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Boys Will Be Boys

Despite all the efforts of psychiatrists, surgeons, and parents to feminize a boy who was accidentally deprived of his sexual organs, "John" is now happily married and living as a man. The unique long-term case study of a boy raised as a girl, described in the March Archives of Pediatric Adolescent Medicine, could rewrite psychology textbooks on the influence--or lack thereof--of environmental factors on sexual identity.

John's penis was accidentally burned off in 1963 during circumcision when he was 8 months old. John's parents brought him to Johns Hopkins University, where experts recommended that John be turned into a girl. This meant snipping off his testicles, excavating a vagina, and, later, pumping him with estrogen and other female sex hormones. John become "Joan."

The story has long been ballyhooed as the "classic" demonstration of how environmental factors can be override nature to form gender identity, says report author Milton Diamond, a sexologist at the University of Hawaii. But despite years of being treated as a girl, "Joan" was never comfortable in that role or accepted by other girls, the report says. John rebelled at 14, after 2 years of estrogen therapy, and confessed to his doctor that "I suspected I was a boy since the second grade." He eventually got a mastectomy and was put on male hormone shots. At age 25, he married a women with children.

Diamond says the case history is the first long-term follow-up of a male with the normal allotment of XY chromosomes who was raised as a female. And it could have major implications for the treatment of any baby born with ambiguous genitalia. The textbooks, Diamond says, tell you "If you can't make a good penis out of it, make a vagina." Now it's clear, he says, that the policy should be "Keep your knife away. Let the kids make a decision when they get older."

"It's big news," says psychologist Michael Bailey of Northwestern University. "This case was heralded by many as the pinnacle of proof that psychosocial factors can override biological factors" in determining gender. And textbooks have continued to cite Joan's successful adjustment despite evidence, which has been accumulating since the early 1980s, that the sex reassignment was not working--despite research showing many aspects of sexual differentiation are biologically influenced, says Bailey. Indeed, he says, Diamond's report "suggests that, if anything, how you're reared matters little."