overwhelmed their fragile coping mechanisms. “Three of the sex-changes I’ve known are now dead—either from suicide or from overdoses of drugs,” says Morgan. “And I’ve heard stories of about twenty others who’ve wound up the same way. … I might have wound up the same way myself, but as I said, I’ve been lucky.” By the end of the book, Morgan has left prostitution and is living on an income generated by her purchase of real estate, funded by an older gentleman who loves and supports her.

The difficulty of distinguishing those individuals who might benefit from sex-reassignment surgery from those who would be crushed under the weight of postsurgical adjustment problems was a major preoccupation of the university researchers. They sought to define characteristics in prospective clients that might predict success in post-surgical life. For this reason, the university clinics have been lambasted by members of the trans community for creating a myth of the “classic” male-to-female transsexual. A classic transsexual was essentially a traditional woman who happened to have been born in a male body. She was attractive, with feminine mannerisms and a feminine outlook, and had felt like a girl all of her life. She was, above all, heterosexual and desired marriage and, when possible, children by adoption or step-parenting. “Back in those days, they used to say that you had to be hyper-feminine to transition, and I’d say, ‘This isn’t me. So maybe I’m not transsexual,’” says Dr. Dana Beyer, who transitioned in 2003 at the age of fifty-one. “If the only true transsexuals are Jayne Mansfield types, how the hell am I ever going to meet the criteria?”

Members of the trans community, with their sophisticated pre-Internet communications network, quickly sussed out the conservative criteria that the clinics were using to choose candidates for surgery. In a self-fulfilling prophecy that would be comic if it weren’t so tragic, candidates for sex-reassignment thus began presenting themselves to researchers as demure heterosexuals who wanted nothing more than a good man and a stable home, with lots of delightful children running around. In fact, many MTFs were attracted to women both before and after sex reassignment, but were careful to keep this fact hidden, knowing that it would destroy their chances of being accepted for surgery.

The university researchers began to sense the deception and to probe deeper, eventually discovering that many of their patients weren’t exactly the transsexual June Cleavers of their intake interviews. “They all claim that they are the same, but I don’t believe that they are,” Paul McHugh says today. “Most of them, the beginning ones, the ones that we were seeing here at Hopkins, were all men wanting to be women. And it was obvious that they weren’t women. They were caricatures of women. They had ideas in their mind about what it meant to be a woman, and you brought a woman into the room to talk to them and the woman quickly got the idea, ‘That’s no woman!’ Secondly, many of them would say, I am a woman in a man’s body, but I’m a lesbian.’ That’s crazy,” McHugh exclaims with some heat. “That’s a long way around for a guy to get a girl. That’s just nuts,” he says.

Echoing the conservative view of gender roles and sexual orientation that guided the decisions of the Johns Hopkins Gender Identity Clinic, and eventually led to its closure, McHugh says, “Look, in this situation, the issue for the person who is making the claim is to prove to you that they really are a woman. When they start saying that they are lesbians, that should increase your level of doubt. Then they have no maternal feelings—none, zip! I think that maternal feelings are a common quality of women. Do you think that the only thing it takes to be a woman is genitalia? No. There is a psychology to womanhood. We’ve just touched on two elements of that psychology which many of these guys coming to be women don’t have.”

Admitting that some genetic women, socialized as women throughout their lives, also lack maternal feeling and also desire other women, McHugh nonetheless maintains that the population of transsexual women ought to reflect statistically the same prevalence of maternal feeling and heterosexuality as natal women. “It’s our job as doctors to look at this issue closely when somebody says, ‘I’m a woman in a man’s body’ And when you look closely, these are the things that pop out immediately. These are not the subtle things about womanhood that women can pick out, but these are the things that anybody, common sense, would say ‘This person says that he’s a woman, but he’s a lesbian.’ Gee, you know, guys like women more than women like women. Secondly—geez, you know, where’s the feeling for children, maternal feelings? It’s zero here.”

Operating with this set of assumptions, McHugh and the researchers who shared them began to view the transsexual people who presented themselves at the Johns Hopkins Gender Identity Clinic with distaste. Clearly, using their criteria, these individuals were not women. Many of them were, in Paul McHugh’s view, “aging transvestites—the kind of people who had been going to Victoria’s Secret since they were twelve years old. And Johns Hopkins is not a branch of Victoria’s Secret!” McHugh characterizes Money’s early advocacy of transsexuals as an ideology. “It’s still an ideology,” he says. “ I believe in transsexuals, and I believe this is what they should be able to do.’ It was an ideology. It was not psychiatry and it was not medicine and it was not science.”

However, the research that might have made the study of gender variance something more substantial than an “ideology” came to an abrupt end when the Johns Hopkins clinic closed in 1979 and most of the other university clinics followed suit. “One of the things that I think was so tragic about SRS being forced off of medical school campuses is that it meant that almost all good research came to an abrupt end. That to me is a tragedy because there’s just so much research crying out to be done,” says Ben Barres of Stanford. At Johns Hopkins, research on gender variance took a conservative turn after the closing of the Gender Identity Clinic, one that denies the medical legitimacy of the condition that Harry Benjamin and John Money sought to define. “Our clinic is still looking at these patients; we still try to help them,” Paul McHugh says. “We tell them that we’re not going to do this surgery on them, because it’s not right. We don’t tell them to stop going to Victoria’s Secret. It’s up to them. But we tell them that they are not correct and that science doesn’t bear them out and their psychology doesn’t bear them out.”

Transsexual people themselves rue the changes at Hopkins set in place by McHugh. “Hopkins’s cachet with transsexual people desperately seeking services remained, so since 1979 those poor patients who didn’t know any better were seen at Hopkins’s Sexual Behaviors Consultation Unit (SBCU), which continued to do research on them but made them pay $150 per visit for that privilege,” says Jessica Xavier, a local activist who in 2000 carried out a needs-assessment survey on transgender health care in the District of Columbia. “They also stopped referrals for sex-reassignment surgery, which McHugh was quoted as calling ‘psychosurgery’ and hoped would go the way of pre-frontal lobotomies. If seen at the SBCU, a transsexual patient would be fortunate indeed to get referred for endocrinology.”

According to Paul McHugh, the incorporation of the diagnosis of transsexuality and later “gender identity disorder” in the Diagnostic and Statistical Manual has only “sustained the misdirection” put in place by John Money and other researchers. “People were being harmed, subjected to a ferocious surgery and being encouraged in an overvalued idea that doesn’t for most of them make sense,” McHugh maintains. “Fundamentally at the root of all this is an idea that is shared by other people in the environment, that is, by other people like Dr. Money, for example—the idea that sex is socially assigned and that it could be changed. These individuals take that idea up and it becomes a ruling passion for them. They don’t think about anything else and it becomes a part of what they call their identity. They have talked themselves into this just like other people have talked themselves into the idea that they are not thin enough.”

McHugh is nonetheless willing to concede that researchers may someday find a biological explanation for at least some forms of gender variance. “If people are afflicted in fetal life by an abnormal hormonal thing, they can have all kinds of peculiar sexual attitudes when they come out,” he admits. But he is quick to distinguish between individuals who can prove that they were subject to “an abnormal hormonal thing” in prenatal life from those who, for whatever reason, choose to dress and live as members of a sex other than that dictated by their anatomy. And he remains adamantly opposed to any form of surgical intervention for the latter group. “This surgery is serious surgery and it’s a misuse of resources when I don’t think that the problem lies in the bodily structure.”

Despite the controversy surrounding sex-change surgery and his ongoing battle with adversaries within Johns Hopkins and without, John Money was continuously funded by the National Institutes of Health for more than thirty-five years, from the start of his career to its ignominious end. In June 1997, Milton Diamond and Keith Sigmund-son published an article in the Archives of Pediatrics and Adolescent Medicine that cast doubt not only on Money’s theories but also on his credibility as a researcher. Sigmundson had for many years overseen the care of Money’s most famous patient, a twin boy named David Reimer, who had been raised as a girl after his penis was accidentally severed during a circumcision. Money had long used this case (identified as “John/Joan” in the Diamond article) as proof that the sex of assignment and rearing trumped all other variables in the formation of gender identity in normatively sexed, as well as intersexual, children. Despite her XY genotype and male genital and endocrine profile at birth, “Joan” was a normal little girl, Money asserted in scientific articles, books, lectures, and interviews, who “preferred dresses to pants, enjoyed wearing her hair ribbons, bracelets and frilly blouses, and loved being her Daddy’s little sweetheart.” Sigmundson, who had witnessed firsthand the acute

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