find out the truth about Brenda. MILTON DIAMOND: I found it very difficult to get information on the twins' case. John Money kept saying he couldn't say any more because of privacy involved. There were no reports coming from anywhere else. I had tried letter writing to professionals that I thought...that might have some input, or putting an ad in the professional journals. And nobody responded. NARRATOR: Ultimately, Milton Diamond's efforts paid off. After 20 years, he finally tracked down Brenda Reimer. She was living anonymously in Winnipeg. And she was ready to speak out. DAVID REIMER: I didn't like dressing like a girl. I didn't like behaving like a girl. I didn't like acting a girl. NARRATOR: Brenda Reimer, the boy who was turned into a girl, was living as a man. DAVID REIMER: I wore dresses on occasion and I never played with girls' stuff. I usually got stuck with a doll or something like that for my birthday or Christmas and they sat in a corner collecting dust...played with my brother's things. I wasn't too happy about sharing, but share with my brother or I don't have anything. NARRATOR: For almost 14 years David had lived as Brenda and for most of that time he had been unhappy. JANET REIMER: During the early years I thought we had made the right choice and it would work out. Dr. Money kept saying it would work out and I thought, "Well, he should know." NARRATOR: But by the time Brenda was a teenager, her life was so difficult she had become a virtual recluse. DAVID REIMER: I was so pitifully lonely. And I tried to put makeup on, but I looked like Bozo the Clown. You never can imagine a guy trying to put makeup on himself. After...after a while of trying I just gave up...says what's the sense of trying. No matter how much I...I put out in effort it's never going to work. There's...there's no way of knowing whether you're a boy or girl 'cause nobody tells you. You don't wake up one morning and say, "Oh I'm...I'm...I'm a boy today." You know? You know? It's...it's...it's in you. Nobody has to tell you who you are. NARRATOR: When Brenda was 14, her parents finally revealed her true sex at birth. Within a few months, Brenda rejected the gender that had been imposed upon her, and chose to live as a male called David. For the last 10 years he has been married and living with his wife and her three children. He has undergone surgery to have his penis reconstructed. MILTON DIAMOND: I felt very sad about David's story. His story is very touching. He was forced to live a life that was not his own, not of his making, not of his choice, in which he was given few options. Every time he tried to assert himself as a youngster, he was thwarted by...so-called...the two forces which are supposed to be most helpful in our lives—our parents and our physicians. NARRATOR: Unaware of the interest in his life's story, David had never considered speaking out in public. DAVID REIMER: By me not saying anything, the medical community was under the impression that my case was a success story. And I was shocked when I heard that people thought that my case was a success story. NARRATOR: It is not known why John Money waited to report the outcome of the twins' case. To date, he has refused all interviews about the story. But in 1998, he did publish a list of reasons why Brenda's re-assignment might have failed. He suggested that the surgery at 22 months might have been performed too late, that having an identical twin brother could have heightened Brenda's sense of being different, and that the trauma caused to the parents by the entire event adversely affected Brenda's development. ANNE FAUSTO-STERLING: I think that John Money's reasons for why the case might have failed are potentially legitimate reasons. On the other hand, they clearly are excuses that were offered up years later, and they take on that look, especially, because he was not forthcoming with what happened. MELVIN GRUMBACH: Many of us were completely in the dark about, you know, what had happened. We heard in the early 70s what a success this had been. Until this denouement, we had really no...no knowledge of how the twins were doing and so this led to major disaffection. And what was disappointing in all of this...and more than disappointing...I mean what was...what hurt a lot of us, is that there'd been no word that this wasn't working out the way it had been first suggested. We'd been let down by somebody who we respected. NARRATOR: Despite David Reimer's tragic experience, John Money's theories still influence the treatment of children born with ambiguous genitalia. Today, most surgeons would no longer attempt to change the sex of a boy born with normal genitals. But some boys born with very small or unformed penises are still surgically changed into girls. Surgeon Philip Ransley is treating one such infant. PHILIP RANSLEY (Great Ormond Street Hospital): This child would have gone through childhood with an extremely tiny phallus and would have had a very small phallus in adult life. The psychological burden that he would have carried as a male would have been enormous. There was no difficulty in this case in everyone agreeing that the appropriate sex of rearing was female, and she was gender-assigned female. NARRATOR: This "normalizing surgery" as it is called, has become such a standard practice that until recently, most physicians considered it beyond debate. ANNE FAUSTO-STERLING: The surgeries are performed, really, because they are part of the still-standing views that were established by John Money in the 1950s—that the successful emotional and psychological development of these kids depended on their parents being comfortable with how they looked , and that the kids themselves would more comfortable if they also had so-called "normalized" genitalia. So most of these surgeries were done, not because the abnormalities were life-threatening, but because it was viewed that they were required for normal psychological development. PHILIP RANSLEY: We have to perform our surgical task with what we believe to be the best interests of that child at heart and that is what we do. And we would not undertake surgical intervention if we were not convinced completely that this was the correct course of action. NARRATOR: Despite the best intentions of surgeons like Philip Ransley, a small percentage of these children do reject their gender assignments later in life. This has led a growing number of physicians to advocate that surgery be delayed until the children are old enough to decide for themselves. WILLIAM REINER: I would recommend to the parents that surgery has great risks, for children with intersex, of being the wrong surgery, and that the children may well reject that surgery at a later time in life because they may choose the gender identity that was not assigned. NARRATOR: Once designed to help the child lead a more normal life, these surgeries are also coming under fire for the physical problems they can cause. ANNE FAUSTO-STERLING: In my opinion, the treatment of intersexual infants has often done a lot of harm. I don't believe the harm was intended, but I believe that the harm is there. Genital surgery can cause permanent scarring and damage which later affects sexual sensitivity. A lot of the surgeries don't work very well and they break down later in life. And so you have the stories of intersexuals who've had surgery after surgery after surgery. There probably are cases where a child has been helped by surgery, but we don't know them. The fact is that the medical community has been enormously remiss in not doing long-term follow-up studies. And as long as those long-term follow-up studies aren't done, then their claim that there are happy customers rings kind of hollow. PHILIP RANSLEY: The scientific data that we would love to have to tell us whether the...the decisions we're making in infancy were correct or not, this data does not exist. Therefore, in this field medicine has to remain a mixture of science and art. NARRATOR: Forty years ago John Money helped establish a standard of care that still has influence today. But now that his most famous case has failed, there is a growing conviction that sex differences are much more inborn than was once believed. But what the balance is between nature and nurture is still being explored. MELVIN GRUMBACH: In the 21st century we can say that the theory of gender neutrality was wrong, that there are important biological factors that play a role. What the mixture is between environmental and biological factors is going to take us a long time to sort out. DAVID REIMER: I was never happy as Brenda. Never. I'd slit my throat before I'd go back to that. I'd never go back to that. It didn't work because that's life, because you're human and you're not stupid and eventually you wind up being who you are. On NOVA's Web site, hear the story of one intersexual who rejected her female gender assignment at age 32, because so many people mistook her for a man, at PBS.org or America Online, keyword, PBS. Educators can order this or any other NOVA program for $19.95 plus shipping and handling. Call WGBH Boston Video at 1-800-255-9424. Next time on NOVA, NOVA's cameras penetrate Russia's largest nuclear missile base. Meet the man at the controls and see what they're up against. Russia's Nuclear Warriors. NOVA is a production of WGBH Boston. Major funding for NOVA is provided by the Park Foundation, dedicated to education and quality television. This program is funded in part by the Northwestern Mutual Foundation. Some people already know Northwestern Mutual can help plan for your children's education. Are you there yet? Northwestern Mutual Financial Network. Scientific achievement is fueled by the simple desire to make things clear. Sprint PCS is proud to support NOVA. And by the Corporation for Public Broadcasting, and by contributions to your PBS station from viewers like you. Thank you. PRODUCTION CREDITSSex: Unknown
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Executive Producer A BBC/WGBH Boston Co-Production © BBC MM Additional program material © 2001 WGBH Educational Foundation
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