The Riddle of Gender - Deborah Rudacille [62]
Intersexual and gender-variant persons were among the first to undergo genetic testing, and certain anomalies were revealed to be genetically caused. Others were found to have no apparent genetic basis.
“It was as a graduate student in the Harvard psychological clinic that I first became directly acquainted with the phenomenon of human hermaphroditism,” Money writes in Gendermaps, published in 1995. He describes the case of a seventeen-year-old boy born with two un-descended testes and external genitalia that “resembled a vulva with a clitoridean organ instead of a penis.” The boy was suffering from a condition then called testicular feminizing syndrome, but today known as androgen insensitivity syndrome (AIS), in which cells throughout the body of an XY child fail to respond to androgens. The child thus develops a female body shape and genitals. Prior to the discovery of a test to determine chromosomal sex, such children were usually raised as girls, though as adults they were infertile. Money’s first intersexual patient “had been reared as a boy after a sex reannouncement from female to male early in infancy on the advice of a wrongly informed physician who had promised surgical and hormonal treatment in the teenage years so as to allow the boy to become a man.”
No such treatment was available, but when doctors informed the seventeen-year-old seeking the promised treatment that he could instead live as a woman, “it was an option too alien for him to contemplate,” says Money. This first experience with an intersexual person led Money to recognize the possibility that the sex of the mind could be at odds with the visible sex of the body. “It pointed clearly toward the principle of a discontinuity between the development of the body, from prenatal life through puberty, as feminized, and the development of the mental life as masculinized, despite the restrictions imposed on genital masculinity by anatomical and hormonal femininity.”
After completing his doctoral dissertation at Harvard, “Hermaphroditism: An Inquiry into the Nature of a Human Paradox,” Money joined the staff of the Pediatric Endocrinology Clinic at Johns Hopkins Hospital. A protege of Lawson Wilkins—often called the father of pediatric endocrinology—Money was recruited by Wilkins to work at Johns Hopkins as a psychoendocrinologist, a clinician/researcher whose primary goal was to develop an understanding of the mental and behavioral changes caused by treatment with hormones. At Johns Hopkins, Money’s caseload of intersexual patients expanded to sixty. His psychological evaluations of these sixty patients convinced him to “abandon the unitary definition of sex as male or female,” based on the commonly accepted criteria of either chromosomal or gonadal sex. Instead, he identified “five prenatally determined variables of sex that hermaphroditic data had shown could be independent of one another”—chromosomal sex, gonadal sex, internal and external morphologic sex, and hormonal sex—and “a sixth postnatal determinant, the sex of assignment and rearing.”
To these six variables, Money added a seventh, one that had previously been absent from scientific and medical discussions of sex: gender role. “The term ‘gender role’ is used to signify all those things that a person says or does to disclose himself or herself as having the status of boy or man, girl or woman, respectively. It includes, but is not restricted to, sexuality in the sense of eroticism,” Money writes in his first published paper on the topic at Johns Hopkins. The term “gender role” was conceived “after several burnings of the midnight oil,” says Money, and was originally “conceptualized jointly as private in imagery and ideation, and public in manifestation and expression.” In Gendermaps, Money confesses that in defining gender role he “had in mind the example