Milton’s eyes were saying that the bad news was not all that bad.
“The bad news is you have to have a little operation. Very minor. ‘Operation’ isn’t really the right word. I think the doctor called it a ‘procedure.’ They have to knock you out and you have to stay overnight in the hospital. That’s it. There’ll be some pain but they can give you painkillers for it.”
With that, Milton rested. Tessie reached out and patted Callie’s hand. “It’ll be okay, honey,” she said in a thickened voice. Her eyes were watery, red.
“What kind of operation?” Callie asked her father.
“Just a little cosmetic procedure. Like getting a mole removed.” He reached out and playfully caught Callie’s nose between his knuckles. “Or getting your nose fixed.”
Callie pulled her head away, angry. “Don’t do that!”
“Sorry,” said Milton. He cleared his throat, blinking.
“What’s wrong with me?” Calliope asked, and now her voice broke. Tears were running down her cheeks. “What’s wrong with me, Daddy?”
Milton’s face darkened. He swallowed hard. Callie waited for him to say the word, to quote Webster’s, but he didn’t. He only looked at her across the table, his head low, his eyes dark, warm, sad, and full of love. There was so much love in Milton’s eyes that it was impossible to look for truth.
“It’s a hormonal thing, what you’ve got,” he said. “I was always under the impression that men had male hormones and women had female hormones. But everybody has both, apparently.”
Still Callie waited.
“What you’ve got, see, is you’ve got a little too much of the male hormones and not quite enough of the female hormones. So what the doctor wants to do is give you a shot every now and then to get everything working right.”
He didn’t say the word. I didn’t make him.
“It’s a hormonal thing,” Milton repeated. “In the grand scheme of things, no big deal.”
Luce believed that a patient of my age was capable of understanding the essentials. And so, that afternoon, he did not mince words. In his mellow, pleasing, educated voice, looking directly into my eyes, Luce declared that I was a girl whose clitoris was merely larger than those of other girls. He drew the same charts for me as he had for my parents. When I pressed him on the details of my surgery, he said only this: “We’re going to do an operation to finish your genitalia. They’re not quite finished yet and we want to finish them.”
He never mentioned anything about hypospadias, and I began to hope that the word didn’t apply to me. Maybe I had taken it out of context. Dr. Luce may have been referring to another patient. Webster’s had said that hypospadias was an abnormality of the penis. But Dr. Luce was telling me that I had a clitoris. I understood that both these things grew out of the same fetal gonad, but that didn’t matter. If I had a clitoris—and a specialist was telling me that I did—what could I be but a girl?
The adolescent ego is a hazy thing, amorphous, cloudlike. It wasn’t difficult to pour my identity into different vessels. In a sense, I was able to take whatever form was demanded of me. I only wanted to know the dimensions. Luce was providing them. My parents supported him. The prospect of having everything solved was wildly attractive to me, too, and while I lay on the chaise I didn’t ask myself where my feelings for the Object fit in. I only wanted it all to be over. I wanted to go home and forget it had ever happened. So I listened to Luce quietly and made no objections.
He explained the estrogen injections would induce my breasts to grow. “You won’t be Raquel Welch, but you won’t be Twiggy either.” My facial hair would diminish. My voice would rise from tenor to alto. But when I asked if I would finally get my period, Dr. Luce was frank. “No. You won’t. Ever. You won’t be able to have a baby yourself, Callie. If you want to have a family, you’ll have to adopt.”
I received this news calmly. Having children wasn’t something I thought much about at fourteen.
There was a knock on the door, and the receptionist stuck her head in. “Sorry, Dr. Luce. But could I bother you a minute?”
“That depends on Callie.” He smiled at me. “You mind taking a little break? I’ll be right back.”
“I don’t mind.”
“Sit there a few minutes and see if any other questions occur to you.” He left the room.
While he was gone, I didn’t think of any other questions. I sat in my chair, not thinking anything at all. My mind was curiously blank. It was the blankness of obedience. With the unerring instinct of children, I had surmised what my parents wanted from me. They wanted me to stay the way I was. And this was what Dr. Luce now promised.
I was brought out of my abstracted state by a salmon-colored cloud passing low in the sky. I got up and went to the window to look out at the river. I pressed my cheek against the glass to see as far south as possible, where the skyscrapers rose. I told myself that I would live in New York when I grew up. “This is the city for me,” I said. I had begun to cry again. I tried to stop. Dabbing at my eyes, I wandered around the office and finally found myself in front of one of the Mughal miniatures. In the small, ebony frame, two tiny figures were making love. Despite the exertion implied by their activity, their faces looked peaceful. Their expressions showed neither strain nor ecstasy. But of course the faces weren’t the focal point. The geometry of the lovers’ bodies, the graceful calligraphy of their limbs led the eye straight to the fact of their genitalia. The woman’s pubic hair was like a patch of evergreen against white snow, the man’s member like a redwood sprouting from it. I looked. I looked once again to see how other people were made. As I looked, I didn’t take sides. I understood both the urgency of the man and the pleasure of the woman. My mind was no longer blank. It was filling with a dark knowledge.
I swung around. I wheeled and looked at Dr. Luce’s desk. A file sat open there. He had left it when he hurried off.
PRELIMINARY STUDY:
GENETIC XY (MALE) RAISED AS FEMALE
The following illustrative case indicates that there is no preordained correspondence between genetic and genital structure, or between masculine or feminine behavior and chromosomal status.
SUBJECT: Calliope Stephanides
INTERVIEWER: Peter Luce, M.D.
INTRODUCTORY DATA: The patient is fourteen years old. She has lived as a female all her life. At birth, somatic appearance was of a penis so small as to appear to be a clitoris. The subject’s XY karyotype was not discovered until puberty, when she began to virilize. The girl’s parents at first refused to believe the doctor who delivered the news and subsequently asked for two other opinions before coming to the Gender Identity Clinic and New York Hospital Clinic.
During examination, undescended testes could be palpated. The “penis” was slightly hypospadiac, with the urethra opening on the underside. The girl has always sat to urinate like other girls. Blood tests confirmed an XY chromosomal status. In addition, blood tests revealed that the subject was suffering from 5-alpha-reductase deficiency syndrome. An exploratory laparotomy was not performed.
A family photograph (see case file) shows her at age twelve. She appears to be a happy, healthy girl with no visible signs of tomboyishness, despite her XY karyotype.
FIRST IMPRESSION: The subject’s facial expression, though somewhat stern at times, is overall pleasant and receptive, with frequent smiling. The subject often casts her eyes downward in a modest or coy manner. She is feminine in her movements and gestures, and the slight gracelessness of her walk is in keeping with females of her generation. Though due to her height some people may find the subject’s gender at first glance somewhat indeterminate, any prolonged observation would result in a decision that she was indeed a girl. Her voice, in fact, has a soft, breathy quality. She inclines her head to listen when another person speaks and does not hold forth or assert her opinions in a bullying manner characteristic of males. She often makes humorous remarks.
FAMILY: The girl’s parents are fairly typical Midwesterners of the World War II generation. The father identifies himself as a Republican. The mother is a friendly, intelligent, and caring person, perhaps slightly prone to depression or neurosis. She accedes to the subservient wifely role typical of women of her generation. The father only came to the Clinic twice, citing business obligations, but from those two meetings it is apparent that he is a dominating presence, a “self-made” man and former naval officer. In addition, the subject has been raised in the Greek Orthodox tradition, with its strongly sex-defined roles. In general the parents seem assimilationist and very “all-American” in their outlook, but the presence of this deeper ethnic identity should not be overlooked.
SEXUAL FUNCTION: The subject reports engaging in childhood sexual play with other children, in every case of which she acted as the feminine partner, usually pulling up her dress and letting a boy simulate coition atop her. She experienced pleasurable erotosexual sensations by positioning herself by the water jets of a neighbor’s swimming pool. She masturbated frequently from a young age.
The subject has had no serious boyfriends, but this may be due to her attending an all-girls school or from a feeling of shame about her body. The subject is aware of the abnormal appearance of her genitalia and has gone to great lengths in the locker room and other communal dressing areas to avoid being seen naked. Nevertheless, she reports having had sexual intercourse, one time only, with the brother of her best friend, an experience she found painful but which was successful from the point of view of teenage romantic exploration.
INTERVIEW: The subject spoke in rapid bursts, clearly and articulately but with the occasional breathlessness associated with anxiety. Speech patterning and characteristics appeared to be feminine in terms of oscillation of pitch and direct eye contact. She expresses sexual interest in males exclusively.
CONCLUSION: In speech, mannerisms, and dress, the subject manifests a feminine gender identity and role, despite a contrary chromosomal status.
It is clear by this that sex of rearing, rather than genetic determinants, plays a greater role in the establishment of gender identity.
As the girl’s gender identity was firmly established as female at the time her condition was discovered, a decision to implement feminizing surgery along with corresponding hormonal treatments seems correct. To leave the genitals as they are today would expose her to all manner of humiliation. Though it is possible that the surgery may result in partial or total loss of erotosexual sensation, sexual pleasure is only one factor in a happy life. The ability to marry and pass as a normal woman in society are also important goals, both of which will not be possible without feminizing surgery and hormone treatment. Also, it is hoped that new methods of surgery will minimize the effects of erotosexual dysfunction brought about by surgeries in the past, when feminizing surgery was in its infancy.