Over the next six years, Money and the Hampsons studied some 131 intersexuals ranging in age from toddlers to adults. Money (who was lead investigator and author of the team’s published reports) claimed to observe a striking fact about intersexes who had been diagnosed with identical genital ambiguities and chromosomal makeups but raised in the opposite sex from one another: more than 95 percent of them reportedly fared equally well psychologically whether they had been raised as boys or girls. Money called these groupings of patients “matched pairs” and said they were proof that the primary factor determining an intersexual child’s gender identity was not biology, but rather the way the child was raised. He concluded that these children were born wholly undifferentiated in terms of their psychological sex and that they formed a conception of themselves as masculine or feminine solely through rearing.
This theory was the foundation on which Money based his recommendation to Johns Hopkins surgeons and endocrinologists that they could surgically and hormonally steer intersexual newborns into whichever sex, boy or girl, they wished. Such surgeries would range from cutting down enlarged clitorises on mildly intersexual girls to full sex reversal on intersexual boys born with undeveloped penises. These conversions to girlhood were foreordained by the state of surgical technology: it was easier for surgeons to construct a synthetic vagina than to create an artificial penis. Money’s only provisos were that such “sex assignments” and reassignments be done within the first two and a half years of life (after which time, Money theorized, a child’s psychosexual orientation ceased to be as malleable) and that once the sex had been decided upon, doctors and parents never waver in their decision lest they risk introducing fatal ambiguities into the child’s mind.
By providing a seemingly solid psychological foundation for such treatments, Money had offered physicians a relatively simple surgical solution to one of the most vexing and emotionally fraught conundrums in medicine: how to deal with the birth of an intersexual child. “One can hardly begin to imagine what it’s like for a parent when the first question—‘Is it a boy or a girl?’—results in a response from the physician that they’re just not sure,” says Dr. Fred Berlin. “John Money was one of those folks who, years ago, before this was even talked about, was out there doing his best trying to help families, trying to sort through what’s obviously a difficult circumstance.”
Money, however, was not interested chiefly in intersexes. As he stated as early as his Harvard thesis, he recognized the scientific worth of intersexes primarily as what he called “experiments of nature”—as a cohort of research subjects who could shed light on the question of sexual development in normal humans—who could, in fact, resolve one of the longest-running debates in science; namely, whether it is primarily nature or nurture that shapes our sexual sense of self. It was in his first published papers at Johns Hopkins that Money generalized the theory of psychosexual neutrality at birth from hermaphrodites to include all children, even those born without genital irregularity.
“From the sum total of hermaphroditic evidence,” he wrote in 1955, “the conclusion that emerges is that sexual behavior and orientation as male or female does not have an innate, instinctive basis. In place of a theory of instinctive masculinity or femininity which is innate, the evidence of hermaphroditism lends support to a conception that, psychologically, sexuality is undifferentiated at birth and that it becomes differentiated as masculine or feminine in the course of the various experiences of growing up.” In short, Money was advancing a view that human beings form a sense of themselves as boy or girl according to whether they are dressed in blue or pink, given a masculine or feminine name, clothed in pants or dresses, given guns or Barbies to play with. Many years later, Money would describe how he arrived at some of his more radical theories about human sexual behavior. “I frequently find myself toying with concepts and working out potential hypotheses,” he mused. “It is like playing a game of science fiction.”
While Money’s theory of human newborns as total psychosexual blank slates may strike a contemporary reader as science fiction, such was not the case in the mid-1950s, when it was met with almost universal acceptance by clinicians and scientists—an acceptance not difficult to understand in the context of the time. Explanations for sex differences had been moving toward a nurturist view for decades. Prior to that, the pendulum had been pointing in the naturist direction—thanks to the discovery at the end of the nineteenth century of the so-called male and female hormones, testosterone and estrogen. The discovery of these chemical-based internal secretions had led biologists to proclaim the riddle of sex differences solved: testosterone was the masculinizing agent; estrogen, the feminizing. They confidently predicted that male homosexuals would be discovered to possess an excess of the “female” hormone in their bloodstream and a deficiency of the “male” hormone. Minute analysis of the urine and blood of adult homosexual men, however, revealed no such hormonal imbalances. Under the microscope, a straight and a gay man’s internal secretions are identical. Other experiments meant to show the hormonal basis of sexual identity also failed, and as the failures mounted, enthusiasm for a biological explanation of sexual differences gradually waned. Simultaneously, the first half of the twentieth century and the advent of Freud and modern psychology saw a rapid increase in social learning models for human behavior. Against this background, the Johns Hopkins team’s conclusions that sexual identity and orientation were solely shaped by parents and society fit perfectly into an intellectual zeitgeist in thrall to behaviorist theories. Nor did it detract from the papers’ reception that they carried the imprimatur of Johns Hopkins Hospital, one of the premier medical research institutions in the world.
The Johns Hopkins team’s 1955 intersex papers were proclaimed instant classics and won that year’s Hofheimer Prize from the American Psychiatric Association. The Hampsons soon left Johns Hopkins for Washington State University and by 1961 had drifted out of gender identity research. As a result, Money alone became heir to the award-winning papers’ reputation. And as sole director of the Psychohormonal Research Unit (after Lawson Wilkins’s death in 1962), he was also the lone beneficiary of the unit’s success. In 1963 Money was awarded a grant of $205,920 from the National Institutes of Health—a considerable sum in early-1960s dollars, but merely the first of several NIH grants that would sustain Money and his unit for the next thirty-five years. In 1965 he served as Mead Johnson visiting professor of pediatrics at the University of Buffalo Children’s Hospital, and was awarded the Children’s Hospital of Philadelphia Medal “for contributions to the study of the psychological development of children.” A year later he would begin to garner fame outside the academic realm when he finally succeeded in persuading Johns Hopkins to establish the clinic for the treatment and study of adult transexuals.
Money had been galvanized by transexualism since 1952, when the revelations about Christine Jorgensen first hit the press. In Jorgensen’s case, Money saw tantalizing proof of his theory that environment, not biology, determines psychological sex, for here was a person born with apparently normal male biological makeup and genitals whose inner sense of self had differentiated as female—in direct contradiction to his chromosomal, gonadal, hormonal, reproductive, and anatomic sex. What greater evidence could there be that gender identity is determined not by biology but by environment? Determined to study such individuals in the greatest number possible, Money set out to get Johns Hopkins into transexual research and treatment, which was still a repellent idea for the majority in the American medical establishment.