J O H N

   J O A N

In 1967, an anonymous baby boy was turned into a girl by doctors at Johns Hopkins Hospital. For 25 years, the case of John/Joan was called a medical triumph — proof that a child’s gender identity could be changed — and thousands of “sex reassignments” were performed based on this example. But the case was a failure, the truth never reported. Now the man who grew up as a girl tells the story of his life, and a medical controversy erupts.

In late June 1997, I arrive at an address in a working-class suburb in the North American Midwest. On the front lawn, a child’s bicycle lies on its side; an eight-year-old secondhand Toyota is parked at the curb. Inside the house, a handmade wooden cabinet in the corner of the living room holds the standard emblems of family life: wedding photos and school portraits, china figurines and souvenirs from family trips. There is a knockoff-antique coffee table, a well-worn easy chair and a sofa – which is where my host, a wiry young man dressed in a jean jacket and scuffed work boots, seats himself. He is 31 years old but could pass for a decade younger. Partly it’s the sparseness of his beard – just a few blond wisps that sprout from his jaw line; partly it’s a certain delicacy to his prominent cheekbones and tapering chin. Otherwise he looks, and sounds, exactly like what he is: a blue-collar factory worker, a man of high school education whose fondest pleasures are to do a little weekend fishing with his dad in the local river and to have a backyard barbecue with his wife and kids.

Ordinarily a rough-edged and affable young man, he stops smiling when conversation turns to his childhood. Then his voice – a burred baritone – takes on a tone of aggrievement and anger, or the pleading edge of someone desperate to communicate emotions that he knows his listener can only dimly understand. How well even he understands these emotions is not clear: When describing events that occurred prior to his 15th birthday, he tends to drop the pronoun I from his speech, replacing it with the distancing you – almost as if he were speaking about someone else altogether. Which, in a sense, he is.

“It was like brainwashing,” he is saying now as he lights a cigarette. “I’d give just about anything to go to a hypnotist to black out my whole past. Because it’s torture. What they did to you in the body is sometimes not near as bad as what they did to you in the mind – with the psychological warfare in your head.”

He is referring to the extraordinary medical treatment he received after suffering the complete loss of his penis to a botched circumcision when he was 8 months old. On the advice of experts at the renowned Johns Hopkins medical center, in Baltimore, a sex-change operation was performed on him, a process that involved clinical castration and other genital surgery when he was a baby, followed by a 12-year program of social, mental and hormonal conditioning to make the transformation take hold in his psyche. The case was reported as an unqualified success, and he became one of the most famous (though unnamed) patients in the annals of modern medicine.

It’s a fame that derives not only from the fact that his medical metamorphosis was the first sex reassignment ever reported on a developmentally normal child but also from a stunning statistical long shot that lent a special significance to the case. He was born an identical twin, and his brother provided the experiment with a built-in matched control – a genetic clone who, with penis intact, was raised as a male. That the twins were reported to have grown into happy, well-adjusted children of opposite sex seemed unassailable proof of the primacy of rearing over biology in the differentiation of the sexes and was the basis for the rewriting of textbooks in a wide range of medical disciplines. Most seriously, the case set a precedent for sex reassignment as the standard treatment for thousands of newborns with similarly injured, or irregular, genitals. It also became a touchstone for the feminist movement in the 1970s, when it was cited as living proof that the gender gap is purely a result of cultural conditioning, not biology. For Dr John Money, the medical psychologist who was the architect of the experiment, this case was to be the most publicly celebrated triumph of a 40-year career that recently earned him the accolade “one of the greatest sex researchers of the century.”

But as the mere existence of this young man in front of me would suggest, the experiment was a failure, a fact revealed in a March 1997 article in the Archives of Adolescent and Pediatric Medicine. Authors Milton Diamond, a biologist at the University of Hawaii, and Keith Sigmundson, a psychiatrist from Victoria, British Columbia, documented how the twin had struggled against his imposed girlhood from the start. The paper set off shock waves in medical circles around the world, generating furious debate about the ongoing practice of sex reassignment (a procedure more common than anyone might think). It also raised troubling questions about the way the case was reported in the first place, why it took almost 20 years for a follow-up to reveal the actual outcome and why that follow-up was conducted not by Dr. Money but by outside researchers. The answers to these questions, fascinating for what they suggest about the mysteries of sexual identity, also bring to light a 30-year rivalry between eminent sex researchers, a rivalry whose very bitterness not only dictated how this most unsettling of medical tragedies was exposed but also may, in fact, have been the impetus behind the experiment in the first place.

But what for medicine has been a highly public scandal involving some of the biggest names in the world of sex research has been for the young man sitting in front of me a purely private catastrophe. Apart from two short television appearances (his face obscured, his voice disguised), he has never spoken on the record to a journalist and has never before told his story in full. For this article, he granted more than 20 hours of candid interviews and signed confidentiality waivers giving me exclusive access to a voluminous array of legal documents, therapists’ noses, Child Guidance Clinic reports, IQ tests, medical records and psychological work-ups. He assisted me in obtaining interviews with his former therapists as well as with all of his family members, including his father, who, because of the painfulness of these events, had not spoken of them to anyone in more than 20 years.