01:10 PM ET 03/13/97
The unidentified man, now in his 20s, was the basis in the
past two decades for most theories of ``sex reassignment'' --
the approach surgeons take when male genitals are badly
mutilated at birth.
But in a lengthy report in the March issue of the Archives
of Pediatric and Adolescent Medicine, researchers reported the
man called ``John'' was now married and that those theories were
The case first appeared in medical literature in 1972 after
the boy, at eight months, lost his penis during an attempted
cauterizing repair. It was ``accidentally burned to ablation,''
the report said.
He was studied at Johns Hopkins Hospital in Baltimore where,
according to accepted theory, it was decided to surgically alter
him and raise him as ``Joan,'' a girl, alongside his twin
brother, a normal boy. He had been castrated and preliminary
At first it seemed to work. In 1973 Time Magazine said the
oft-cited case ``provides strong support ... that conventional
patterns of masculine and feminine behavior can be altered. It
also casts doubt on the theory that major sex differences,
psychological as well as anatomical, are immutably set by the
genes at conception.''
But the newly published report said:
``The evidence seems overwhelming that normal humans are not
psychosexually neutral at birth but are, in keeping with their
mammalian heritage, predisposed and biased to interact with
environmental, familial, and social forces in either a male or
The new report was written by Milton Diamond of the John A.
Burns School of Medicine in Honolulu and H. Keith Sigmundson of
the Ministry of Health, Victoria, B.C.
Sigmundson once headed a psychiatric team that handled the
case, and Diamond at one point was a consultant for the British
Broadcasting Corporation which investigated the case several
Their study said the boy had trouble from the start. His
mother reported ``Joan'' rebelled at wearing dresses, preferred
his brother's toys to dolls, tried to urinate standing up, liked
to play soldier and went for rough and tumble games.
Between the ages of nine and 11, the study said, ``Joan''
realized she was male. At age 12 ``Joan'' rejected estrogen
therapy designed for feminization. At the age of 14 ``Joan''
decided to become ``John,'' undergoing a mastectomy and phallus
construction in the next two years.
At 16 he obtained a windowless van with a bed and bar. Girls
had crushes on him and at 25 he married a woman several years
his senior, adopting her children.
``Coitus is occasional with his wife ... sufficient for his
needs but is less than his wife would desire,'' the study said.
''John can have coital orgasm and ejaculation'' but resents that
castration deprived him of fatherhood.
The researchers said they believe the case shows that any
male child with a normal nervous system ``should be raised as a
male'' and that genital surgery, however difficult, should be
conducted to assure that is possible.