The Riddle of Gender Read online

  Q: The gender rules were looser for girls?”

  Only up to a certain age, though. At that point it did begin to become quite difficult. I can remember that I wanted to be in the Cub Scouts so bad, and Boy Scouts. Instead I was in the Brownies, and I hated that. We were baking cookies, and I wanted to go camping. I wanted to take shop and auto mechanics. There are a lot of girls who might want to do that stuff, too. I can remember feeling strongly about it and really being distressed, particularly when some of the guys were allowed to take cooking classes. But I’ve always been the kind of person who has had a lot of interests and can keep myself busy, so I just decided to be by myself rather than playing with my sister’s friends or the other girls. I was kind of ostracized growing up. I was never in the “in” group. I was always sort of socially rejected. Because I was different. I really was sort of like that boy in a dress, or something.

  I was remembering just the other day something that happened in grade school, or maybe it was in junior high. I remember the Girl Scout leader yelling at me, saying, “Why do you always have to be different, Barbara? Why do you always have to be different?” And she was absolutely at her wits’ end. And I remember being shocked by this because I was always the good kid. You know, I always got good grades and I never got in trouble. I wasn’t trying to cause any trouble. And I remember being shocked because obviously I had, without even trying, really pissed this teacher off. And then I remember, because she shocked me so much, I started thinking about it and kind of said to myself, “You know, I guess I am doing something kind of different than the other girls.” Well, I didn’t want to do what they were doing. That was boring.

  So that was what it was like growing up, but then you reach puberty. That got really weird, you know, because then you start to get breasts. I really didn’t want them, and they just seemed like foreign objects. I wore really loose T-shirts just like I’m doing now so that they wouldn’t show. I never did the binding thing, I think because I wasn’t that big-chested, and maybe if I had been I would have. Another thing that I noticed in puberty was my incredible discomfort about wearing dresses. I wanted to wear guys’ clothes. Ever since I could choose my own clothes, I would always wear jeans and shorts.

  The only way to explain it is that I felt very uncomfortable and I didn’t understand why. Like when it came time to shave my legs. I didn’t want to do that. I felt like a naked chicken or something. And makeup: there was just no way I was going to put on makeup. And jewelry. I was constantly being given jewelry as gifts and being encouraged to, you know, do my hair, but of course I always had my hair cut short. In puberty, it really started to get very weird. I could never dance because that would mean behaving female, and there was no way that I was going to do that. Dating, wearing dresses—guys never asked me out anyway because I think that I was very masculine in my behavior. But, overall, I guess that I had this feeling of just being wrong in my body. I just started to feel very uncomfortable and in fact became uncomfortable for the rest of my life because you have to wear dresses. If you are a doctor, you have to wear a dress to go to the clinic. You have to wear a dress to funerals and weddings. Having to go to my sister’s wedding and wear this flowery dress. These are amongst the big traumatic experiences of my life!

  And that sort of discomfort (because I’ve only changed my sex over the past few years) has characterized most of my life. Just this very, very uncomfortable feeling about being female—every aspect of it. But I didn’t understand it and I was always very confused about it. When I went to college, I was diagnosed with mullerian agenesis.

  They realized that I didn’t have a vagina or uterus. I remember the doctors going up and looking for testicles that were undescended, checking my karyotype. They never told me the results of the kary-otype, so I just assumed that it was normal. I remember talking to these doctors and they were saying that they were going to construct an artificial vagina, and I never had any say in the matter. They never asked me if I wanted it. I remember thinking, “God, I’m just an interesting case to them.” They would come in and they would go out, but they would never ask me how I felt. And I had feelings! I felt very confused about the whole thing, like why are they going to do this, and I really don’t feel female, and I didn’t think that I particularly wanted a vagina. But on the other hand, I was a girl and I should have a vagina. It didn’t seem like there was any choice really. And I had a boyfriend at the time—I’m attracted to men, by the way, weakly, not strongly—so I thought if I’m going to have sex with him, I guess that I should have a vagina. But I never really had an interest in vaginal sex. But they did it anyway.

  And then I remember when I was in medical school learning about testicular feminization [the discarded name for androgen insensitivity syndrome, a condition in which the lack of cellular receptors for testosterone and dihydrotestosterone creates a female-body morphology even though the person is of XY chromosomal sex], and that seemed to me to be the thing that explained it all when I learned it in class. I still remember that day etched vividly in my mind. It just explained it. I thought, “Okay, I’ve always felt like a guy, and I just have testicular feminization and they just didn’t tell me.” I remember going through the literature when I was in medical school and trying to understand. I assumed that the reason I felt so different about myself was the mullerian agenesis. That’s an aspect that a lot of transsexuals don’t have—they don’t have this physical problem. But for me it was a confounding thing, and a confusing thing. I think it kept me from realizing my transsexuality for a long time. I thought that everything was somehow related to that.

  I also knew that my mother had been treated during her pregnancy with an androgen-like drug—not DES, one of the androgenic proges-terones. My sister asked the doctor who treated my mother with this hormone many years ago (he’s long dead now) and she was told that it was definitely not DES, but rather an “androgenic progesterone.” I was never told the exact name. Anyway, I’ve always assumed that my gender variance was due to that drug, and that’s what caused this reproductive defect. But then in fact if you look at the [scientific] literature, there really isn’t a correlation between androgen exposure and mullerian agenesis; there is no evidence that mullerian agenesis is caused by hormonal anomalies. And in addition, women who have mullerian agenesis feel like women. They don’t have this gender disturbance. And again I found that very confusing.

  So, I just thought, “Well, there hasn’t been a lot of research, and what do they know anyway?” It was really only after I moved to the Bay Area and read a newspaper article about James Green [a well-known Bay Area transman and activist] that I realized that there was anyone else out there like me. I had never really talked to anybody. I just felt kind of ashamed of it.

  Q: Yet you grew up in a time when there was extensive media coverage of celebrity transsexuals like Chris Jorgensen and Rene e Richards. You didn’t make the connection?

  No, I never did. Partly because while I was in high school, college, and medical school, I never read the newspaper. I never watched TV. I was very intense about my studies. I knew a lot about science, but I didn’t know a lot about other stuff. I was a typical science geek, and I really had no other interests. It wasn’t until I came here [to Stanford] that I started reading the newspaper. I was just very driven. I worked seven days a week, fifteen-hour days, right through training. So I didn’t hear a lot about those people.

  Then after two years of being here, I got breast cancer, which runs in my family. My mother died of it when she was my age. So when I had breast cancer I remember going to have the surgery, and even though they had picked it up early and it hadn’t spread, I begged my doctor to do a bilateral mastectomy, even though only one breast needed to come off. I said to him, “You know my mother died of this. I think it’s genetic and I think it would be best to do it [the double mastectomy] as prophylaxis.” This was before the [BRCA] gene test was available. It turns out that a couple of years afterward, I did have the gene test and I did
test positive. Anyway, I finally did manage to convince him to cut it off, over a lot of objections. This was one of the things that made me feel very comfortable about the gender change later because I remember leaving that doctor’s office feeling like this was the best thing that had ever happened to me. And I remembered that when my mother went through it, she just had one breast cut off, and it was so traumatic for her. So incredibly traumatic. And I experienced nothing like that. I was happy to have them cut off. I was relieved. “Relief” is a really good word to describe it.

  But at this hospital where I had my surgery, they also did sex changes, and I remember one of the nurses talking about this person who’d changed from male to female, and I remember thinking, “Man, what a pervert. How weird.” I think I had the same reaction that everybody else had: “What a bunch of weirdos.” And I never related that to me. I don’t know what that’s about. Here I am, a doctor. I’ve been confused about my gender my whole life, but I didn’t—maybe it’s some form of denial—but I still find it fantastic that I didn’t make the connection. And then you read this article, and it’s like in your face. It was so moving. It was like everything he said was the story of my life. And in the article it mentioned this clinic right down the street and how you need to get this evaluation. So I just contacted them, filled it out, and the next thing you know they were seeing me and saying, “You are a classic case. Would you like to change your sex?”

  It was all done very quickly. There was a period of a few weeks where I was pretty stressed because I was thinking, “Do I really want to do this?” And you know, a lot of transsexuals, when they change their sex, they move somewhere and change their entire identity. But I am internationally known, and my whole career rests on my not changing my last name at least. So that was rough, wondering if I would lose my career, lose my job, wondering whether students would still come to my lab. So I thought about it a lot. And I actually talked to some senior people here about what I was thinking about doing, and when they said that they didn’t think that it would hurt my career, that made me feel good.

  I really felt by that point that life had been so hard on me—I never feel like I really do a good job of explaining what it was like, but I didn’t sleep a lot of nights, I was suicidal, life was so uncomfortable. Don’t get me wrong, I’ve really enjoyed my life, but somehow it’s like it was split into two parts. The personal part, which has been very uncomfortable, and the professional part that’s been a pleasure, that I’ve really enjoyed. But the personal part was just so uncomfortable that sometimes you think, “I’ve had enough.” It’s that distressing.

  So, at the time I went to the clinic, I just felt like it was either this or suicide. I didn’t see any other alternatives. And it all happened very quickly. Within a few months of being seen, I was on hormones and then within a few months after that, I had my ovaries taken out—which was actually prophylactic surgery for the genetic mutation that I had, although female-to-male transsexuals really should have their ovaries taken out anyway. Then when I came back to work after the oophorec-tomy, I had begun shaving, and I sent a letter out to a few people in the department letting them know that I was changing my sex. It’s amazing how when you are well known, how quickly rumors get around. Really, within a day or two after sending out that letter, everybody around the world knew. Especially with e-mail, you can imagine how quickly the news spread, and of course there was a lot of talk, but after a couple of months it died down. Everyone here at Stanford has been fantastically supportive, from students, my faculty here, the deans.

  Q: Your first scientific meeting after transition must’ve been interesting.

  Some people made funny comments about it, but most people just didn’t say anything. I’m sure they were shocked. The hardest thing is pronouns. It’s very hard for people to switch. Most of them are very good about that, but every once in a while they’ll slip, particularly if they’ve had any alcohol. I have trouble with it myself sometimes. I was just interviewing a young female-to-male transsexual who lost her job when she … he announced that he was changing sex and came to talk to me about the possibility of a job here, and throughout the whole interview I kept calling him “her.” Once I know, even I do it. And I had to keep checking myself. I don’t care if someone accidentally calls me “she.” I care if they do it systematically and as a form of harassment. Fortunately, that hasn’t happened to me.

  I feel like I had this gender issue, I dealt with it, and it’s resolved. The most important thing is that I’ve been happy. I’ve been so much happier. I enjoy life now.

  Q: It seems like FTMs in general choose to transition and then get on with their lives. They don’t seem so interested in activism, in being out and politically active as MTFs.

  Well, I’m out. I don’t hide it. Hiding is why people are so ignorant about transsexuality. That’s why it took me so long to figure it out. But I think that males to females are so much more defensive in how they deal with it afterward. It seems to me that not that many males to females remain in the same job that they were in before they changed. For example, a geology professor here at Stanford changed male to female, and she totally changed her research. She does gender studies now. She had a much rougher time [than I]. She had a very difficult time. I think that the medical school is a more accepting environment because we are biologists, familiar with biological variation. Geology is much more of a macho, male-dominated field.

  Q: What do you think about gender? Is it in the body or the mind? Is it biological or is it social?

  I think that there is something bimodal about gender. Biologically bimodal because it’s important for evolution and all species have it. Males and females are designed differently, and it’s all under the influence of hormone-driven programs, and if you look at behavior, male and female behavior is different, and I don’t think that’s all social. In fact, some of the best evidence for that comes from transsexuals. If you look at female-to-male transsexuals and results of their spatial tests before and after testosterone—and hundreds of studies have shown, and everyone agrees, that males and females differ in certain verbal and spatial tests—what’s cool about transsexuals is that they are their own control; you can do before-and-after tests. They have the same genes; the only thing that’s different is the hormones—and you find that female-to-male transsexuals become more malelike in their spatial abilities after testosterone. So there clearly are some gender-specific things that are controlled by hormones.

  So it’s a very bimodal thing, but of course in any spectrum there’s going to be something in between. I just think that’s biology; it’s just the way we are. I would think that a lot of transsexuals feel this way because otherwise why do they feel so strongly from the time they are born that there’s something wrong? Why can’t they just get used to the way they are? That doesn’t come from the way society treated me. That comes from deep within. It comes from within. That’s my own personal view.

  Two

  THROUGH SCIENCE TO JUSTICE

  Plato was acquainted with persons on the borderline of both emotional worlds, that of man and that of women. “Mixed beings” they are called. But here in my sickly body dwelt two beings, separate from each other, unrelated to each other, hostile to each other, although they had compassion on each other, as they knew that this body had room for only one of them. One of these two beings had to disappear, or else both had to perish.

  LILI ELBE (NEE EINAR WEGENER), BERLIN, 1930

  Western science first took notice of cross-gendered people and tried to provide some kind of therapeutic assistance for those who sought it in the first decades of the twentieth century. Much of this work was carried out in Berlin, at the Institut für Sexualwissenschaft (Institute for Sexual Science), founded in 1919 by the pioneering physician and activist Magnus Hirschfeld. Housed in a beautiful old building in the heart of Berlin once owned by the violinist Joseph Joachim, the institute served as a doctor’s office for Hirschfeld and his colleagues, research facility, libr
ary, museum, and lecture hall. Hirschfeld and his staff studied a wide range of sexual behaviors and treated a broad array of clients, acquiring data on the gender identities and sexual practices of more than ten thousand men and women through a tool that Hirschfeld termed a “psychobiological questionnaire.”

  Few people today recognize Hirschfeld’s name, and yet he was one of the most famous scientists in the world during the 1920s. Hirschfeld was the most prominent public figure in the first generation of sexologists, biological and social scientists who approached the study of human sexual behavior as a serious scholarly endeavor, best suited to interdisciplinary study. Hirschfeld was born in 1868. Early in his career as a physician he was drawn to the subjects that would become his life’s work. Stirred by the international furor over the trial of Oscar Wilde in England, Hirschfeld published a thirty-four-page monograph titled Sappho und Socrates, in which he asked, “How can one explain the love of men and women for people of their own sex?” In 1897 Hirschfeld founded the Scientific Humanitarian Committee, a group of scientists and activists who would work tirelessly for the next thirty years for the repeal of Paragraph 175, a German law criminalizing sexual acts between men. The motto of the committee was “through science to justice.”

  In Hirschfeld’s Berlin, two crucial strands of modernity met and mingled. Berlin was a great scientific center in an era when Germany led the world in research, and it was also a place where gay and trans people were visible and in some respects tolerated. At the center of this coupling stood Hirschfeld, a gay man and a scientist, who existed comfortably in both worlds and brought them together in his work. The city of Berlin, “a strange million-headed city like a cuirass,” in the words of Hirschfeld’s patient Einar Wegener, was the womb that nurtured the budding sexologist. “Berlin, in Hirschfeld’s time, changed from a quiet, almost rural Prussian town into the large German capital and hectic metropolis,” writes Erwin J. Haeberle, in The Birth of Sexology, describing the environment that incubated the study of human sexual behavior. Haeberle notes that Hirschfeld and his contemporaries “lived through the most extraordinary scientific upheavals, technological innovations, cultural breakthroughs, social upheavals and political changes,” as Berlin was transformed from the city of Bismarck and Kaiser Wilhelm’s imperial residence to the heart of Weimar culture. “All of this had its impact on our pioneers,” Haeberle says. “It constituted the climate in which sexology was conceived and could grow.”