Free As Nature Made Him by John Colapinto Page A

conversion to girlhood.
    The main procedure was a bilateral orchidectomy—removal of both testicles. As Jones’s operating room notes reveal, the baby, under general anesthesia, was placed on his back on the operating table, each foot secured in a stirrup so that the groin was exposed for the doctors. Three clamps were placed on the scrotum, and two incision lines were drawn on either side of the midline. With a pair of scissors, Dr. Jones cut away the demarcated scrotal flesh in a strip 1.5 centimeters long to lay bare the testicles and seminal vesicles within. With a scalpel, Jones cut away both the right and left testicles, then used a length of catgut thread to tie off the cord and vessels that in adulthood would have carried sperm to the severed urethra.
    In closing the scrotum, Dr. Jones then fashioned a rudimentary exterior vagina using the remaining scrotal skin, which he pulled up from its lower edge to meet the top edge of the incision and sewed in a manner that left the scrotum not as a single empty sack, but as two symmetrical flaps. “A rolled piece of gauze covered with telfa was then placed in the midline to effect a midline furrow leaving constructed labia majora on either side,” Jones’s operating room note concludes.
    Ron and Janet say that by the time they decided to have their baby undergo clinical castration, they had eradicated any doubts they might have had about the efficacy of the treatment. This was a crucial turnabout since according to Dr. Money it was a “vital consideration” that the parents of a sex-reassigned child harbor no doubts that could weaken the child’s identification as a girl and woman.
    Whether Dr. Money himself was able to eradicate his own doubts about the child’s future development is debatable. In a letter he wrote on 28 August 1967, more than a month after Brenda’s sex change surgery, his tone admitted of considerable caution regarding the child’s prognosis. This was perhaps to be expected, since the letter was addressed to the Winnipeg lawyer whom Ron and Janet had hired to sue St. Boniface Hospital and the doctor who had botched the circumcision.
    “The reassignment of a baby’s sex is usually undertaken only in cases of a birth defect of the genitalia,” Money wrote. “Then one usually expects that the child’s psychosexual differentiation will be congruous with the sex of rearing. In any given case, however, it is not possible to make an absolute prediction.”
    And indeed, by the summer of 1967, when Bruce Reimer underwent his castration, Dr. Money had special reason to be particularly reluctant to make an “absolute prediction” about the patient’s future psychosexual development. Two years earlier he had undertaken to discover if the findings of the Kansas team about the masculinizing effects on behavior of prenatal testosterone in guinea pigs could be observed in humans. Under Money’s direction, one of his graduate students, Anke Ehrhardt, had studied a group of ten girls, ranging in age from three to fourteen, who had been subjected to excesses of testosterone in the womb when their pregnant mothers had taken a synthetic steroid called progestin to prevent threatened miscarriage. Like the guinea pigs in the Kansas team’s study, nine of the ten girls had been born with masculinized genitals—an oversized clitoris and in some cases partially fused labia. As interviews with the children and their parents revealed, all nine of those girls demonstrated what Money and Ehrhardt called (in an article published six months before Bruce Reimer’s castration) “tomboyishness.” This, the authors explained, included marked preferences for “masculine-derived” clothes and “outdoor pursuits,” a “strong interest in boys’ toys” (these included guns and toy soldiers), a “high incidence of interest and participation in muscular exercise and recreation,” and a “minimal concern for feminine frills, doll play, baby care, and household