Transgender Patient Zero

Remembering David Reimer & the Dark History of “Gender-Affirming Care”

In 1980, a 14-year-old boy was oddly invited to select for himself the third and final name by which he would be known. He chose a most fitting name, “David”—the giant slayer, an icon of youthful, masculine courage.

The Experiment Begins

I learned of David Reimer, or of his medical mythology, during my first year of medical school in 1986 when a psychiatrist lecturing on “Psychosocial Dimensions of Health Care” gave our class an optimistic spin on the macabre case of identical twin boys born in 1965. The boys were anonymous, yet they were also famously serving as a case study in gender-identity development. In 1966 one of the twins, Bruce, had lost his penis to an injury resulting from a botched circumcision procedure, and Bruce’s horrified young parents found themselves under the “care” of Dr. John Money, an arrogant and charismatic Johns Hopkins University sexologist.

In the 1960s, John Money reigned as the foremost authority on the management of hermaphroditism, or intersex anomalies, the rare category (fewer than 2 in 10,000 births) of developmental or metabolic anomalies resulting in infants born with ambiguous sexual differentiation. Dr. Money was devoted to the convictions that humans are born as psychosexual blank slates, that gender is a social construct wherein nurture can override nature, and that in the early postnatal stage, gender identity is malleable.

Beginning in 1955, Money advocated for early surgical intervention—choosing a gender for the infant on the postulate that any infant could become either gender. This usually translated into surgical feminization to be followed later with estrogen supplementation, even if the patient had an XY male genome. Money believed early gender identity would be indeterminate and fluid, even in a subject who was genetically and developmentally normal at birth, a proposition that had never been tested before the 1960s. For Dr. Money, Bruce—an injured but otherwise normal study subject under the age of two with a genetically identical control in his twin brother Brian—was a gift. Together, he believed, the boys would prove the primacy of psychosocial conditioning as the determining factor in gender identity.

Bruce’s parents, convinced Dr. Money could grant their injured child a near-normal life as a female, consented to his being castrated at age 22 months and undergoing a vulvoplasty, the surgical construction of rudimentary female-like genitalia from scrotal tissue. Bruce was renamed Brenda, and his parents, as instructed, set about raising him as a daughter while Brian was treated as a son.

Bruce-Brenda

But Brenda Reimer never accepted his designation as female. As the twins grew, Money saw them annually, amicably reassuring their parents that all was well with both their son and their adorable little girl. Yet despite the gaslighting, family, teachers, physicians, and psychologists who saw the pair regularly could not deny the truth before their eyes. Brenda came to understand what the grown-ups desperately expected of him, and he could deliver a performance of girlish social graces and behaviors to ease their anxiety; but when his guard was down, or when he was simply worn out from pretending, he was observed to be a naturally scrappy and aggressive boy, prone to fist fights and fascinated with traditional boy things, such as dump trucks, forts, and go-carts. Despite surgical emasculation prior to his second birthday, he instinctively urinated standing and had a characteristically male canter that, along with a coarse voice, earned him the cruel moniker “Cavewoman” from his junior-high classmates. Aware that the experiment was not going as planned, or as reported, the adults closest to the twins’ daily lives nonetheless chose to stay the course, given Dr. Money’s towering reputation and an implicit belief that the experiment had likely progressed too far to be turned back.

As Brenda approached puberty, Money prescribed estrogen tablets to induce breast development, then badgered Brenda to consent to further pelvic surgery to lower his urethra into a more feminine position and plastic surgery to construct a vagina-like canal. The surgery was to be performed by Dr. Howard Jones, the same surgeon who had castrated baby boy Bruce a decade earlier.

Like a surly trail boss directing his cowboys to bring in a wayward maverick, Money mustered every resource he could to corral Brenda into the operating room. But submitting again to the scalpel was a hill Brenda was, quite literally, willing to die on. At age fourteen, and after two years on estrogen, he ceased playing the charade. Though still identified as Brian’s odd sister Brenda, he stopped wearing dresses, primping his hair, and hiding his depressed alienation. He eventually stopped attending school. In his bones he knew he was not female, even if he did not understand how he knew.

“No!”

In early 1980, alarmed by Brenda’s intractable depression, his hometown psychiatrist, Dr. Keith Sigmundson, sensed it was time to defy Dr. Money. The experiment was an unequivocal failure, and an innocent young life was at stake. Among the boy’s medical and psychiatric team, Sigmundson was hardly alone.

Dr. Jeremy Winter was a pediatric endocrinologist who had been enlisted to manage Brenda’s estrogen therapy. One afternoon in Winter’s office an attempted breast exam ended in a tense standoff, with Brenda refusing to cooperate.

“Do you want to be a girl or not?” Winter asked. It was a tiresome, now infuriating, question adults had been subtly asking Brenda for as long as he could remember.

Like a smooth verbal river stone hurled from a sling, Brenda bellowed “No!”

“Okay, you can get dressed and go home.”

This time the weary warrior was heard. The boy had prevailed against the near-invincible giant Goliath. Shortly thereafter his father Ron broke the news to him over ice cream. He sat through the incredible story—his life’s story told from birth forward—in stony silence as the ice cream melted. His first response was a question: “What was my name?”

His first emotion was intense relief, and he decided at once to embrace his male identity. Yet shedding the physical and psychological sequelae of castration and the moulage from fourteen years of forced incarnation as a female did not come easy.

Adolescence can be tumultuous under the best of circumstances. In a bid to protect his privacy and dignity, David continued school at home as he and Brian devised a ruse whereby Brenda, having disappeared for several months, was reported to have moved away to live with a boyfriend before dying in a plane crash. David’s estrogen supplements were replaced with testosterone, and after a double mastectomy he reappeared as a long-lost cousin from another town coming to live with the Reimer family.

Not surprisingly David’s remaining teenage years, shadowed by continued secrecy, fabrications, and medical complications, were marred by a struggle with awkwardness, anger, shame, and bouts of suicidal depression. Yet, despite the intense burdens, he pressed on. At age 18 he acquired settlement funds from the original injury, bought a stylish van, and before his twentieth birthday enjoyed a vacation to Hawaii with two of his best friends. He eventually underwent a successful phalloplasty, met a single mother with three children, married in 1990, entered the work force, and found pride and purpose in the responsibilities of being a husband and father.

Doctor Undeterred

While David was struggling through a uniquely difficult childhood and adolescence, John Money was touting Brenda as the poster girl for his pet gender theory. Beginning in 1972, cheery reports of the twins’ progress became a staple of Money’s lectures, writings, and reputation. His theory of gender neutrality—that early childhood social learning overrides biological imperatives in the shaping of human sexual identity—seemed, at least to him, confirmed and triumphant.

In 1986, during our impressionable freshman year in medical school, my classmates and I heard how the “Oops Baby” disliked being dirty and loved playing with dolls and wearing frilly dresses, i.e., that “she” was a normal girl. We were treated to an animated short film which drove home the point that it is overwhelming familial and social messaging that teaches girls to exhibit feminine behaviors and tastes while boys are programmed in another direction. We were thus taught that gender identity was environmentally and culturally determined; the transmission of gender roles was viewed as a bad, or at least suspect, enterprise, even in conservative 1980s Texas.

In lending medical credence to the thesis that any gender gap is purely a result of cultural conditioning, Money’s message perfectly complemented the feminist ideology of the time. Endorsed by the American Academy of Pediatrics, Money’s gender-plasticity convictions carried the day—and the decades ahead. By 1975 The New York Times dubbed John Money “agent provocateur of the sexual revolution,” and as the Reimer twins progressed through their singular childhood, early sex reassignment became the standard of care.

Long before the Reimer twins began their medical tragedy, however, there were dissenting voices among those seeking the best understanding and care of intersex disorders. Among them was Dr. Milton Diamond, a professor of anatomy and reproductive biology whose own work with intersex persons and research with animal models offered compelling support for the role of the sexual genome and prenatal and early-life hormones in neuronal development, gender differentiation, and development of sex-specific behaviors.

John Money, however, had no tolerance for opposition, even when congenially and professionally offered. His rebuttals to dissenting voices such as Dr. Diamond’s went beyond sneering and ridicule to threats, profane outbursts, and even the throwing of punches. From his storied position in one of the world’s premier medical institutions as director of the Psychohormonal Research Unit and co-founder of the Johns Hopkins Gender Identity Clinic, and with the adulation of the popular media of his day, Dr. Money successfully brushed aside those skeptical of his assertions on the development of gender identity.

Truth Outs

Though late in coming, a dogged pursuit of the truth by Dr. Diamond, in cooperation with psychiatrist Keith Sigmundson, resulted in the March 1997 publication of an article in the Archives of Adolescent and Pediatric Medicine. It revealed that the famous “Oops Baby” case, like so many modernist tales, was a lie.¹ Later that year, Rolling Stone reporter John Colapinto published “The True Story of John/Joan,” an award-winning article on the case introducing the tragic story to the world at large.2 While the Reimer family’s location and identities remained protected, the conversation about sex-reassignment practices in children finally broke out for honest debate.

But when co-opted into the service of propaganda, useful icons die hard. Ernst Haeckel’s fictitious 1868 embryology drawings, for example, remained in freshman biology textbooks as evidence supporting Darwinian evolution even decades after it was well-known among biologists that the drawings were frauds. As I sat among classmates at the UT Medical School in San Antonio in 1986, the Reimer twins were 20 years old, and the lid had long been blown off. Yet four years later, during my residency, I asked a visiting psychiatrist if he had heard an update on the experiment. In a muted response I was told that there were unofficial reports that “she had some adjustment difficulties as a teenager.” More than five years would pass before I learned more. A full 15 years passed after David Reimer came out to live as a male before the world would hear an honest professional reckoning.

Yet during those years, John Money continued to tout the experiment as an unqualified success. Thousands of children worldwide born with intersex conditions, and a few suffering genital injuries similar to David’s, underwent early-life, sex reassignment surgery without their consent—a practice driven by his powerful influence and justified by the “success” of his one famous, yet fraudulent, case.

In the pantheon of 20th-century sexual revolutionaries, John Money’s influence stands with that of Sigmund Freud, Margaret Sanger, Margaret Mead, Alfred Kinsey, and Hugh Hefner. His legacy, like theirs, includes a personal crusade to de-stigmatize all forms of sexual expression, which he referred to as “paraphilias,” a word coined to replace the judgmental implication of words like “perversion.” Money championed acceptance of fetishism, incest, open marriages, bestiality, transvestitism, and pedophilia. Like other sexual revolutionaries of his time, he viewed traditional morality as a harmful vestige of a puritanical, religiously oppressed past. Prudery, such as an aversion to pederasty, was to him a regrettable neurosis of Western society, the root of much unhappiness, and a tradition in need of eradication. Such were the biases of the man who directed an unprecedented psychosexual-engineering experiment on the hapless infant son of two desperate working-class parents.

Both twins described their early experiences of self-awareness as being permeated by a sense that there was something peculiar and curious about the two of them, that there was a secret involving them to which they were not privy, and that they were watched by adults with a disquieting intensity that made them feel like specimens under a microscope. Both hated their annual encounters with Dr. Money, and Brenda honed skills of evasive resistance and placation to get through his intrusive interviews. Money deployed dubious tactics to coax Brenda along the path of feminine identity, including exposure to pornography and sexual role-playing with Brian. The terrible stress made the family miserable, and the Reimer parents battled depression, alcohol abuse, and contemplations of divorce.

A turning point for David came after the 1997 exposé interviews with Dr. Diamond, Dr. Sigmundson, and John Colapinto. It wasn’t until age 32 that he learned how for three decades John Money had misrepresented him and his family’s personal catastrophe to support an unproven pet ideology. By hailing the experiment as a clinical triumph, Money had influenced near-universal acceptance of sex-reassignment practices in children. David, in his own words, was “appalled, disgusted, and angry” and motivated to go public.

Neither of the Reimer twins recovered from their tortured childhood. As an adult, Brian struggled with mental illness and died of an overdose in 2002. In deep grief over the loss of his twin brother, David experienced financial and marital stress, and in 2004 he took his own life at age 38. John Money survived until 2006. He never recanted, never apologized.

Moral Imperatives vs. Medical Doublespeak

Legitimate science progresses through a healthy argument-counter argument give-and-take that usually leads down an interesting and winding journey of discovery. This tradition defines the core purpose of peer-reviewed journals in science and medicine. Alleged discoveries, hypotheses, and assertions are presented to the professional fraternity, critiqued, challenged, honed, and then accepted at some level or discarded. Most confident scientists value the integrity of the process and welcome the creative tension that comes with open discussion, recognizing refined truth to be the reward in view.

If David Reimer and three decades of intersex-surgery victims teach us anything, it is that male genomes build male brains while female genomes build female brains, and, contra Freud, what develops in the loins is far less determinative of one’s identity than what forms in the cranium. At least four decades of data attest that children are not capable of giving informed consent to radical medical and surgical therapies. In intersex conundrums and anatomical injuries alike, hubris and the scalpel must be held in check until the patients themselves are mature enough to lead the decision-making team.

As progressive transgender activism today gives the practice of child sex-reassignment a renaissance, David Reimer, by ideological necessity, must be forgotten. I currently serve as faculty with a family medicine residency program where I daily interact with recent graduates of several medical schools. None of the young doctors-in-training have heard of the “Oops Baby” or David Reimer’s case, nor had an acquaintance who graduated from the University of Cincinnati in 2013 with a master’s degree in “Women’s Sexuality and Gender Studies.” It appears that so long as John Money’s famous twins supported his gender neutrality theory, it stood as a teaching staple for schools of medicine and psychology. Once the script flipped and it became a cautionary tale against early sex-reassignment surgery and hormone therapy for children, the sordid story and its revelations were hastily pushed down the memory hole.

To be fair, as a science, medical progress requires a degree of trial and error. It is understandable that clinicians in the 1960s investigated surgery and hormonal therapies as a potential solution to the complex difficulties of intersex disorders. But before sufficient time had passed, or a respectable body of data had been assimilated, David Reimer became “patient zero” for surgical, hormonal, and social sex-reassignment experimentation. And more than 50 years on, the outcome of the Reimer experiment, the distress of more than a generation of intersex patients, and the research of biologists like Milton Diamond offer sufficient data to give anyone with a modicum of objectivity a hard pause.

While the sequelae of the transgender project currently underway will not be realized for decades, the legacy of the John Money era is evidence enough to demand open professional and public debate, hard challenges to current practices, and legal accountability where justified. The aggressive and radical treatments that went so awry for David and others are currently being foisted upon prepubescent children, not as remediation for injury or developmental anomalies, but merely as treatment for anxiety, for doubts, or for entertaining fashionable groupthink about their biological sex. A boy walking out of his mother’s closet grinning while wearing her red high-heeled shoes, or a girl with a tomboy personality, or a group of adolescent girlfriends dabbling in transgender thinking now risk ensnarement into an activist agenda of tampering that includes early puberty blockers, cross-sex hormones, and body-part amputations. In such a milieu the term “Gender Affirming Care” is not merely a euphemism; it is a jarring example of doublespeak.

Had he survived, David Reimer would be 60 years old this year. His earnest, engaging eyes and baritone voice still speak a desperate call for patience, humility, and caution.

Notes
1. M. Diamond and H. K. Sigmundson, “Sex Reassignment at Birth. Long-Term Review and Clinical Implications,” Archives of Adolescent and Pediatric Medicine, vol. 3 (Mar. 1997), 298–304.
2. John Colapinto, “The True Story of John / Joan,” Rolling Stone (Dec. 11, 1997).