The Relevance of David Reimer to Transsexuals
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During the late 20th century, a medical scandal took place, wherein XY males without Disorders of Sexual Development were surgically reassigned female. The most famous of these cases is David Reimer, who was erroneously reported as a "successful" case by John Money, until Milton Diamond and John Colapinto later revealed he had refused to be reassigned female. In the end, Reimer tragically committed suicide. There are harrowing parallels between this scandal and the modern scandal of "transgender children" (child sex changes). However, conservative media has taken it a step further by comparing it to the transition of adults. Does David Reimer prove that transsexuality is a sham?
Nature vs. Nurture: Revisited
To make sense these debates, one must contrast three theories about sex (male or female) and gender (masculine or feminine) when it comes to the sexual differentiation of the brain:
- Conservative: Although they do not believe in "gender", conservatives believe there are differences between masculine and feminine brains. When they say "people only have sex, not gender", they mean that a person's brain is always linked to their biological sex. All XY males have masculine brains and all XX females have feminine brains.
- "Neutrality-at-Birth": People have sex and "gender", but "gender" is not innate. "There is no such thing as male or female brains." A person's brain is undifferentiated at birth, only learning to become "masculine" or "feminine" from social experience. Believed by radical feminists and queer theorists.
- "Neurohormonal Theory": People have sex and "gender", and "gender" is, at least partially, innate. Prenatal hormones influence whether the brain is masculinized or feminized at birth. Most XY males have masculine brains and most XX females have feminine brains, but there are rare cases of mismatch because the fetal brain develops at a different stage from the genitalia.
In his account of the "Origin of Gender Theory", Conservative commentator Matt Walsh decries both of the other theories, describing John Money as a "pioneer" of "gender ideology":
"[John Money] was among the first to take the word gender out of the realm of grammar and apply it to people... Until him, we never said that "people have a gender". People have a sex, and words have gender. But [John Money] said "no no no", people have gender and sex, and he also coined the terms gender role, gender identity, and sexual orientation."
When conservatives say "sex not gender", what they actually mean is "a person's gender is their sex", especially when it comes to sexual differentiation of the brain. This is contrasted with gender critical feminists, who believe gender has no biological basis and is completely learned.
Of the three theories, the Conservative position can be readily debunked. With some notable exceptions, most XY individuals with Complete Androgen Insensitivity Syndrome (CAIS) identify as Female in spite of their male biology. From the Androgen Insensitivity Syndrome Support Group: "The vast majority of our members have a secure female gender identity." This disproves the notion that gender is determined by one's biological sex, especially sex chromosomes.
If the Conservative position is wrong, who is right? Below, I explain why the David Reimer case supports "Neurohormonal Theory" better than Conservative or "Neutrality-at-Birth" theories.
Milton Diamond's Position on Gender Identity
Contrary to Walsh's description, John Money might have popularized the term "gender identity", but the concept of transsexualism ("sexual inversion") had been discussed by sexologists long before his time. During the 20th Century, John Money was the ideological rival of Milton Diamond. Where Money was a "pioneer" of "Neutrality-at-Birth" theory, Diamond was a proponent of "Neurohormonal Theory".
Writing in 1965, Diamond critiqued Money's position like so:
Essentially the theory advocated by Money and the Hampsons holds that gender role—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, and sexual orientation as a male or female—is independent of chromosomal sex, gonadal sex, genital morphology, hormonal balance, or other commonly used indicators of sex (Hamp- son and Hampson, 1961; J. L. Hampson, 1964). In their own words:
. . in place of a theory of instinctive masculinity or femininity which is innate, the evidence of hermaphroditism lends support to a conception that psychologically, sexuality is undifferentiated at birth and that it becomes differentiated as masculine or feminine in the course of the various experiences of growing up (Money, Hampson, and Hampson, 1955b).
Now it becomes necessary to allow that erotic outlook and orientation is an autonomous psychologic phenomenon independent of genes and hormones, and moreover, a permanent and ineradicable one as well (Money, 1961e).
It is more reasonable to suppose simply that, like hermaphrodites, all the human race follow the same pattern, namely, of psychosexual undifferentiation at birth (Money, 1963a).
Thus, in the place of the theory of an innate, constitutional psychologic bisexuality . . . we must substitute a concept of psychologic sexual neutrality in humans at birth (Hampson and Hampson, 1961).
In brief, their theory may be called a psychosexual "neutrality-at-birth" theory, as opposed to a "sexuality-at-birth" theory.
While he rejected "Neutrality-at-Birth" theory, Diamond was not entirely opposed to the role of upbringing in shaping gender. Noting the human capacity for "flexibility" and "adaptability", Diamond (1968) argued that "the effect of the sex of rearing is strong when reinforcing the fetal and developmental endocrine predisposition but meets strong opposition when going counter to it."
By 1972, John Money had modified his view, arguing that prenatal factors ("nature") and postnatal experience ("nurture") both influenced the outcome of a person's "gender". However, he maintained that postnatal experience could override prenatal factors, as argued in Chapter 7 and Chapter 8 of Man & Woman, Boy & Girl. In order to prove this point, Money & Ehrhardt (1972) misrepresented David Reimer's case in both of these chapters.
From Chapter 8 "GENDER IDENTITY DIFFERENTIATION":
Chromosomes, Hormones, and Gender Identity
The foregoing three matched pairs of hermaphrodites, and many others like them, concordant for diagnosis and discordant for gender identity, wreck the assumption that gender identity as male or female is preordained by the sex (XX, or XY) chromosomes. Clearly it is not.
The three pairs also prohibit the assumption that gender identity is automatically preordained by prenatal hormone history...
...The ultimate test of the thesis that gender identity differentiation is not preordained in toto by either sex chromosomes, the prenatal hormone pattern, or the postnatal hormone levels would be undertaken, if one had the same ethical freedom of working in experiments with normal babies as with animals. Since planned experiments are ethically unthinkable, one can only take advantage of unplanned opportunities, such as when a normal boy baby loses his penis in a circumcision accident. We have under long-term study two such children, both reassigned in infancy and given the first stage of surgical reconstruction as females. One of these children is now of school age (see Chapter 7), and her behavior as a little girl is in remarkable contrast to the little-boy behavior of her identical twin brother...
From Chapter 7 "GENDER DIMORPHISM IN ASSIGNMENT AND REARING":
Rearing of a Sex-Reassigned Normal Male Infant After Traumatic Loss of the Penis
The extreme unusualness of this case of sex reassignment in infancy lies in the fact that the child was born a normal male and an identical twin, without genital malformation or sexual ambiguity. The idea of sex-reassignment would never have been entertained were it not for a surgical mishap at the age of seven months in which the penis was ablated flush with the abdominal wall. The mishap occurred when a circumcision was being performed by means of electrocautery. The electrical current was too powerful and burned the entire tissue of the penis which necrosed and sloughed off...
During the follow-up time of nearly six years since surgery, the parents have kept in close contact with us, making visits on an annual basis to get psychological support and guidance. The mother's observations and reports have provided us with an insight into changes in her rearing practices towards the sex-reassigned child, and into the different way that she rears this child as compared with the twin brother.
The first items of change were clothes and hairdo. The mother reported: "I started dressing her not in dresses but, you know, in little pink slacks and frilly blouses . . . and letting her hair grow." A year and six months later, the mother wrote that she had made a special effort at keeping her girl in dresses, almost exclusively, changing any item of clothes into something that was clearly feminine. "I even made all her nightwear into granny gowns and she wears bracelets and hair ribbons." The effects of emphasizing feminine clothing became clearly noticeable in the girl's attitude towards clothes and hairdo another year later, when she was observed to have a clear preference for dresses over slacks and to take pride in her long hair.
Related to being dressed nicely is the sense of neatness. The mother stated that her daughter by four and a half years of age was much neater than her brother, and in contrast with him, disliked to be dirty: "She likes for me to wipe her face. She doesn't like to be dirty, and yet my son is quite different. I can't wash his face for anything. . . . She seems to be daintier. Maybe it's because I encourage it." Elsewhere in this same recorded interview, the mother said: "One thing that really amazes me is that she is so feminine. I've never seen a little girl so neat and tidy as she can be when she wants to be. . . . She is very proud of herself, when she puts on a new dress, or I set her hair. She just loves to have her hair set; she could sit under the drier all day long to have her hair set. She just loves it."...
Regarding domestic activities, such as work in the kitchen and house traditionally seen as part of the female's role, the mother reported that her daughter copies her in trying to help her tidying and cleaning up the kitchen, while the boy could not care less about it. She encourages her daughter when she helps her in the housework.
Rehearsal of future roles can also be seen in girls' and boys' toy preferences. The girl in this case wanted and received for Christmas dolls, a doll house, and a doll carriage, clearly related to the maternal aspect of the female adult role, while the boy wanted and obtained a garage with cars and gas pumps and tools, part of the rehearsal of the male role. His father, like many men, was very interested in cars and mechanical activities...
Milton Diamond (1997) later exposed the truth about David Reimer, dispelling Money's postulate that "Individuals are psychosexually neutral at birth":
Mother recalls: As soon as he had the surgery, the doctor said I should now start treating him as a girl, doing girl things and putting him in girl's clothes. But that was a disaster. I put this beautiful little dress on him, … and he [immediately tried] to rip it off… I think he knew it was a dress and that it was for girls and he wasn't a girl.
On the other hand, Joan could act quite feminine when she wanted to, and was reported as doing so, e.g. mother was quoted to have said: One thing that really amazes me is that she is so feminine. I've never seen a little girl so neat and tidy as she can be when she wants to be… (pp. 119).11 However, she most often, would prefer to reject such behavior. It was also more common that she, much more than the twin brother, would mimic Father. One incident Mother related was typical: When the twins were about 4 or 5 they were watching their parents. Father was shaving and Mother applying makeup. Joan applied shaving cream and pretended to shave. When Joan was corrected and told to put on lipstick and makeup like Mother, Joan said: No, I don't want no makeup, I want to shave.
Girl's toys, clothes and activities were repeatedly proffered to Joan and most often rejected. Throughout childhood Joan preferred boy's activities and games to those of girl's; she had little interest in dolls, sewing or girl's activities. Ignoring the toys she was given, she would play with her brother's toys. She preferred to tinker with gadgets and tools and dress up in men's clothing; take things apart to see what makes them tick. She was regarded as a tomboy with an interest in playing soldier. Joan did not shun rough and tumble sports nor avoid fights.
Diamond & Sigmundson (1997) go on to describe how David Reimer ("Joan") realized he was not a girl between ages 9 and 11, that he rebelled against feminizing hormone treatments between ages 12 and 14, and that he "as much as possible, refused to live as a girl" by age 14. The complete text of Diamond & Sigmundson's (1997) report is an important read for anyone interested in reviewing the history of the David Reimer case.
John Colapinto (2012) summarized Diamond's findings, like so:
Written over the winter of 1994, the paper cast David’s life as living proof of precisely the opposite of what Money had said it proved. Citing the Kansas team’s classic work from the late 1950s, Diamond wrote that David’s case was evidence that gender identity and sexual orientation are largely inborn, a result of prenatal hormone exposure and other genetic influences on the brain and nervous system, which set limits to the degree of cross-gender flexibility that any person can comfortably display. Diamond argued that while nurture may play a role in helping to shape a person’s expressed degree of masculinity or femininity, nature is by far the stronger of the two forces in the formation of a person’s private inner sense of self as man or woman, boy or girl.
In fact, Diamond is one of a number of researchers to liken transsexuality to "brain-restricted intersexuality"(Diamond, 2016), with his research on transsexual twins affirming his belief in "Neurohormonal Theory": "The responses of our twins relative to their rearing, along with our findings regarding some of their experiences during childhood and adolescence show their identity was much more influenced by their genetics than their rearing." (Diamond, 2013)
Unfortunately, Diamond (2016) doesn't do the most thorough job in reviewing the research on transsexual brains. A more careful review of the literature suggests that "Neurohormonal Theory" could be correct, but only for Homosexual Transsexuals.
William G. Reiner's Position on Gender Identity
In "Thoughts on the nature of identity: How disorders of sex development inform clinical research about gender identity disorders", Reiner (2012) challenges Diane Ehrensaft's "Neutrality-at-Birth" approach, stating that:
Denying a dichotomy of gender the author [Diane Ehrensaft] affirms a belief in a wide range of gender identities (is it infinite?). Looking at the dichotomous conception of male and female with its nearly universal acceptance for at least thousands of years (as long as we have written records), this view would seem a bit suspect. Indeed, whenever a clinician or researcher has been deeply influenced by the work of any single theorist (here, D. W. Winnicott), especially without providing high levels of evidence, one must worry about perspective and bias.
Ehrensaft indeed firmly admits a bias that is in contrast to the other clinics. But a vision of reframing an individual’s identity in a celebration of one aspect of identity, albeit an important aspect, as the embodiment of the sense of self—and it is an almost singularity of identity that comes across as being celebrated, in her article—seems in sharp contrast to the empirical, theoretical, and philosophical views discussed by the other authors. Each of us is different, of course. Still, we recognize multiple crucial variations to our own individual humanness. There is insufficient space here—or need, for that matter—to discuss those things that make us, peculiarly enough, human and diverse. But we recognize ourselves as male or female. (Do the children themselves not state that they want to be the other sex? Do they claim an undefined gender, or rather do they claim a male or female gender?). Finally, the author’s dividing of the brain from the mind from the psyche is at least a break from “dualism”—but certainly not a theoretical or clinical advance.
In contrast with Milton Diamond, Reiner (2012) notes the dissimilarities between intersexuality and transsexuality. Although he describes the brains of XX Gender Dysphoria patients as "Atypical (more male typical)", he hesitates to liken them to XY males with Disorders of Sexual Development. In addition to elevated prenatal androgens, Reiner (2012) notes that "presence of a Y chromosome may be important" for brain virilization. Reiner (2012) concludes by stating that "children with gender dysphoria and those with DSD experience wildly different early life experiences", noting that autism is associated with Gender Dysphoria.
The source of Reiner's disagreement with Diamond might be due to the fact that "Gender Dysphoria is not one thing." There is mounting evidence that Homosexual (Early Onset) Transsexuals follow a different etiology from Late Onset Transsexuals, where the former can arguably be compared to intersexuality while the latter cannot. It is possible that Diamond and Reiner both erred in failing to notice the differences between Early Onset and Late Onset Transsexualism.
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