The Riddle of Gender

my depression and a clinical trial with 1,400 patients showing that a placebo is just as effective as the herb 90 percent of the time. Most scientists greatly mistrust anecdotal evidence. Until anecdotal evidence is rigorously challenged by laboratory experiment or in a large clinical trial, it remains closer to myth than to fact. The puzzling thing about the intersex research that John Money and the Hampsons conducted in the 1950s is that anecdotal evidence based on a relatively small sample was quickly accepted and assimilated by physicians despite the paucity of hard data supporting their sweeping assertions. As Ben Barres asks, “How could so many physicians, intelligent physicians, base so much treatment on one case study?”

By way of contrast, Paul McHugh points to research being conducted today by William G. Reiner, a pediatric urologist who advises a reexamination of the practice of sex reassignment of intersexual children. Reiner, says McHugh, is “a wonderful pediatric urologist and he’s catching a lot of heat from people within the medical profession who have these very strong feelings about what should be done and why. But all he’s trying to do is collect data, and that’s what should have been done years and years ago.” In a 1999 paper, Reiner indicates that his data show “that with time and age, children may well know what their gender is, regardless of any and all information and child-rearing to the contrary. They seem to be quite capable of telling us who they are, and we can observe how they act and function even before they tell us.”

“This guy is terrific,” says Ben Barres. “He’s getting some papers in the journals. He feels very strongly, based on his research, that to operate on intersexual people before they can tell you is a tremendous mistake. And this is based on hard data.” Regretting that research like Reiner’s was not being conducted forty years ago, when the neonatal intersex protocol was being developed, Paul McHugh says that “maybe if all that kind of data had been collected, we would have known better. We would have our feet more firmly on the ground.”

Scientific hindsight is, of course, not very comforting to intersexual people who have suffered a lifetime of physical and emotional pain as a result of the recommendations that began flowing from Johns Hopkins in the fifties. However, in one of those painful paradoxes that often characterize biomedical research, the same theory that created agony for the intersexual has helped make surgical and hormonal treatment for transsexual people more accessible. Although the surgical reconstruction of the anomalous genitals of intersexual children was becoming standard practice in 1965, the sex reassignment of genitally normal adults was still taboo. Christine Jorgensen was not the only American who sought what was then called “sex-change” surgery in the fifties and sixties—far from it. As previously noted, Harry Benjamin alone saw more than 1,500 patients from 1953 until his retirement in 1978; no doubt thousands more were unable to find the help they sought, or were inhibited by shame from seeking help at all. Well-informed, well-connected, affluent people were able to travel overseas for medical assistance, but many who sought counseling, hormones, or surgery in the United States were turned away or, worse, subject to various forms of “aversion therapy.” My Unique Change by Hedy Jo Star, published in 1965, attests to the enormous difficulties and challenges faced by transsexual people in this era, and testifies to the great strength of will and determination that were necessary to pursue a “sex change.”

Like Christine Jorgensen and Aleshia Brevard, Hedy Jo Star, born Carl Hammonds in 1920, felt like a girl from a young age—but in Star’s case these feelings were reinforced by physical changes at puberty, including gynecomastia, or breast development. “Besides the rounding out of my hips and the slenderness of my legs (when I got into a gym uniform the boys would whistle and say, ‘Ain’t she sweet’), I noticed that my breasts were filling out. At first this didn’t surprise me, because I assumed that this happened to everyone. But when I saw that this didn’t happen to other boys, I was convinced that I was different from them physically as well as emotionally,” Star writes.

The teenager’s budding breasts were noticed by his mother, who took her child to a number of doctors, including a “brain specialist” who suggested “an exploratory operation to see if I had female sexual organs.” Though Mrs. Hammonds refused to consent to the surgery for fear of complications, the response of the physicians “proved to my mother that beyond a doubt I was half-man and half-woman,” Hedy Jo Star writes in her autobiography. “They proved her suspicions that my ‘sissiness’ was really inborn femininity.” The doctor’s prognosis was discouraging to Mrs. Hammonds, though she concealed this fact from her child. Years later, Mrs. Hammonds confessed to Star that “a couple of the doctors who examined me said that I would probably not live past thirty-five because of my dual sexual nature. One doctor told her that even if I did live a normal life span, I would probably go insane.”

Instead, Carl Hammonds ran away at seventeen to join a carnival freak show. Dragged back home by his disgusted father, the unhappy teen ran away again and found work as an exotic dancer in carnivals. Living and working as a woman, Hammonds took the name Hedy Jo Star, and by age twenty-four she owned and performed in a traveling burlesque show called The French Follies. “The first couple of years on the road I worked harder than I had ever done before. I painted the scenery for the show, created the dances, trained the girls, made their costumes, and even was the show’s barker,” Star writes in her autobiography. “By the end of two years the show had earned enough money so that I owned my own tent, costumes, scenery, truck, car and a house trailer. I was proud of my achievement.” Despite her business success, Star had one overwhelming problem. She might look like a woman and feel like a woman, but she was not a woman beneath her g-string. Despite her great legs, her rounded hips, and the small breasts that she enhanced with falsies onstage, Star had the genitals of a man—and those genitals were a source of torment to the dancer and to the men who fell in love with her. When it came time to reveal her secret to various lovers, Hedy Jo began the difficult conversation by telling them that she was a “morphidite”—a hermaphrodite or inter-sexual person—before revealing the truth: that she had a penis, but no vagina. Star’s anatomy failed to intimidate her great love, a fellow carny named Red, and the two lived together for over six years. But eventually the relationship began to fall apart, and Hedy Jo placed the blame on her genitals. “Red was a normal man with a normal sexual desire, and I was a physically abnormal woman with emotionally normal wants. I had the sex organs of a man but the sexual feelings of a woman. I knew I could never be fulfilled the way I was, nor could I possibly fulfill a man sexually. If I was ever to be happy, I had to be a woman completely.”

In 1956 Star traveled to New York to see a female endocrinologist, who performed physical and hormone tests that led the physician to conclude that despite her male genitalia, Hedy Jo Star was female— and to recommend sex-change surgery. The physician, whose name Star does not reveal in her autobiography, brought in a number of other specialists (also unnamed) to examine her unhappy patient. “My face was covered during the examination with a sheet. Then my doctor and her colleagues examined me. Later my doctor explained to me that what she was planning to do was illegal under New York law, which is the reason the other specialists she consulted wished to remain anonymous. It was all right, she said, for a doctor to straighten a cripple’s twisted limbs, but not all right to straighten a sexual cripple.”

Star’s endocrinologist explained that “there wasn’t a single hospital in New York who would take the case.” Her disappointment was somewhat assuaged by the intermediate steps the doctor suggested— administration of estrogen and breast-enhancement surgery. “I was disappointed that I couldn’t have the operation immediately but at least I knew I was heading in the right direction. I knew that eventually I would have the change and that was all that really mattered.” But more disappointments were to follow for Star. Despite the feminizing effects of the hormones, and the testimony of twelve physicians in favor of sex-change surgery for her, the New York State Medical Society refused to grant permission for the surgery a year later. The decision of the society was based not on medical or scientific criteria, but on a fear of legal action. In New York State, as in almost every other civic jurisdiction in the United States, it was illegal to surgically remove a man’s testicles.

These “mayhem” statutes, imported from English common law dating from the sixteenth century, forbade the amputation of any body part (fingers, toes, hands, or feet) that might prevent a male-bodied individual from being able to serve as a soldier. Although castration might not, strictly speaking, fall under the jurisdiction of the law, few American surgeons were willing to risk prosecution by becoming test cases. Christine Jorgensen circumvented the law by traveling to Denmark, where she had family and friends and knew the language. Hedy Jo Star had neither the money nor the connections to make such a trip possible. In the fifties and early sixties, mayhem statutes were the single greatest obstacle faced by every transsexual person in America unable to travel overseas for surgery or locate one of the few surgeons willing to flout the law by performing surgery in the United States.

On the advice of her endocrinologist, Star tried another route. In November 1958, she took a train to Baltimore and presented herself to the researchers at the Johns Hopkins Hospital who were becoming famous in medical circles for their work with intersexual children. Star was hopeful that they would be able to help her, too. “The hormone shots had done wonders. My testicles had all but disappeared. My penis had shrunk considerably. My