Middlesex - Jeffrey Eugenides [219]
In his office Luce got straight to the point. “Let me review the facts of your daughter’s case,” he said. Tessie noted the change at once. Daughter. He had said “daughter.”
The sexologist was looking reassuringly medical that morning. Over his cashmere turtleneck he wore an actual white coat. In his hand he held a sketchpad. His ballpoint pen bore the name of a pharmaceutical company. The blinds were drawn, the light low. The couples in the Mughal miniatures had modestly covered themselves in shadow. Sitting in his designer chair, with tomes and journals rising behind him, Dr. Luce appeared serious, full of expertise, as was his speech. “What I’m drawing here,” he began, “are the fetal genital structures. In other words, this is what a baby’s genitals look like in the womb, in the first few weeks after conception. Male or female, it’s all the same. These two circles here are what we call the all-purpose gonads. This little squiggle here is a Wolffian duct. And this other squiggle is a Müllerian duct. Okay? The thing to keep in mind is that everybody starts out like this. We’re all born with potential boy parts and girl parts. You, Mr. Stephanides, Mrs. Stephanides, me—everybody. Now”—he started drawing again—“as the fetus develops in the womb, what happens is that hormones and enzymes are released—let’s make them arrows. What do these hormones and enzymes do? Well, they turn these circles and squiggles into either boy parts or girl parts. See this circle, the all-purpose gonad? It can become either an ovary or a testis. And this squiggly Müllerian duct can either wither up”—he scratched it out—“or grow into a uterus, fallopian tubes, and the inside of the vagina. This Wolffian duct can either wither away or grow into a seminal vesicle, epididymis, and vas deferens. Depending on the hormonal and enzymatic influences.” Luce looked up and smiled. “You don’t have to worry about the terminology. The main thing to remember is this: every baby has Müllerian structures, which are potential girl parts, and Wolffian structures, which are potential boy parts. Those are the internal genitalia. But the same thing goes for the external genitalia. A penis is just a very large clitoris. They grow from the same root.”
Dr. Luce stopped once more. He folded his hands. My parents, leaning forward in the chairs, waited.
“As I explained, any determination of gender identity must take into account a host of factors. The most important, in your daughter’s case”—there it was again, confidently proclaimed—”is that she has been raised for fourteen years as a girl and indeed thinks of herself as female. Her interests, gestures, psychosexual makeup—all these are female. Are you with me so far?”
Milton and Tessie nodded.
“Due to her 5-alpha-reductase deficiency, Callie’s body does not produce dihydrotestosterone. What this means is that, in utero, she followed a primarily female line of development. Especially in terms of the external genitalia. That, coupled with her being brought up as a girl, resulted in her thinking, acting, and looking like a girl. The problem came when she started to go through puberty. At puberty, the other androgen—testosterone—started to exert a strong effect. The simplest way to put it is like this: Callie is a girl who has a little too much male hormone. We want to correct that.”
Neither Milton nor Tessie said a word. They weren’t following everything the doctor was saying but, as people do with doctors, they were attentive to his manner, trying to see how serious things were. Luce seemed optimistic, confident, and Tessie and Milton began to be filled with hope.
“That’s the biology. It’s a very rare genetic