Women After All: Sex, Evolution, and the End of Male Supremacy (4 page)

But before we delve further into their fascinating, sometimes threatened, and often heroic lives, we must look a bit at how maleness and femaleness, evolved over eons, are re-created in each embryo, infant, and child. What are those two classic pathways, from which some of us depart? The die is not cast in the same way in all sexual animals, but we will meditate on mammals. They cast light like that of a candle on our lives, flickering at times, dim at others, always warm, with some hue of gold. We cannot ethically probe ourselves as we can animals, but studies allow inferences, up to a point, from them to us. Here is the story of sexual development that comes out of both kinds of studies.

We humans have forty-six chromosomes, of which (
usually
) two—X and Y—are sex chromosomes. A woman’s eggs each carry one X, and a man’s sperm are about equally divided between those with an X and those with a Y. The fertilized egg becomes XX or XY,
usually
synonymous with female and male. Many millions of little sperm spiritedly storm the vastly larger egg, but only one gets in before the egg’s rim shuts tight. The winning swimmer loses his tail—although we might also say he’s lost his head, which breaks off
inside, enveloped by the egg. But, unlike the praying mantis male (of which more later), the sperm doesn’t offer its head for nourishment; the egg’s huge independent mass takes care of that. The sperm’s head delivers genes, particles of prized variation, toward the equally gene-rich nucleus of the egg. When they fuse, the sexual destiny of the fertilized egg is set—it is either male or female. So in losing its head, the sperm gains its reproductive future.

There is more to it than this alone, but the Y chromosome plays the key sex-determining role; however, that doesn’t make the Y itself a masterpiece. It’s a fraction of the size of the X and looks like a stunted sibling; this is not true in all sexual animals, but it is true in mammals. The Y, petite as it is, ordinarily carries one gene that tips the balance: this gene makes the testis determining factor, or TDF, which triggers the growth of testes from organs that would otherwise become (basically) ovaries. The testes take over from there by brewing specifically male hormones—androgens—that mold the rest of maleness. Another Y gene creates a molecule that suppresses female organs.

Other genes on the X and other chromosomes make their mark on sexual development, but the TDF manufactured by the Y is the chemical key that unlocks the androgens. As we saw at the outset, we can think of maleness as a syndrome, a chromosomal defect shared by 49 percent of humans. It does serious damage. It quashes the body’s ability to create new life, causes excess death at all ages, shortens life, increases the risk of diseases ranging from heart attack to autism, and causes physical violence, among other symptoms. Most of this is due to androgen toxicity, mainly testosterone poisoning, although estrogen deprivation and other hormonal glitches play a role. But most of it can be traced back to the Y.

Why “toxicity” and “glitches”? Isn’t this just rhetoric? No. The mammalian body plan is basically female. If you have just one X (Turner syndrome), you will not be fertile, but you will otherwise be female, as long as you have no Y. If you have two or more X’s but also a Y (Klinefelter syndrome), you will not be completely typical,
but you will be basically male. There are rare cases of infertility in women who are found to be XY but are insensitive to androgens due to another gene. And a few men seem to be XX under the microscope but are found to have the key Y genes accidentally attached to one of their X’s—something that can happen in a slightly awry cell division. Otherwise it’s fair to say: the body plan is female unless the Y flips it into maleness.

With this foundation, we can look at Barbin’s modern counterparts, and they will tell us much about the
biological
part of the male-female story. I will try to give them gender-neutral nicknames to avoid either backing them into a gender role or pinning them like scientific specimens.

First, we have people born with ambiguous genitals who were XX embryos partly androgenized in the womb. This can happen either because of a naturally occurring condition or because their mothers were given a drug that mimicked androgens. One natural problem is congenital adrenal hyperplasia, and babies born with it—I’ll call them “Ahs”—have a genetically altered enzyme in the adrenal gland, so instead of just making its usual hormones (relating to stress and salt), the gland makes excess androgens. Ahs are born with their genitals somewhat masculinized, as well as with significant medical problems that can be treated but not cured. Some other XX babies with ambiguous genitals were exposed to medications related to progesterone. Unfortunately, progesterone has some of the same effects as androgens, a fact not known when the hormone was given to some women to help them keep their pregnancies. The resulting babies—I’ll call them “Andras”—also may have partly masculinized genitals but do not have medical problems.

Ahs and Andras are two of the groups that make the “It’s a girl!” or “It’s a boy!” decree difficult. But often, like Barbin, they’ve been raised as girls. Some had their small penises removed sometime after birth so that as children they would have fairly typical-looking
female bodies. The Ahs also received hormones, plus further ones at puberty, in an attempt to fine-tune their adrenals and prevent masculine development. As for their genitals, psychologists until recently recommended that Ahs and Andras not be left with ambiguous gender identities. Doctors thought, for surgical as well as psychological reasons, that it would be easier to make them girls.

The prevailing theory back then was called “psychosexual neutrality at birth,” a fancy way of saying that children form their gender identities purely through experience—how parents and others treat them, how they are taught to conform, how they identify with and imitate adults, and how just looking at their own bodies confirms their sense of who they are. This, said the theory, is why boys (usually) think of themselves as boys, act as boys, and, in due course, choose girls as their sexual partners. Girls, it was thought, become women psychologically because of a very different, complementary set of experiences. Children and adults who didn’t fit—cross-dressing boys, “tomboys,” gays, lesbians, and others—supposedly turn out as they do because of family psychology while they were growing up, reinforced by peers and school environments.

Today we know that the process, although surely affected by culture, does not depend on it entirely; in fact, culture is not even close to being the key determinant.

The not-very-numerous Ahs and Andras, along with their families, have often entered patiently into studies of gender identity, and it turns out that by many measures they are more boylike in their behavior than their sisters or other matched girls: they pick boys’ games, toys, and clothes more often and like dolls and dresses less. In drawing tests, like boys, they tend more often to draw mobile and mechanical objects with dark or cold colors seen from a bird’s-eye view, while unaffected girls tend to draw people, flowers, and butterflies in light and warm colors and depict these living things in a row on the ground. As children, the Ahs and Andras are less likely than other girls to say that they someday want to be mothers.
(I am not saying motherhood is a preferable choice; I am only stating some facts about differences in tendencies.) And, in fact, once they’re grown up, more of them say that they do not feel like women (although most do), and more fall in love with and have sex with women. They take this developmental path despite having had hormonal treatments, especially in puberty, that gave them more or less typical women’s bodies.

Not everyone interprets these facts in the same way, but for many scientists, they confirm what was known from lab studies: not just the body but the brain, too, is bathed in sex hormones in the womb, and in typical males androgens masculinize the brain. In one classic study, pregnant monkeys carrying female fetuses received testosterone only in the latter part of pregnancy, long after the formation of female anatomy. Even before puberty, with its impressive hormonal makeover, male monkeys one to two years of age are much more aggressive in their play than typical females the same age. But exposure to testosterone before birth gave otherwise normal females an in-between level of this monkeying around, known as rough-and-tumble play.

That’s one of thousands of experiments with many different species—rats, mice, hamsters, rabbits, ferrets, dogs, and several kinds of monkeys, a whole menagerie. These experiments show shifts in at least three kinds of behavior: aggression (playful or serious), sexual activity, and responses to infants. There is also an impact on brains; male hormones affect only small areas, but these are in circuits involved in sex, nurturance, and physical aggression. The differences in the brain (mainly in the hypothalamus) and in two behavioral categories—aggression and nurturance—are clear before adult sex hormones come into play. In almost all studies, the early exposure to androgens—the exact timing depends on the species—pushes females in a male direction, while castration or anti-androgen treatment makes males more like females. For these reasons, many psychologists and brain scientists now routinely speak of androgenization (or masculinization) of the brain.

Does this prove beyond a doubt that the Ahs and Andras had their brains and behavior masculinized by exposure to androgens or similar hormones? No. Does it, combined with much other evidence, strongly suggest that this is what happened? Yes, but that’s not all.

It’s not only XX individuals who can be born with undefined genitals. XYs can be too, or at least with very underdeveloped male genitals, among other anatomical problems. One such condition is called cloacal exstrophy, a complex diversion of developing anatomy. Today, techniques of surgical reconstruction allow almost all XY babies with this condition—suppose we call them “Clokes”—to be assigned as male and have penises with at least some functionality. But this was not the case in the past, and so, as was true of Ahs and Andras, Clokes were often assigned to be female and had surgery and hormone treatments accordingly.

Eventually their gender psychology was explored. In a 2004 study by William Reiner and John Gearhart of sixteen of them, aged between eight and twenty-one, two had been labeled male at birth and remained male by all psychological measures. The other fourteen had been assigned to grow up as female and raised as such. But in the 2004 follow-up, eight of the fourteen expressed a desire to be male, nine had mainly male friends, ten had typically male levels of rough-and-tumble play, and all fourteen preferred typically male toys and games. It’s important that six remained content with their female gender identity, but the weight of evidence pointed to a significant role for prenatal androgens.

That same year, Reiner published a longer paper with a larger series of patients and more details. Here is an exchange with a thirteen-year-old who had been told eight months earlier the truth about his condition of birth, diagnosis, and early treatment:

Q: How long did it take you when your mom and dad actually told you . . . how long did it take you to realize that they were telling you the truth and all of that kind of stuff?

BJ: Right when they told me, because now everything made sense.

BJ took a boy’s name, tore the flowers off the wall in his pink room, and had his mom repaint it. He stayed out of school for a week and sometimes felt sad, mainly because he was worried about his friends’ reactions. According to Reiner, the parents of these kids were often in turmoil, yet they reported that “at times the children seemed to be almost empowered by their declaration” and the interview with BJ about his transition experience “demonstrates a scenario that is typical of many of these children.”

Reiner does not suggest that these children, now boys, have an easy future ahead, but he stresses that surgical correction to female anatomy and rearing as girls was a mistake for many of them. Their parents reported good social functioning. Six had at some point spontaneously declared their status as changed to male; seven others had made the transition decisively after their parents decided to inform them, at various times in their development, about their early condition. The transition was typically easier for the child than for the parents. Reiner (whose follow-up team preserved whatever information or secrecy the family had previously established) concludes movingly, “These children adapt to their lives with severe somatic anomalies, pathophysiologic vulnerabilities, and complex medical and surgical interventions from birth. They do not observe their lives; they live their lives.” He also says that the research implies “an important role for prenatal androgen exposure in male-typical development, including male sexual identity. Clinical algorithms and paradigms in these children need to be re-evaluated.”

This is equally true of XY babies born without a penis or who lost a penis through a botched circumcision, infection, dog bite or other accident, or even abuse. Again, the idea that gender identity and gender-related behavior was overwhelmingly due to social rearing conditions—combined with the fact that it was easier surgically
to create something like a vagina than a penis—led to a number of these boys being labeled and raised as girls and getting hormone treatments at puberty to make them as much as possible into women. One such unlucky child, whose identical twin was typically male, was assigned to be female shortly after the accident. A vagina was surgically constructed early on, and female hormones were given in adolescence. It was hoped that these interventions, along with enveloping family and cultural influences, would make this child an infertile but otherwise normal woman.

It didn’t. The young woman always felt uncomfortable in her role. Eventually she searched for information about her early life and learned for the first time her own physical history. What she found out came as a great relief to her. It explained a whole life of feeling like a misfit, and she made up her mind to reorient her identity. When she was a girl named Joan, others arranged for her to have surgery and hormone treatments to make her more female. Now
she
decided to become John and as an adult independently arranged to have the reverse surgeries and medical treatments. One of Joan/John’s doctors said in an interview later on, “He got himself a van, with a bar in it. He wanted to lasso some ladies.” Sadly, two years after his twin brother committed suicide, John was depressed and took his own life. Since his twin had a typical male anatomical history, John’s suicide cannot simply be attributed to his unusual one; obviously the causes were complicated.