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In 1977, when she was 14, Joan decided she had only two options: either commit suicide or live her life as a male. Finally, in a tearful confrontation, her father told her the true story of her birth and sex change. "All of a sudden everything clicked," John remembers. "For the first time things made sense, and I understood who and what I was." With the support of a new set of doctors, Joan underwent a pair of operations to reconstruct a penis--albeit a diminutive one without the sensitivity of a normal sex organ.
Following this second set of sex-change procedures, John's new doctors advised the family to move to a new town and another school and start over. This time, however, John's parents rejected the expert advice. People would find out anyway, they reasoned. It was better to stay put and be open about what had happened. Their strategy seems to have worked. After a brief transition, John was accepted by his peers in a way that Joan never was. Once, when John first began dating, he confessed to a would-be girlfriend that he was insecure about his penis, and she started telling tales in school about his condition. But Joan's old schoolmates stuck loyally by John, refusing to be drawn into the girl's malicious gossip.
At its worst, this story could be read as a lesson in scientific hubris. At its best, it's a story about the courage of one boy who claimed the right to determine his own identity.
Unfortunately, no follow-up study reporting that John had rejected his initial sex change was ever published. As a result, say Diamond and Sigmundson, dozens of other boys may have been needlessly castrated. In defense of the original team, Johns Hopkins says it wasn't able to conduct a follow-up because the family stopped coming to see its doctors.
Diamond and Sigmundson suspect that most boys-made-girls will, like John, reject their female identity by the time they reach puberty. Other experts are not so sure. "We don't have the answers," says Dr. William Reiner, a surgeon and psychiatrist at Johns Hopkins (who was not involved in the original case). "Let's listen to these kids. They eventually are going to give us the answer."
--Reported by Dick Thompson/Washington