Can Gender Be “Assigned” At Birth?

A few decades ago, a psychologist by the name of Dr. John Money advanced what has become known as “the theory of gender neutrality.” The basic idea was that with respect to gender, everyone comes into the world as a blank slate. In Money’s own words: “It seems that every child is born with some predisposition to go both ways. Which way it will finally go is determined by its environment." Money had the opportunity to put this theory to the test when he was contacted by a very concerned mother who did not know what to do after her son’s penis was accidentally destroyed during what was supposed to be a routine circumcision.

Money advised the parents to raise their little boy, Bruce, as a girl. On his advice, Bruce was castrated, renamed “Brenda,” and given female sex hormones during adolescence.  Money also recommended that sex reassignment surgery be performed at a later age in order to create a vagina. Dr. Money followed the case for years afterward and personally met with Brenda annually to evaluate her progress. According to Money’s reports published in leading sex journals, Brenda’s transition was a smashing success and the theory of gender neutrality had been supported. However, the facts of the case didn’t quite match up to what Money had claimed.

In reality, Brenda did not see herself as a girl. She did not want to wear dresses and she preferred to play with boys. She felt depressed and confused, had a hard time fitting in, and later became suicidal. As a teenager, Brenda rebelled against the hormone treatments and refused the genital surgery to complete her transition. At that point, her parents came clean and told her the truth about what had happened. Shortly thereafter, Brenda adopted a male gender identity, started calling himself David, and eventually underwent several surgical procedures to become the man he felt he was always supposed to be.

The Brenda/David story is fascinating on multiple levels and there a numerous aspects of it worth discussing (to read more about this case, check out the book As Nature Made Him). However, the main point I want to emphasize in this article is that David’s case tells us that gender is not something that we can simply assign at birth. Not only did David’s doctors and parents try to “teach” him a specific gender, but they also modified his genitals and gave him hormone treatments. Even with all of that, they still could not override David’s feeling that he was supposed to be a man. This tells us that gender identity is likely “wired” in our brains before we are born.

As some additional evidence for this idea, consider that studies of transsexuals’ brains have revealed that certain structures in the hypothalamus (a brain region that controls several aspects of sexual behavior) are not typical for their biological sex.¹ Specifically, the hypothalamus in male-to-female transsexuals looks more like it would in a biological female than a biological male; the hypothalamus in female-to-male transsexuals looks more like it would in a biological male than a biological female. In other words, transsexuals' brains resemble the sex with which they identify, not their genetic sex. Scientists believe that these brain differences are determined by exposure to hormones while developing in the womb.

Findings like these have a number of important implications. For one thing, they tell us that transsexualism has a physiological basis and is not a form of mental illness. Moreover, this research is fundamentally changing the way that physicians and families are dealing with intersexed children (i.e., children who are born with genitals that are not clearly male or female). Traditionally, when an intersexed child was born, doctors and parents would work together to “pick” a gender. Genital-altering surgery would then be performed during infancy in order to make the child’s body a match for their assigned sex.² Why take such drastic measures? They likely stem from the fact that most societies do not accept or accommodate people who do not fit neatly into the either the male or female category. Just think about it--most things in this world are divided into men’s versus women’s (e.g., restrooms, sporting leagues, clothes, etc.). So if you fall in between, where do you fit in?

The problem with trying to select an intersexed child’s gender for them is that numerous cases have been reported where intersexed individuals have switched away from their assigned gender identity later in life. Many of these individuals have also been upset to learn that their genitals were irreversibly altered without their consent and that they never had a chance to decide for themselves what they would like to do with their own bodies. Such cases have led to a growing movement away from trying to force intersexed children to conform to an arbitrary gender both physically and psychologically.³

In short, gender appears to be anything but neutral at birth and we need greater recognition of the fact that a person’s gender identity is not a simple matter of what is between someone’s legs and how society decides to treat them.

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¹Kruijver, F. P. M., Zhou, J. N., Pool, C. W., Hofman, M. A., Gooren, L. J. G., & Swaab, D. F. (2000). Male-to-Female Transsexuals Have Female Neuron Numbers in a Limbic Nucleus. The Journal of Clinical Endocrinology & Metabolism, 85, 2034-2041.

²Bomalaski, M. D. (2005). A practical approach to intersex. Urological Nursing, 25, 11-18.

³Diamond, M., & Sigmundson, H. K. (1997). Management of intersexuality. Guidelines for dealing with persons with ambiguous genitalia. Archives of Pediatric and Adolescent Medicine, 151, 1046-1050.

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Comments

[Scott McGreal]

I read in an issue of Scientific American that many intersexual individuals who had genital surgery early in life to "assign" them to a particular sex (usually female) have not only complained they were assigned the wrong sex, but the surgery left them with permanent scarring that reduced their genital sensitivity. I'm glad there has been a move away from this cruel practice and hope that society will become more accepting of people who don't fit neatly into the binary conceptualisation of gender.

[Dr. Justin J. Lehmiller]

Thanks for mentioning that--you're right that genital-altering surgery may also permanently reduce sensitivity, which is a whole other reason why these surgeries should be delayed until the patient can decide for their self what they want to do. People are slowly but surely starting to realize that forcing a child to undergo unnecessary and experimental surgery for the sole purpose of providing a psychological benefit to the parent is not grounds for going through with the procedure.