Galileo's Middle Finger (7 page)

 • • • 

D
URING THE BIG
BLOOM
in popularity of Eugenides’ book, in 2004, Bo and I sneaked in together to the intersex session of the American Academy of Pediatrics Section on Urology, in San Francisco. We got a friendly doc to register us as “family” so that we could have name badges and slip in through security without being noticed on the regular registered participant list. We sat together and quietly listened to what the big guys were saying. They were tangled up in doubt. Progress!

Tina Schober—a surgeon out of western Pennsylvania who’d become a pariah for associating with us—had actually been invited to speak. The UCSF surgeon Larry Baskin was admitting that they weren’t really sure about where they should be cutting the clitoris, because the nerves were turning out to be located where they hadn’t been expected to be, so that the outcomes were unclear, unpredictable. Indianapolis surgeon
Richard Rink
, who had always advocated “total urogenital mobilization”—ripping out everything that didn’t seem right to the doctor and rebuilding a girl’s genitals from scratch using Frankenstein stitches—was now expressing doubt about what the whole process was really based on. Of course, he then proceeded to say that, as a consequence, he was now just advocating “
partial
urogenital mobilization.” But we were thrilled to hear Rink say that the most important consideration was “how to preserve function.” He even told his colleagues, “I think there is a very important question: no one has proved it is a problem to have a large glans or a large clitoris, [so] should we really do anything about this?”

Afterward, we went up to say hello to the various panelists, and a few seemed shocked when they realized we had been there listening. I heard one person ask about what security thought they were doing at the door, but most of them were now cordial, though uncomfortable. Bo and I were not, after all, with the extremists on the picket line outside, anticircumcisionists who were covered in mock blood, calling doctors butchers. We were being taken very seriously.

However, because we were being taken seriously, we were taking crap from certain intersex activist quarters. I was an especially easy target of the identity-card-carrying activists. I was not intersex, I was not queer, I was not a clinician, so what was I doing there? In the story of the intersex rights movement, I was just plain funny looking. Some accused me of being a kind of mole—of “being in bed with the doctors.” When people put this charge to my face, I asked whether they realized that being in bed with the doctors provided a lot more opportunities to tickle their nuts, so to speak, than simply yelling at them from outside the window. In fact, I admitted, I found the window-yellers useful, precisely because they made us look sane and reasonable. (I even donated cash to their groups to keep them yelling.)

And we
were
sane and reasonable.

But by then, totally exhausted. Eight years into our collaboration, Bo and I were both well on our way to being out of steam. When you think you’re Good fighting Evil, you can continue fighting well past the point that would otherwise count as spent. But Bo and I had come to realize we were not Good fighting Evil. We were dealing with well-intentioned but myopic people who weren’t seeing what we couldn’t help but see when we took the long view in weighing the evidence.

Fully understanding how tired Bo was of it all, in 2004 I found myself having to push her to attend a hearing of the
San Francisco Human Rights Commission
that had been organized by David Strachan and Thea Hillman. The commission was investigating whether the treatment of intersex children constituted a human rights abuse. I thought this could be pretty scrumptious—I was fantasizing about writing our press release with the headline “Human Rights Abuses at U.S. Children’s Hospitals.” I talked Bo into going, and we went with Robin, Bo’s wife. (Although at that time they could not be married legally because they were both identified by the state as women, Bo and Robin had decided a couple of years earlier to have a private wedding. They asked Aron and me to officiate.)

When it came time for public testimony at the Human Rights Commission, I got up and said a bunch of things, and so did other people, and everyone kept wondering, when would Bo get up and say something? When would the most prominent member of the movement speak? She finally realized she had to—there was no way out of what she saw as a waste of time. She’d told me the docs would never listen to the San Francisco Human Rights Commission, no matter what they said, so she had not prepared anything to say. By then I had developed the habit of leaving index cards in my bag so that I could quickly write down what I thought we should say. I grabbed some cards, started scribbling, and
wrote something like this
:

What the Human Rights Commission has done here today is to recognize me as a human being. You’ve stated that just because I was born looking in a way that bothered other people doesn’t mean that I should have been excluded from human rights protections that have been afforded other people. . . .

Bo got up and went to the microphone in the front of the little hearing room. Glancing down at the index card, she started to speak. And then she suddenly stopped speaking. I turned to Robin and, groaning, whispered, “Oh no, she can’t read my handwriting.”

Robin answered, taking my hand, “No, Alice, no. She’s crying. She can read what you wrote, and she’s crying.”

Robin and I had never seen Bo cry in public before. I wasn’t even sure I had seen her cry
ever.

I realized at that moment that, after almost a decade together, we had finally gotten to the core of the matter. What I had learned from her was what I had written down on that card: that all she had ever wanted was
simply to be treated as human
. All of these people were simply asking to be given basic rights that were automatically accorded to all other humans: the right not to have your sex changed without your consent, the right to be told the truth about your medical history, and the right to be treated as an equal member of the human family without having to first pass through an operating theater.

We weren’t asking for a new, third gender category for our society, nor for a belief in innate gender identity, nor anything else so culturally radical. We were just asking for children and adults who had been born with sex anomalies to be recognized as fully human, deserving of decent medical science, and deserving of basic human justice.

The good news was that a lot of people, including the doctors, were truly starting to get it.

B
O AND
I
managed to limp along together for about one more year after the Human Rights Commission hearing. In that last year of work together, we coordinated and published the first detailed consensus-based clinical guidelines for intersex pediatric care, along with a handbook for parents. By the time we finished, leaders from all of the major diagnosis-specific intersex support groups, clinicians from every relevant specialty, parents of affected children, and adult intersex activists all had signed on to the collaboration. Soothing these forty-some people into compromise over the phone for these texts damn near killed me. But when the
two handbooks
came out and were passed around in medical settings, even the old guard muttered appreciation. Although we lacked adequate data to know that our model was better for patients than the old way, we put forth an approach that seemed most likely to minimize harm, given what we knew historically and scientifically: For newborns with confusing sexual anatomy, assign a best-guess preliminary gender
label
of boy or girl, with the understanding that no surgery is required for a gender label. Provide medical and surgical care known to be needed to lower serious risk of illness or death, but hold off on all elective interventions, including elective genital surgeries, until the patient can decide. Provide ongoing psychosocial support by well-trained professionals for children and families. Above all, tell people the truth.

Right about the time we were getting ready to publish our handbooks, the big North American and European pediatric endocrinology groups decided to hold a conference on intersex care to arrive at their own “consensus.” Bo was given an invitation to the meeting, as were several clinicians now firmly on our side. After talking with each ally who was invited, I put together a confidential
list of talking points
and gave it to each. As we hoped, a high-level
international medical consensus
emerged: The specialists agreed that they needed to work harder to collect and then follow long-term-outcomes data, to provide team care featuring dedicated psychosocial professionals, to find ways to tell patients and their parents the truth without making them feel overwhelmed and helpless, to stop counting patients who grow up gay or change their gender labels as medical failures, and to hold off on at least some genital “normalizing” surgeries until the patient could decide. Although these guidelines would not end surgical normalizations of genitals in early childhood right away, this consensus did mean that parents (and their sons and daughters) finally might get serious psychological support and be told what we know and don’t know about intersex. Some of the doctors even started talking about shame, which had always been the
real problem in intersex care
. Moreover, they were
all
talking about needing to do better science to figure out what medical care really helps and what harms.

You’d think I’d have been dancing in the streets at this point, but like Bo, I was seriously worn down. For ten years, I had put up with the hardships of activism, and now the friendship with Bo that had long sustained me had started to evaporate. ISNA, once our joint baby, had morphed through its success into a sort of miserable small business, something neither of us felt especially excited about. A lot of pushing and pulling ensued. It turns out that having been through a war together doesn’t necessarily mean you come back home able to make dinner together. I finally quit.

Relinquishing ISNA to Bo felt like losing a beloved stepchild in an unhappy divorce, and losing Bo as an intimate friend felt even worse. It didn’t help that just a few months before leaving ISNA—back when I was still kidding myself that I could keep working with Bo if I could just find a way to make my workload manageable—I had also quit my tenured professorship at Michigan State University. With a lovable four-year-old at my knee, I was tired of trying to do everything the university wanted of me. (A funny thing about writing manuals for parents of intersex children: You start thinking a lot about what’s missing from your own parenting.) I just wanted to work from home, doing patient advocacy for victims of medical trauma, writing histories, and limiting my son’s day care to six hours a day.

Then, like a tsunami after an earthquake, just a few months later, Aron was suddenly pulled from his medical-faculty position into an associate dean’s chair at Michigan State, putting him essentially in charge of medical education at the university. While this meant plenty of family income to support me in my unconventional career move, it also meant that my rock of ten years had become the medical school’s quarry just when I needed his grounding most.

Fortunately, not long after I’d turned in my resignation letter to Michigan State, a couple of colleagues had talked me into taking a part-time faculty position at their place, the Medical Humanities and Bioethics Program at Northwestern University’s medical school in Chicago. The program’s director promised that I could work almost entirely from home and basically do whatever work I wanted in exchange for putting the program’s name on it. I could also have the unit’s great faculty to lean on as colleagues. Still, with Aron suddenly absent, my job officially requiring almost nothing of me, and ISNA gone from my days forever, I found myself thoroughly unmoored—stumbling around as if I kept forgetting I’d had one leg amputated.

I found myself doing what any self-respecting straight woman does when she’s disoriented by an identity-rocking emotional smash-up: I listlessly rearranged playlists and bookshelves while talking on the phone to my gay friend Paul. Paul Vasey is a Canadian scientist who spends part of the year studying the
fa’afafine,
biological males who live as women on the tropical island of Samoa, and part of the year studying girl-on-girl monkey action in the snowy mountains of Japan. (The
Weekly World News
once featured the macaque monkeys Paul researches under the headline L
ESBIAN
M
ONKEY
S
HOCKER
! Paul told me it was actually a pretty good article.) Not long after the time I was calling him three times a week for company, Paul and his colleagues conducted a formal
study of “fag hags
”—straight women like me who have many gay male friends. They showed scientifically what Paul demonstrated in my life that year: that gay men make their close women friends feel better about themselves. Being a hard-driving scholar like me, Paul knew—and told me bluntly—that I just needed a big new project, one that would feed my hungers for intensive historical research and social justice. Soon enough, he’d lead me into one: the
Bailey transsexualism controversy
.

 • • • 

W
HEN PEOPLE ASK
ME
how transgender is different from intersex, I usually start by saying that intersex and transgender people have historically suffered from opposite problems for the same reason. Whereas intersex people have historically been subjected to sex “normalizing” hormones and surgeries they have
not
wanted, transgender people have had a hard time getting the sex-changing hormones and surgeries they
have
wanted. Both problems arise from a single cause: a heterosexist medical establishment determined to retain control over who gets to be what sex.

Aside from that huge shared problem, intersex and transgender actually are quite different. By definition, intersex involves having some anatomical feature that makes one’s body atypical for males or females; it’s primarily about anatomy—your body. By definition, being transgender means rejecting the gender assignment that was given to you at birth; it’s primarily about self-identity—your feelings. Although a small minority of intersex people do reject their birth gender assignment, most don’t, and most transgender people weren’t born intersex. In the great majority of cases, medical scans won’t detect any intersex feature in a transgender person’s body. Nevertheless, many people
believe
that transgender must be a special form of intersex involving the brain. Here’s that
popular, comforting narrative
: Everyone is born either male or female in the brain. But a person might accidentally be born with the “wrong” sexual anatomy—be born with an essentially female brain in a male body, or vice versa. If this happens, the person will know from early childhood that a terrible mistake has been made. If fortunate, such a person will eventually be able to come out of the closet and use surgery, hormones, and the legal system to end up with the body and social identity she or he should have always had.

Although there is very little science to support it, this has become the most popular explanation of transgender, probably in part because it is the easiest one for uptight heterosexuals to accept. Some people
appear
to switch sides, but everyone can rest assured that they didn’t
really
switch; they just finally got sorted out correctly by having their internal gender realities externalized by transsexual hormone treatments and surgeries. In practice, this story of transgender can function as a kind of get-out-of-male-free card for men who seek to become women anatomically. When that card is played, the comforting narrative of “true selves” is preserved. Everybody
really
has just one true gender from birth to death, so gender seems ultimately very stable. Now, no one really gets out of being male for free—the physical, financial, and personal costs of transition are pretty high—but this narrative does give a person a way out to which other people can’t easily object, at least in America, where the
quest for the true self
counts as admirable, even sacred.

If Northwestern University psychology professor J. Michael Bailey had accepted this story of male-to-female transsexualism, he and I might never have met, because he never would have gotten himself into such a pickle with transgender activists. But as I was to learn, Mike Bailey has never cared for simple, politically correct stories. In fact, he liked using his research and his college classes to kick politically correct assumptions around until they were as dented as soda cans on the sidewalk. In his view, the simple “female brain in a male body” was unscientific and had to go.

In 1997—right about the time I had started helping Bo with ISNA—Bailey decided to write a book for the general public about “feminine males.” His decision came after he attended a Barnes & Nobel book-signing by a Chicago-based therapist named Randi Ettner, who was promoting her new book,
Confessions of a Gender Defender.
In it, Ettner pushed the politically correct “brain of one sex trapped in the body of the other” story of transgender.
This rankled Bailey
. Make no mistake: It wasn’t that he wanted to stop transgender people from getting access to the hormones and surgeries they wanted. Far from it. As a libertarian, he always wanted to see these folks get whatever medical technologies they needed to feel whole, just as Ettner did. But he also wanted to replace what he saw as a false picture of male-to-female transgender with what he saw as the true one. He wanted better science
and
progress for transgender rights, and he hoped to help push both by writing his own popularization.

It took Bailey another six years, until 2003, to complete and publish
The Man Who Would Be Queen
: The Science of Gender-Bending and Transsexualism.
The first hint that this work would reject simplistic gender-identity stories—from transgender people or anyone else—came from the book’s provocative and insensitive cover. It featured a photo of two hairy masculine legs standing in a pair of pretty pumps, shown from the knees down—an image seen by most people (including me) as more befitting a Monty Python cross-dressing sketch than a book about science from a trans-friendly writer. (Bailey chose this cover against the
advice of colleagues
, who preferred a vastly less offensive alternative showing three faces, one feminine, one masculine, and one androgynous.) Meanwhile, in the text, like a lot of feminists with whom he otherwise tangled, Bailey rejected the idea of anybody being simply male or simply female in the brain. He suggested to his readers that “gender identity is probably not a binary, black-and-white characteristic. Scientists,” he complained, “continue to measure gender identity as ‘male’ or ‘female,’ despite the fact that there are undoubtedly gradations in inner experience between the girl who loves pink frilly dresses and cannot imagine becoming a boy and the extremely masculine boy who shudders to think of
becoming a girl
.”

Rejecting the idea that everybody is truly and easily assignable to one of two gender identities, Bailey unapologetically and aggressively introduced his readers to a generally unfamiliar understanding of male-to-female transgender. This understanding depended not on an idea of a “true female” trapped within, but on sexual orientation. Male-to-female transgender, in Bailey’s view, was more about
eroticism
than gender identity per se. Here Bailey was drawing on the work of Ray Blanchard, a sex researcher working at Canada’s Centre for Addiction and Mental Health in Toronto. When Blanchard considered the historical and clinical literature and his own experience working as a psychologist with hundreds of adult men seeking sex reassignment, he realized that there are
two
basic types of male-to-female transsexuals, very different from each other in terms of their life histories and demographics. Blanchard also realized that these two types could be recognized primarily by their sexual orientations.
Blanchard concluded
that male-to-female transsexualism isn’t simply about gender identity (whether you really feel yourself to be male or female) but is fundamentally about sexual orientation (whom or what you really desire).

The first of the two types of male-to-female transsexuals identified by Blanchard begin life as very femme little boys. They are “sissy boys” who like activities generally considered girly. Little boys of this type like to dress up in girls’ clothes, play house, and play games involving fashion, and many are downright averse to “boyish” rough-and-tumble sports or games of war. They seem more classically feminine than masculine in social interactions. They are highly attuned to social relations and often like helping their mothers with housework. From the moment of the development of their sexual interests, these folks are unequivocally sexually attracted to other males. Before they become women, in their behavior and their exclusive sexual interest in men, they appear to be superfemme gay men. Unfortunately, this means that their sexual opportunities are often limited while they are presenting themselves as men. Straight men aren’t interested in having sex with them because they’re male, and gay men often aren’t sexually attracted to them because most gay men are sexually attracted to masculinity, not femininity, and these guys are really femme.