- 6/21/2025
A documentary about the Brenda Reimer story and the work of Psychologist John Money.
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00:00In August 1965, in the small Canadian town of Winnipeg, Janet Reimer gave birth to identical
00:19twin boys. When I was a little girl, I used to dream about having twins. And I always
00:27thought I would never be lucky enough to have twins. I wasn't the lucky kind. And I had
00:33twins. Janet called her sons Bruce and Brian. We were so pleased and so proud and we settled
00:45right into our little one-room apartment. But within eight months, events would take
00:53a dramatic turn. The twins began having trouble urinating. To relieve the problem, their doctor
01:03suggested circumcision. On the 27th of April, Janet left her twins at the local hospital
01:13in Winnipeg. Circumcision was a straightforward procedure and she expected to pick up her
01:20boys the next day. But early the following morning, she got a call from the hospital.
01:29When we first heard that there had been an accident, we thought, well, what kind of accident could
01:36there be? We went to the hospital and then the doctor said, the penis has been burnt off from
01:53circumcision. And I could not comprehend what he was talking about because, you see, I thought they were
02:02going to use a knife. Inexplicably, the physician treating her son Bruce had chosen an extremely
02:11unconventional method of circumcision. Bruce's penis had been completely destroyed. The doctors knew of no way
02:21to undo the damage. But one American psychologist by the name of John Money advised the Reimers that they
02:32could best help their son by raising him as a daughter. It was a radical and untried course of treatment.
02:42It was high drama. It was a particularly dramatic case. It looked scientifically, it looked beautiful
02:51because of the fact that there were twins involved. This tragic situation made for a perfect case study.
03:02What does gender mean if one male twin can be raised as a boy while the other male twin becomes a girl?
03:13But no one knew if this experiment would work.
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04:47In a quiet Manitoba suburb, the Reimer family was home, trying to recover from a devastating
04:54accident.
04:57Just ten months earlier, their infant son's penis had been destroyed during circumcision.
05:05In shock, the Reimers shut themselves off from the rest of the world.
05:12With their own doctors bewildered by what to do, they had nowhere to turn.
05:18And we saw this show on TV, we just happened to be watching TV.
05:29On the screen was a young psychologist by the name of John Money, talking about the dramatic
05:35new field of sex change surgery.
05:37Dr. Money was on there and he was very charismatic.
05:45He seemed very highly intelligent and very confident of what he was saying.
05:50And what he was saying was that a boy whose gender was changed could be raised as a girl, that
06:04it was nurture, not nature, that made the child.
06:08This is not in the very strict sense of sex change.
06:12For Janet Reimer, John Money's words offered hope, despite their shocking implications.
06:21I think that she was faced with an extreme situation.
06:28That there were no resources available to her to figure out what would be the best thing
06:33to do.
06:34And so to have a well-known authority say, I have a solution for you, must have been
06:39incredibly tempting.
06:44Within weeks of the television broadcast, Janet Reimer took her infant son to Johns Hopkins
06:49University to meet with John Money.
06:56Once there, she was told by Money's team that Bruce could be made into a girl.
07:05Surgery, it was explained, would transform his body.
07:10And careful reinforcement of his new female identity would transform his mind.
07:16Dr. Money felt that it was going to be helpful to change Bruce into a female because he knew
07:27of the heartbreak and horror Bruce would have to go through, living as a male, when at that
07:37time there was no possibility of enhancement surgery for men.
07:45John Money and the team at Johns Hopkins first developed their controversial ideas in the 1950s.
07:55They did so by studying a group of individuals once associated with sideshows and carnival acts.
08:04Known as hermaphrodites, this remarkable test group offered the researchers a unique
08:10opportunity to study how gender is formed.
08:13I think it's important to understand that John Money here at Johns Hopkins was a pioneer in
08:20this field and one of the very few and probably at the beginning almost the only person exploring
08:25these areas and in trying to understand the conditions and to understand the children and
08:29the adults with these conditions.
08:32Each year, thousands of children are born with genitals that fail to develop normally.
08:37This intersex condition, as it is now called, is more common than cystic fibrosis and Down
08:45syndrome combined.
08:49And the causes are many.
08:55All embryos start life the same.
09:00From six weeks, if the baby is to be a boy, the genes on the Y chromosome cause the fetus
09:06to develop testicles, which then produce the male hormone testosterone.
09:16It's this testosterone that makes the male organs grow.
09:21If, however, something goes wrong with the delicate balance of hormones in the womb, the genitals
09:33can appear ambiguous.
09:38This baby girl was exposed to too much testosterone, causing her genitals to appear masculine.
09:48And infant boys who aren't exposed to enough testosterone because of a genetic defect can be born like
09:53this, with genitals that look almost feminine.
10:00Since these malformed genitals were easy to misidentify, babies like this were often raised as the opposite
10:07sex.
10:10Through his research, John Money came upon many cases of children who'd been born one sex, but
10:16raised by mistake as another.
10:20You find, for example, once in a while, not very often, but you do indeed find, a person
10:26who is chromosomally a female, who has two ovaries inside, a uterus, who with appropriate treatment
10:33could in fact get pregnant and carry a baby.
10:36But that same person is born not with a clitoris, but with a penis.
10:40And I mean a regular type little boy's penis.
10:45Money found girls with external male genitals who were raised as boys.
10:51Astonishingly, they accepted themselves as boys, even though they were genetically female.
10:58Likewise, a genetic male born with a tiny penis could be raised successfully as a girl.
11:09With research results like this, John Money came to believe that gender was susceptible
11:14to change, and that upbringing played a significant role in developing a female or male identity.
11:30The team at Johns Hopkins expanded their theory to include the notion that gender was malleable
11:35in all children, not just intersex children.
11:41And eventually they came to understand there was a critical period during the first two years
11:46of life when this could happen.
11:51The theory that had emerged at Hopkins was that you were really neutral at birth.
11:59You were neither male or female and how your environment determined whether you were a boy or a girl.
12:11To put in a nutshell what, since we're saying at that early time, was that yes, there are
12:17a lot of biological factors to be considered, but when all is said and done, the most important
12:24one is how the individual is reared.
12:26So to make it simplistic, if you put a child in a blue room, it'll become a boy, and if
12:32you put it in a pink room, it'll be a girl.
12:37In the 1950s, this notion of gender neutrality at birth was not a particularly radical idea.
12:46The power of nurture was already well understood, especially among mothers.
12:55Human behavior specialists like Dr. Spock convinced parents that they held the key to their child's
13:00future happiness.
13:04So when John Money suggested that an infant's gender could be changed through upbringing,
13:10people listened and believed.
13:14John Money's ideas dovetailed with a lot of ideas that were being produced in the period.
13:21So in the context of the 1950s, his ideas were not crackers.
13:26They were not insane.
13:28They were pretty good scientific ideas.
13:35Many doctors also embraced John Money's ideas because they offered solutions.
13:43Physicians treating intersex boys could now feel more confident changing them into girls.
13:49It allowed me, as a surgeon, to be able to deal with parents of a child who was a genetic
13:55male but had no penis and feel comfortable in saying, we have a surgical solution because
14:00we have a psychological solution.
14:03And that surgical solution is going to coincide with a psychological solution.
14:07We can rear the child as a female.
14:08We can construct the child as a female.
14:11And your child will grow up and be a successful, happy girl or woman.
14:16Boys born with small or ambiguous genitals were often surgically changed into girls.
14:24In this field, sex assignment as a girl has been deemed necessary if the penis was below
14:31a certain critical size.
14:35The argument was that the penis had to be large enough for a little boy to pee standing
14:40up.
14:43And if it wasn't, then the recommendation was to assign the child as a female, to remove
14:49the penis, fashion a clitoris out of some of the penile material to create an artificial
14:54vagina.
14:58By the mid-1960s, surgeries like this had been performed on intersex infants.
15:06But this procedure had never been attempted on a child born with normal genitalia.
15:13This was not clear to Janet Reimer when she brought her infant son in to meet with John
15:18Money.
15:20I asked him at the time if this had been done before.
15:30And he said, yes, it had been successful.
15:34He did not say it was an experiment.
15:38We're not told that it was the first one.
15:47On July 3rd, 1967, Bruce Reimer had his testicles removed and the beginnings of a vagina surgically
15:56created.
16:00He was almost two years old.
16:04From now on, Bruce would be Brenda.
16:08She would be raised as a girl, treated as a girl, encouraged to behave as a girl.
16:15She would receive psychological support, and at puberty she would be given female hormones.
16:22The plan was that with this combination of treatments, Brenda would grow up not only to
16:26look like a woman, but to think like a woman as well.
16:32In the 1960s, as the idea of nurture's dominance over nature gained popularity, critics began
16:42to emerge.
16:46Among the most vocal was University of Hawaii professor Milton Diamond.
16:52He did not agree that a child's gender could be altered through upbringing.
16:56My immediate reaction to the thesis was it was simplistic.
17:04I thought humans were a lot more complicated than just being a product of their upbringing.
17:10Milton Diamond is a biologist.
17:14He believes that just as animals are born with instincts to behave like males or females,
17:20so are humans.
17:21I saw no reason for humans to be that different.
17:27Certainly we're influenced by our society, certainly we're influenced by our learnings, but our basic
17:33inclinations, our basic framework or predispositions we have, have to come from biology.
17:47During the powerful hormone testosterone, Diamond took part in a series of animal experiments
17:52designed to show the influences of this hormone in the womb.
18:01Pregnant rats were injected with testosterone, which found its way through the umbilical cord
18:06into the baby's bloodstream.
18:15When they were born, the females in the litter had genitalia that looked almost male.
18:24The artificial surge of testosterone had transformed their bodies.
18:30But the big question was, would these masculine-looking females also behave like males?
18:39The answer was yes.
18:42The females who had received the hormone in utero even attempted to mate as if they were male.
18:50It appeared that testosterone had reprogrammed their brains, giving them the instincts and
18:55behavior of males.
18:57So, in other words, here's an intervention during their embryonic life, which affected their
19:08adult life.
19:10So those type of experiments showed, at least for animals, that this was possible.
19:19But what affects animals does not necessarily affect humans.
19:24To prove that testosterone in the womb could also change a child's gender identity, Diamond
19:31would need far more evidence.
19:35So when he attacked John Money's theories, few people listened.
19:41My view was a minority view because the Hopkins group had a great status.
19:47And my ideas were relatively out of the ordinary.
19:59John Money's theories about gender helped determine the treatment of hundreds of infants each year.
20:10John Money's influence in the field for probably 30 years was almost monolithic.
20:20The couple of times that people challenged him in 30 years in print, there were angry letters
20:25from Money responding to the challenge.
20:31In Winnipeg, as Brenda Reimer was growing up, John Money and his ideas continued to play a
20:38big part in her life.
20:42Brenda's mother, Janet, would fill her correspondence with whatever news she thought would please
20:47him.
20:50I wrote him letters regularly.
20:52If there was anything that Brenda was trying to do to please me, then I wrote him about it.
21:00Brenda did this, Brenda did that.
21:05John Money used these letters to promote his views.
21:11By 1972, when Brenda was just six years old, Money believed that he had enough evidence to
21:18announce to the medical community that he had changed a child born a perfectly normal boy
21:24into a perfectly normal girl.
21:30The case was published in textbooks, discussed at conferences, even reported in Time magazine.
21:39It became an international scientific sensation.
21:44It seemed John Money was right.
21:46That nurture could override nature.
21:50That a little boy could be made to think and feel like a girl.
21:55It was the ultimate test of John Money's hypothesis that all of these influences in prenatal life,
22:02sex chromosomes, hormones, conatal development, could be overcome by socialization.
22:13I think it was certainly used as very strong evidence that children are a blank slate, newborns
22:19are a blank slate, and that we can impose a gender identity on a newborn.
22:26The twins case, what we knew about it, really so reinforced Money's hypothesis that it was very hard to challenge.
22:44Here was an unambiguous, true-to-life, et cetera, et cetera, male that was switched to be a true-to-life female.
22:55That made a significant impact on the clinical treatment, and it was like everybody was saying,
23:00oh, wow, really, well, then we can do this.
23:05Surgeons in the 1970s became even more confident that the gender choices they were making for their intersex patients would work.
23:13Any hesitation they might once have had about surgically changing infant boys into girls was now all but gone.
23:26I think that the twins case was tremendously important in solidifying Money's ideas about the treatment of intersex kids.
23:37It was the case that just drove home how correct his ideas were, and it solidified the practice of doing surgery on young infants who had unusual genitalia,
23:52so that it became the only acceptable practice.
23:57The idea of being able to turn a genetic male into a female is a tenet of our training, a dogmatic teaching, and it was one of those that we accepted.
24:08We questioned many others, and none of us seemed to question that.
24:11As John Money's twins case was making headlines, work in a Los Angeles laboratory would soon cast further doubt on the whole idea of gender neutrality at birth.
24:26My interest in research is what's going on in the rat, a species that we can manipulate, a species that we can understand.
24:39Building on the work done in earlier behavioral studies, Roger Gorski and his team set out to see if testosterone actually changed the structure of the brain.
24:51But before he could link behavioral differences with brain anatomy, Gorski first had to see if there were any physical differences between the brains of male and female rats.
25:12Slice by slice, millimeter by millimeter, he compared male and female brains, hoping to spot even the smallest sex difference.
25:26After years of searching, he found nothing.
25:35Then 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.
25:45I had a graduate student in the laboratory, and he announced to the lab group that there was a marked structural sex difference.
25:55The student claimed that the difference in this area of the brain was blatantly obvious.
26:00No one in the laboratory believed him.
26:05And so he arranged for a meeting in a conference room, had two projectors side by side, and one he put a slice of male brain, and another he put a slice of a female brain.
26:23Deep in the center of the brain, in an area known as the hypothalamus, Gorski's student had found what they'd been looking for.
26:33There was this dramatic difference that just jumped out at us.
26:38The male brain on the left had a structure twice as big as the female brain on the right.
26:44None of us believed it until we saw it, and then we couldn't disbelieve it.
26:49This is the actual part of the brain that they isolated in a male rat.
26:54They called it the sexually dimorphic nucleus, or SDN.
26:59And this is what it looks like in the female rat.
27:03Here was physical evidence showing a sex difference between a male and female brain.
27:10When we first discovered the sexually dimorphic nucleus of the rat, I was very much interested in is it sensitive to hormones?
27:28When does it develop? What does it do?
27:32Gorski next wanted to see what could have caused this difference.
27:37Could it be the hormone testosterone?
27:43The team repeated earlier experiments by injecting a pregnant rat with testosterone.
27:48As before, females that were exposed to testosterone in the womb soon began acting like males.
28:04Gorski then examined their brains.
28:09The SDN had indeed been transformed by testosterone.
28:15Each female rat now had the SDN of a male.
28:21This particular area of the brain appears to be totally dependent on the hormone environment.
28:29What this meant was that in rats at least, male and female brains were physically different at the time of birth.
28:38But what did this mean for humans?
28:40There are a lot of difficulties in linking animal studies to human behaviors.
28:46And the biggest really is that there's tremendous variability within the animal world.
28:53The move from rats to primates is very problematic.
28:57You cannot assume that the mechanism that you study in one animal will be identical in a different species.
29:04Even though Roger Gorski could not apply the results from his rat studies to human behavior, he considered it a step in that direction.
29:15Given the fact that the general view in the clinical world was that nurture was by far the more important,
29:22I think our demonstration that hormones played a role, at least in my mind, challenged that view.
29:33Another challenge to the primacy of nurture was beginning to develop inside the Reimer home.
29:40Brenda was having difficulty at school.
29:46As the Reimer family was dealing with her problems,
29:52John Money was publishing yet another book describing the twins as dramatic proof of his theories about gender.
29:58But far away from the textbooks, Brenda's reality was much different.
30:08I 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.
30:20She was very rebellious, she was very masculine, and I could not persuade her to do anything feminine.
30:41Brenda had almost no friends growing up.
30:45Everybody ridiculed her, called her cave woman.
30:56She was a very lonely, lonely girl.
31:07It wasn't long before the local psychiatrist looking after Brenda wrote to John Money about the concerns she had with Brenda's development.
31:16She was showing signs of being deeply disturbed.
31:20Now on estrogen, Brenda began overeating in an effort to conceal her growing breasts.
31:26She even began dressing like a boy.
31:30Problems at school escalated to a point where Brenda, in fear of her own safety, finally had to leave.
31:37In 1979, a BBC series called Open Secret revealed some of the problems Brenda was having adjusting to her life as a young woman.
31:51Claiming the show would violate Brenda's privacy, John Money refused to appear.
31:59Dr. Money was describing the child.
32:01But one of the psychologists treating Brenda in Canada was interviewed.
32:04It was suspicious that she will ever make an adjustment as a woman.
32:09Milton Diamond was interviewed as well.
32:12During that production, it seemed to become clear to the psychiatrists that were treating the kids,
32:18the non-Hopkins psychiatrists, that the child was not developing as presented.
32:23And there was doubt expressed that the child would ever become a successful woman.
32:30Many doctors and scientists continued to believe that the case was a success.
32:36John Money never published anything to suggest that Brenda Reimer had problems adjusting to her female role.
32:44Unfortunately, there were few papers about the twins' case.
32:52It was just the same stuff, re-reported and re-re-re-re-re-reported, as if here is proof.
33:01And we never got more evidence.
33:03All we did was get reiteration of the first original story.
33:07And that's one of the things that convinced me I really want to find out what happened to the kid,
33:15and prove it, see for myself.
33:22As Milton Diamond went in search of new information,
33:25evidence against John Money's theories continued to mount.
33:29In Amsterdam, work was being done to find sex differences in the brains of humans.
33:46It took quite some time to make the leap from Gorski's work into the human brain,
33:53because in the first place you need the right material.
33:56Post-mortem material of human beings without brain disease is very hard to get.
34:07It took five years to collect enough human brains for this research.
34:14Then the painstaking work began.
34:19Just as with the rats,
34:21slice after slice of male human brain was meticulously examined,
34:26and compared to identical slices of female brain.
34:33Ultimately, I think we measured over 100 brain samples.
34:39The difference between male and female brain became gradually apparent.
34:50Professor Swab found what he thought to be evidence of sexual differences in the human brain.
34:57In the slide on the left, a portion of the hypothalamus, which regulates hormones,
35:04is larger in the male than in the female brain on the right.
35:09Could this be evidence that the root of what makes us feel male or female can be traced to the brain?
35:17To answer this question, the team in Amsterdam turned to a unique set of individuals.
35:27Emma Martin is a transsexual.
35:33She was born a genetically normal male,
35:36but she's spent her whole life feeling like a woman.
35:43When I was four years old,
35:46something happened which I guess was the starting point of my realization that I was different from other people.
35:55I was playing in the back garden in my pedal car,
35:59and I suddenly realized that there was a little girl in the garden next door,
36:06basically doing the same thing, just going up and down the garden on a tricycle.
36:10And I saw her through the fence,
36:13and I just realized that they've made a mistake.
36:20And I couldn't understand why my parents were treating me as a boy.
36:26Throughout her life, Emma was never able to accept her male gender,
36:39even though she was raised as a boy.
36:45Transsexuals don't describe themselves as having a female brain.
36:50They describe themselves as being female.
36:53But of course, this strong feeling to be a female should come from somewhere,
37:00and we are certain it's not coming from the heart.
37:03It's coming from the brain.
37:12In the 1990s, Professor Swab's team began to study the brains of transsexuals
37:17to see if there was some structural reason for their particular gender identity.
37:27He focused on the region of the hypothalamus where he had first noticed sex differences between male and female brains.
37:34After years of work, he found what he was looking for.
37:44In a tiny portion of the hypothalamus, the male transsexual brains looked similar to the female brains from his control group.
37:55It seemed clear to Swab that this similarity between male transsexual brains and female brains could prove important in defining gender identity.
38:09I think if we look to the entire set of data, it's clear that we are not born neutral, that there are sex differences present already very early in development.
38:26Swab's work with transsexual brains is controversial, in part because it has not yet been replicated.
38:32But some of his earlier work showing sex differences between the brains of males and females has been confirmed.
38:47But the significance of these findings remains to be seen.
38:53This established sex difference in the brain is an anatomical difference,
38:57and quite frankly no one knows what it means in terms of behavior.
39:04It might well have something to do with the different kinds of physiology involved with the productions of sperm versus the production of eggs.
39:16There's no evidence that it has to do with behavior per se,
39:20which doesn't mean to say there might not be some evidence in the future,
39:23but at the moment no one really knows what that little group of cells does.
39:31With the evidence incomplete,
39:34many in the medical community continued to view the nature-nurture debate
39:39through the lens John Money had provided.
39:42But this wasn't good enough for Milton Diamond.
39:46Distrustful of Money's research,
39:49Diamond was determined to find out the truth about Brenda.
39:54I found it very difficult to get information on the twins' case.
39:59John Money kept saying he couldn't say any more because of privacy involved.
40:05There were no reports coming from anywhere else.
40:08I had tried letter-writing to professionals that I thought that might have someone put,
40:16or putting an ad in professional journals,
40:20and nobody responded.
40:25Ultimately, Milton Diamond's efforts paid off.
40:28After 20 years, he finally tracked down Brenda Reimer.
40:41She was living anonymously in Winnipeg.
40:46And she was ready to speak out.
40:48I didn't like dressing like a girl. I didn't like behaving like a girl. I didn't like acting like a girl.
41:03Brenda Reimer, the boy who was turned into a girl, was living as a man.
41:13Well, I wore dresses on occasion.
41:17And I never played with girl stuff.
41:20I usually get stuck with dolls or something like that for my birthday or Christmas.
41:26And I sat in the corner collecting dust.
41:29Played with my brother's things.
41:31Wasn't too happy about sharing.
41:34Share with my brother or I don't have anything.
41:38For almost 14 years, David had lived as Brenda.
41:44And for most of that time, he had been unhappy.
41:50During the early years, I thought we had made the right choice.
41:53That it would work out.
41:55Dr. Money kept saying it would work out.
41:59And I thought, well, he should know.
42:01But by the time Brenda was a teenager, her life was so difficult, she had become a virtual reckless.
42:13I was so pitifully lonely.
42:15And I tried to put makeup on, but I looked like Bozo the Clown.
42:22You ever can imagine a guy trying to put makeup on himself.
42:28After a while of trying, I just gave up.
42:31I said, well, what's the sense of trying?
42:32No matter how much I put out in effort, it's never going to work.
42:34There's no way of knowing whether you're a boy or a girl, because nobody tells you.
42:42You don't wake up one morning and say, oh, I'm a boy today.
42:46You know.
42:48It's in you.
42:50Nobody has to tell you who you are.
42:54When Brenda was 14, her parents finally revealed her true sex at birth.
42:59Within a few months, Brenda rejected the gender that had been imposed upon her,
43:06and chose to live as a male called David.
43:10That's a coming, that's a coming.
43:13Hey, sweetie, do you want a drink?
43:16You want a drink?
43:18For the last ten years, he has been married, and living with his wife and her three children.
43:24He has undergone surgery to have his penis reconstructed.
43:27I felt very sad about David's story.
43:34His story is very touching.
43:36He was forced to live a life that was not his own, not of his making, not of his choice,
43:43in which he was given few options.
43:46Every time he tried to assert himself, as a youngster, he was thwarted by so-called the two forces,
43:53which are supposed to be most helpful in our lives, our parents and our physicians.
44:00Hi! Paul! Billy! David!
44:04Hi!
44:06Unaware of the interest in his life story, David had never considered speaking out in public.
44:12By me not saying anything, the medical community was under the impression that my case was a success story.
44:26And I was shocked when I heard that people thought that my case was a success story.
44:33It is not known why John Money waited to report the outcome of the twins' case.
44:43To date, he has refused all interviews about the story.
44:49But in 1998, he did publish a list of reasons why Brenda's reassignment might have failed.
44:59He suggested that the surgery at 22 months might have been performed too late.
45:05That having an identical twin brother could have heightened Brenda's sense of being different.
45:10And that the trauma caused to the parents by the entire event adversely affected Brenda's development.
45:19I think that John Money's reasons for why the case might have failed are potentially legitimate reasons.
45:28On the other hand, they clearly are excuses that were offered up years later.
45:34And they take on that look especially because he was not forthcoming with what happened.
45:43Many of us were completely in the dark about, you know, what had happened.
45:47We heard in the early 70s what a success this had been.
45:51Until this denouement, we had really no knowledge of how the twins were doing.
46:01And so this led to major disaffection.
46:05And what was disappointing in all of this, and more than disappointing,
46:11I mean, what hurt a lot of us is that there had been no word that this wasn't working out the way it had been first suggested.
46:21We'd been let down by somebody who we respected.
46:32Despite David Reimer's tragic experience,
46:35John Money's theories still influence the treatment of children born with ambiguous genitalia.
46:43Today, most surgeons would no longer attempt to change the sex of a boy born with normal genitals.
46:51But some boys born with very small or unformed penises are still surgically changed into girls.
46:58Surgeon Philip Ransley is treating one such infant.
47:03This child would have gone through childhood with an extremely tiny phallus, and would have had a very small phallus in adult life.
47:14The psychological burden that he would have carried as a male would have been enormous.
47:21There was no difficulty in this case in everyone agreeing that the appropriate sex of rearing was female and she was gender assigned female.
47:32This normalizing surgery, as it is called, has become such a standard practice that until recently most physicians considered it beyond debate.
47:45The surgeries are performed really because they are part of the still standing views that were established by John Money in the 1950s that the successful emotional and psychological development of these kids depended on their parents being comfortable with how they looked.
48:06And that the kids themselves would be more comfortable if they also had so-called normalized genitalia.
48:13So most of these surgeries were done not because the abnormalities were life threatening, but because it was viewed that they were required for normal psychological development.
48:25We have to perform our surgical tasks with what we believe to be the best interest of that child at heart, and that is what we do.
48:38And we would not undertake surgical intervention if we were not convinced completely that this was the correct course of action.
48:48Despite the best intentions of surgeons like Philip Ransley,
48:52a small percentage of these children do reject their gender assignments later in life.
48:57This has led a growing number of physicians to advocate that surgery be delayed until the children are old enough to decide for themselves.
49:07I would recommend to the parents that surgery has great risks for children with intersex of being the wrong surgery,
49:16and that the children may well reject that surgery at a later time in life because they may choose the gender identity that was not assigned.
49:29Once designed to help the child lead a more normal life, these surgeries are also coming under fire for the physical problems they can cause.
49:41In my opinion, the treatment of intersexual infants has often done a lot of harm.
49:51I don't believe the harm was intended, but I believe that the harm is there.
49:56The genital surgery can cause permanent scarring and damage, which later affects sexual sensitivity.
50:05A lot of the surgeries don't work very well, and they break down later in life,
50:10and so you have the stories of intersexuals who've had surgery after surgery after surgery.
50:16There probably are cases where a child has been helped by surgery, but we don't know them.
50:29The fact is that the medical community has been enormously remiss in not doing long-term follow-up studies.
50:36And as long as those long-term follow-up studies aren't done, then their claim that there are happy customers rings kind of hollow.
50:51The scientific data that we would love to have to tell us whether the decisions we're making in infancy were correct or not, this data does not exist.
51:04Therefore, in this field, medicine has to remain a mixture of science and art.
51:15Forty years ago, John Money helped establish a standard of care that still has influence today.
51:26But now that his most famous case has failed, there is a growing conviction that sex differences are much more inborn than was once believed.
51:37But what the balance is between nature and nurture is still being explored.
51:48In the 21st century, we can say that the theory of gender neutrality was wrong,
51:56that there are important biological factors that play a role.
52:01What the mixture is between environmental and biological factors is going to take us a long time to sort out.
52:14I was never as happy as Brenda. Never.
52:20And I'd slit my throat before I'd go back to that.
52:23But I'd never go back to that.
52:26It didn't work because that's life.
52:34Because you're human.
52:36You're not stupid.
52:37And eventually, you wind up being who you are.
52:41On NOVA's website, hear the story of one intersectional who rejected her female gender assignment at age 32
53:00because so many people mistook her for a man at PBS.org or America Online keyword PBS.
53:07Educators can order this or any other NOVA program for $19.95 plus shipping and handling.
53:20Call WGBH Boston Video at 1-800-255-9424.
53:33Next time on NOVA, NOVA's cameras penetrate Russia's largest nuclear missile base.
53:35Meet the men at the controls and see what they're up against.
53:40Russia's nuclear warriors.
53:53NOVA is a production of WGBH Boston.
54:08Major funding for NOVA is provided by the Park Foundation, dedicated to education and quality television.
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54:53And by the Corporation for Public Broadcasting and by contributions to your PBS station from viewers like you.
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