The Boy who was Turned into a Girl
BBC2 9.00pm Thursday 7th December 2000
NARRATOR (DILLY BARLOW): In August 1965 in the small Canadian town
of Winnipeg Janet Reimer gave birth to twin boys, Bruce and Brian.
Her twins would form the basis of one of the most controversial
case studies in the history of science, a study that is still having
repercussions to this day, because by the time they were two years
old, before they were even out of nappies, Brian would be a happy,
bouncing boy and Bruce would have been turned into a girl called
Brenda. For many years science has believed it could turn a boy
into a girl. Not just make a boy look like a girl but make him think
like a girl, feel like a girl, be a girl, to turn a boy's brain
into a girl's brain.
DR WILLIAM REINER (Johns Hopkins Medical Institution): The idea
of being able to turn a genetic male into a female is a, a tenet
of our training, of dogmatic teaching and it's one of those that
we accepted. We questioned many others and none of us seemed to
NARRATOR: To do this science would have to override the very blueprint
of nature - our genes. The theory was that although the genes on
the X and Y chromosomes and our hormones turn us physically into
males and females in the womb, they don't irrevocably shape our
minds. Scientists believe that what happens in our brains to make
us think, feel and behave differently as boys and girls, to give
us what's called our gender identity is shaped by a force perhaps
more powerful than nature - nurture, our upbringing. In theory,
the key to our gender identity is that we are taught it, by things
like the toys we're given, the clothes we wear, whether we're encouraged
to behave in male or female ways.
PROF. MILTON DIAMOND (University of Hawaii): So to make it simplistic
if you put a child in a blue room it'll be a, become a boy and if
you put it in a pink room it'll be a girl.
NARRATOR: If this was true then it would theoretically be possible
to turn a boy into a girl, to make a boy feel like a girl, think
he was a girl by, amongst other things, carefully raising him as
a girl. This theory would end up influencing the treatment of thousands
PROF. MEL GRUMBACH (University of California, San Francisco): So
it gave us confidence that, you know, on the basis of this well
that, you know, this child could be raised as a, as a female just
as well as a male.
NARRATOR: And dramatic proof of this theory was said to be the case
of Bruce Reimer. It all began on a summer's morning in 1965 when
Janet Reimer was granted her dearest wish.
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 identical twin boys 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 six months events would take a dramatic turn.
JANET REIMER: Bruce and Brian both started having trouble urinating.
The doctors suggested circumcision.
NARRATOR: On 27th April Janet left her twins at the local hospital
in Winnipeg. Circumcision was a straight-forward procedure and she
expected to pick up her boys the next day, but early the next 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 sic, circumcision and I could not comprehend what he was talking
about because you see I thought they were going to use a knife.
I didn't know there was electricity involved.
NARRATOR: Strangely, the doctors had chosen an extremely unconventional
method of circumcision. Bruce's penis had been completely destroyed.
JANET REIMER: Daily I was crying. Every time I changed his diaper
I'd cry. I was in shock for a while. I guess about a year I was
NARRATOR: Janet and her husband took their twin babies home and
shut out the rest of the world. She had a little boy with no penis
and didn't know where to turn. Months past.
JANET REIMER: Then we saw this show on TV. We just happened to be
TV PRESENTER: Dr John Money, a psychologist at Johns Hopkins is
one of the leading advocates of sex change operations. Dr Money
is in the bear pit tonight with Alvin Davies.
NARRATOR: On television that night was a brilliant young psychologist.
John Money was a pioneer in the astonishing new field of sex change
ALVIN DAVIES: Dr Money, it's still a pretty drastic procedure isn't
JOHN MONEY: Well it's a drastic procedure by your standards and
mine, but for the people who are living in desperation perhaps the
best way to understand it is that it seems no more drastic to them
JANET REIMER: Dr Money was on there and he was very charismatic,
he was very, he seemed very, highly intelligent and very confident
of what he was saying.
NARRATOR: Janet thought that there might be a chance that he could
help her son by changing him into a daughter. Within weeks Janet
Reimer had taken her son to the prestigious Johns Hopkins University
in Baltimore where John Money ran a world famous unit. There, Money's
team explained to her how to turn her little boy Bruce into a little
girl, make him think and act for the rest of his life like a female.
The reason the team felt this was possible was because they believed
they had made a new discovery about human psychological development.
Traditionally it had been thought that all children had an inborn
sense of being a boy or girl, a natural instinct towards male and
female behaviour, that before birth our gender identity is programmed
by our genes and hormones and that it's unchangeable. If this was
true then Bruce Reimer already had his male gender identity biologically
fixed in the womb and he could never be turned into a girl, but
John Money didn't think things were that simple.
JOHN MONEY: We've been stereotyped in, in our view of male and female,
male and female behaviour. I suppose primarily because it's been
that way for literally centuries and probably hundreds of centuries.
NARRATOR: The Hopkins team believed that the main key to how we
develop our gender identity was not genetic or hormonal. It was
how we were raised. A child might be born with some innate sense
of its gender, but this could be overridden by upbringing, but
nurture could override nature. A child taught to behave in a masculine
way would grow up thinking and feeling like a boy. Raising a child
like a girl - for instance giving it dolls to play with - would
encourage it to develop a maternal instinct and a feminine way of
behaving. If this theory was true, it could be used as the basis
for raising Bruce successfully as a girl.
JANET REIMER: It made sense at the time that he became a daughter
because we thought well maybe it can work, maybe it is a matter
of nur, nurture over nature.
NARRATOR: John Money and the team at Hopkins had reached their ground-breaking
theory about nurture and gender identity while they were trying
to help people born with a rare and distressing condition. Historically
called hermaphrodites, these were people born with genitals that
were neither fully male nor female. In medicine they're known as
WILLIAM REINER: I think it's important to understand that John Money
here at Johns Hopkins was a pioneer in this field and, and one of
the very few, and probably at the beginning, almost the only person
exploring these areas and in trying to understand the conditions
and to understand the children and the adults with these conditions.
NARRATOR: Intersex cases are caused by an imbalance of hormones
in the womb. All embryos start life as female with internal female
organs, but from six weeks if the baby is to be a boy the genes on
the Y chromosome cause the foetus to develop testicles which then
produce the male hormone testosterone. It's this testosterone that
makes the male organs grow. If, however, something goes wrong with
the delicate balance of hormones in the womb the child's genitals
won't develop fully and can be ambiguous. Intersex covers a wide
range of complex conditions. For instance, this baby girl has been
exposed to too much testosterone in the womb and so her genitals
appear masculine, but she is genetically female. This boy did not
receive enough testosterone in the womb and so he was born with
a tiny penis that could be mistaken for a clitoris. Because mistakes
were made when looking at their genitals, babies like this were
often brought up in the wrong sex. In the 1950s John Money studied
intersex children who'd been born genetically 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: The astonishing thing that Money found was that if a girl
like this was raised as a boy she would fully believe that she was
a boy, even though she was born genetically female. Likewise, a
boy born with a tiny penis could be raised successfully as a girl
and believe himself to be a girl. From studying these intersex children,
John Money and his team came to a ground-breaking universal theory
about all human development. The theory was that we were all born
with such an unformed sense of being male or female that for up
to two years after birth all babies' brains were malleable. There
was a window of opportunity when you could train any baby to believe
itself to be either a boy or a girl, but only if you started early
enough and provided the right support. It meant up-bringing could
override whatever effects genes and hormones had had in shaping
our gender identity in the womb, but after two years this malleability
ended and the child's gender identity would be for ever fixed.
MEL GRUMBACH: 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.
NARRATOR: This became known as the Theory of Neutrality. For those
dealing with the complex problem of intersex, Money's work offered
hope. He advised doctors to pick whichever gender seemed most suitable
and assign the baby accordingly, importantly before it was two years
old. This decision would often mean performing surgery to alter
the genitals of the child.
WILLIAM REINER: It allowed me as a surgeon to be able to deal with
parents of a child who was a genetic male, but who had no penis
and feel comfortable in saying we have a, 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: This meant that boys born with a tiny penis were often
surgically transformed into girls and raised as girls.
MEL GRUMBACH: They were castrated and their external genitalia were
surgically modified along female lines.
NARRATOR: It may sound brutal, but many doctors who deal with the
deeply complex problems of intersex see this as the best solution.
Over the years thousands of children have been treated this way.
Today, here at Great Ormond Street Hospital intersex children are
treated along similar lines. This baby did not receive enough testosterone
in the womb. It is genetically male, but was born with a tiny penis,
undeveloped testicles and some internal female organs. This child
has not been fully masculinised before birth. Surgeon Philip Ransley
believes that turning this child into a girl offers her the best
PHILIP RANSLEY (Great Ormond Street Hospital, London): 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
NARRATOR: Once the baby's gender is assigned, the next step is surgery
to make her genitals as like a girl's as possible. No further surgery
is likely to be needed, though the child and her family will be
helped with continued medical and psychological support. At puberty,
she will be given female hormones to develop the external appearance
of a woman.
PHILIP RANSLEY: This child will not suffer a significant problem
from very abnormal external appearance of their genitalia and therefore
are not likely to suffer from psychological difficulties at school.
I think the stage is set for this child to have an extremely successful
life as a female.
NARRATOR: Back in the early 60s gender assignment surgery had only
ever been performed on intersex children, but Money's ideas went
beyond the specific problem of intersex. He had devised, he believed,
a universal theory about gender identity that we are all born with
an unformed sense of being male or female, so theoretically any
boy could be raised as a girl, even if he'd been born completely
normal. Then, in 1967, John Money became involved with the baby
boy, Bruce Reimer. Bruce was not intersex. It was the first time
that Money's theories would be used to help a completely normal
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: On 3rd July Bruce Reimer was surgically castrated. He
was 22 months 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. It seemed the ultimate test that
nurture could override nature. If it worked, Brenda would grow
up not only with the body of a woman but with the mind of a woman
as well. Meanwhile, one scientist had been constructing a theory
that seemed to contradict John Money's one. If he was right, then
it could spell disaster for Brenda.
MILTON DIAMOND: My immediate reaction to the thesis was 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 an instinctive set of behaviours to act 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: Diamond had become obsessed with the idea that it was
the hormone testosterone that held the key not only to our physical
gender but also to our gender identity, to what makes us feel like
men or women. As a student in the 50s, Diamond was involved in a
series of ground-breaking experiments that began to uncover the
secrets of testosterone's power. Pregnant laboratory animals were
injected with testosterone. That testosterone in the mother made
its way through the umbilical cord into the babies in her womb.
When the litter was born the females' genitals looked almost male.
The testosterone pumped into them before birth had transformed their
bodies, but the big question was: would this same testosterone affect
their minds, their instincts, make these females behave like males?
The answer was yes. The females who had received testosterone in
the womb even attempted to mate as if they were male. It seemed
that testosterone had programmed these females' brains to give them
the instincts and behaviour of males and it all happened before
MILTON DIAMOND: So in other words here's an intervention during
their embryonic life which affected their adult life, so those type
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 irrevocably defined a human's
gender identity, Diamond would need far more evidence, so when he
attacked the Theory of Neutrality in the 1960s nobody 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
NARRATOR: Meanwhile, John Money was closely monitoring the progress
of the twins. He felt Brenda was growing up successfully as a little
girl and had adopted a female gender identity. By 1972 Money believed
that he had enough evidence to announce to the medical community
that he had changed the gender identity of a child born a perfectly
normal boy. The case was published in textbooks, discussed at conferences,
even reported in Time magazine. It became an international, scientific
sensation. It seemed dramatic proof that John Money was right, that
we all have an unformed gender identity at birth that we learnt
to feel like men or women. Whatever was in our genes could be overridden
MEL 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 socialisation.
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.
MEL GRUMBACH: The twins' case, what we knew about it really so reinforced
the, Money's hypothesis that it was very hard to challenge.
NARRATOR: If John Money's theories had worked in such an extreme
case as Brenda, then any doubts that doctors had about reassigning
the sex of intersex cases vanished.
MILTON DIAMOND: Here was an unambiguous true-to-life etc, etc. 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 on wow, really, then we can do this.
NARRATOR: But just as John Money was announcing the success of the
twins' case, in a laboratory in Los Angeles another discovery was
about to be made that would 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, a species that
we can manipulate, species that we can understand.
NARRATOR: Gorski and his team believed that the difference in behaviour
between males and females must be caused by some physical difference
in the brain and Gorski was determined to find this difference.
The team set about comparing the brains of male and female rats
in minute detail. Slice by slice, millimetre by millimetre, they
compared every area of the brain hoping to spot even the smallest
of differences, but after years of searching they found nothing.
Then out of the blue 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
NARRATOR: The student claimed that the difference in this area of
the brain was blatantly obvious. No-one in the laboratory believed
ROGER GORSKI: And so he arranged for a meeting in a, 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 centre of the brain in an area known as the
hypothalamus, Gorski's student had found what they'd been looking
ROGER GORSKI: There was this dramatic difference that just jumped
out at us.
NARRATOR: The male brain on the left had an area 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 here it is in the female rat. Nobody knew what this part
of the brain did, but it was the first proof that there was a difference
in the brains of male and female rats.
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 knew that testosterone caused all the physical
changes in the body of a male rat, but could testosterone be turning
the brain male? The team repeated Diamond's early experiments by
injecting a pregnant rat with testosterone. As before, the females
of the litter behaved like males. Then Gorski examined their brains.
The SDN had been transformed by testosterone while the rats were
still in the womb. The female rats had the brain of a male before
they were born.
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 and the difference
was caused by the hormone testosterone in the womb and Gorski suspected
the same difference would be apparent in the brains of humans. At
this stage no one could say how this difference might affect behaviour,
but it was the first hard evidence that leant support to the idea
that we are not born neutral.
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: Back in Winnipeg, Brenda was growing up out of the public
eye. She was making her way through school. By now John Money had
written another book describing the twins' case as dramatic proof
of his theory about gender identity, but far away from the textbooks
the family were dealing with the reality of the situation. Bringing
up Brenda was not always easy.
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 really killed her, called her cave
woman. She was a very lonely, lonely girl.
NARRATOR: At about this time the local psychiatrist looking after
Brenda wrote to John Money about the concerns she had with Brenda's
development. Brenda was showing clear signs of being deeply disturbed
and unhappy. John Money didn't publish this. When Brenda was 13
the Reimer family decided to stop seeing Money. From then on nothing
would be heard about Brenda for 15 years. During this time most
of the scientific community continued to believe that the case was
a success, dramatic proof of the whole idea that you could change
the gender identity of a perfectly normal boy. But now biologists
were closing in on one crucial new piece of evidence about the brain.
Although a difference had been found in the brains of male and female
rats, scientists had, as yet, been unable to find a difference in
the human brain, but one team in Amsterdam was looking.
PROF DICK SWAAB (Netherlands Institute for Brain Research): it took
some time to make the leap from Gorski's rat 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 them five years to collect enough human brains for
their research. Then the painstaking work began. Just like with
the rats, slice after slice of male human brain was meticulously
examined and compared to an identical slice of female brain.
DICK SWAAB: Ultimately I think maybe I measured over 100 brain samples.
The difference between the male and female brain became incredibly
NARRATOR: they had finally found the sexually dimorphic nucleus
in human brains. In the male brain on the left the SDN is twice
as big as it is in the female brain on the right. Over the years
four more types of SDN, different in males and females, were found
clustered together. Could this be where our gender identity lies?
The part of the brain that makes us feel male or female. To answer
this question the team in Amsterdam turned to a unique set of individuals.
Emma Martin is a transsexual. Physically she was born a normal boy,
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 realisation that, that I was different
from other people. I was playing in the back garden in my pedal
car and I suddenly realised 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 realised 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: Emma's case seems to go against the very idea that nurture
can override nature. She was brought up as a completely normal
boy, yet something inside her brain appears to have overridden
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
NARRATOR: In the 1990s Prof Swaab's team began the first ever study
of transsexual brains to see if there was some physical reason for
transsexuals unusual gender identity. Swaab was convinced that the
answer must lie in the cluster of sexually dimorphic nuclei. If
he could prove this, it would be the first evidence that gender
identity was linked to a specific part of the brain. After years
of painstaking investigation he found a key new SDN. The picture
on the left shows that particular SDN in a normal male brain. The
picture on the right shows the same SDN in a male transsexual like
Emma. It's the same size as that of a woman. The eleven male transsexual
brains Swaab studied showed this SDN to be the size of a woman's.
It seemed clear to Swaab that this cannot be coincidence, that this
particular SDN must be important in defining our gender identity.
Other preliminary studies seem to suggest that this difference in
the brain between men and women happens before birth and if so,
it may be that our gender identity is already so established in
the womb that it cannot be overridden by upbringing.
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 developments.
NARRATOR: The big question was: what had happened to Brenda Reimer
and in 1995 she was tracked down. The girl who had helped to make
John Money world famous was living anonymously in Winnipeg and it
was time to go public.
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 dolls or something like that
for my birthday or Christmas and they sat in a corner collecting
dust. Played with my brother's things. Wasn't too happy about sharing,
but share with my brother or I don't have anything.
NARRATOR: For almost 14 years David has lived as Brenda and for
most of this 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 had become a teenager her life
had become so difficult she had become a virtual recluse.
DAVID REIMER: I was so pitifully lonely and I tried to put make-up
on, but I looked like Bozo the Clown. You ever can imagine a guy
trying to put make-up on himself. After, after a while 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, of knowing whether you're a boy or girl 'cos 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, you know, it's
in your genetics, it's in your brain, you, nobody has to tell you
who you are.
NARRATOR: When Brenda was 14, after years of unhappiness, her parents
revealed her true sex at birth. Within a few months Brenda had decided
to become David.
For the last 20 years he has been married and living in Winnipeg
with his wife and her three children. He has undergone surgery to have
his penis reconstructed.
DAVID REIMER: Make sure the cow won't move.
NARRATOR: Unaware of the significance his case had had to science,
David had never realised how important it might be to go 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
NARRATOR: In 1998 John Money, now in semi-retirement, published
ten reasons why Brenda's case might have failed. These included the
possibility that the surgical reassignment at 22 months had been
performed late, that having an identical twin brother could have
heightened Brenda's sense of being abnormal, and that the trauma
caused to the parents by the entire event would have adversely affected
Brenda's development. These were problems that Dr Money had never
emphasised before, but for many people it was much simpler. The
gender reassignment of a perfectly normal boy hadn't worked.
MEL 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, in, in, 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: With the most dramatic case of gender reassignment a failure
controversy has also arisen in the field of intersex. Some patients
and doctors had begun to question gender assignment surgery for
intersex cases even before David went public.
WILLIAM REINER: I would recommend to the parents that surgery had
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
NARRATOR: But many surgeons and psychologists believe David's case
has no bearing on intersex…
DAVID REIMER: I'm not done yet.
NARRATOR: …because he was born a normal boy, unlike intersex children
who receive an imbalance of hormones in the womb and their brains
may well reflect this. For many who have to deal with the complex
problems of intersex, the wider body of John Money's work is still
highly valued and he remains respected in the field. Indeed while
the guidelines for treating intersex have evolved continuously since
the 1960s, they have not altered as a result of David's case. Many
experienced surgeons continue to believe that intersex children
do genuinely benefit from gender assignment surgery.
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
NARRATOR: The fact is that neither the case for or against assignment
surgery for intersex is proven. There simply is not enough evidence.
Over the last 40 years because of the sensitivity and complexity
in tracking patients there have not been sufficient long-term follow-up
studies to fully judge the outcome of gender assignment surgery
for intersex. Many doctors who continue to have contact with their
patients say most are happy in their assigned gender, but it will
continue to be difficult to gain independent evidence of this.
PHILIP RANSLEY: The, 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: Whatever it means for intersex, David's case has also
caused the medical community to re-examine another belief. The theory
that we are all born neutral is now being questioned by many.
MEL 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.
Back to 'The Boy Who Was Turned Into A Girl' programme page