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brain gender

Quite a while back I posted about the case of David Reimer who was reassigned as a female after a botched circumcision inadvertently removed most of his penis. Reimer eventually committed suicide at the age of 34.

Recently, I found a reference online to a New England Journal of Medicine article dating back to 2004 which dealt with genital reassignment surgeries performed on patients suffering from Cloacal exstrophy which is a severe birth defect that occurs in approximately 1 in 400,000 live births. One of the most pronounced characteristics is severe phallic inadequacy, or the complete absence of a penis in genetic males. Historically, doctors have treated cloacal exstrophy by surgically altering, or "reassigning" these babies as female.

John Gearhart, M.D., director of pediatric urology at Johns Hopkins Children's Center and an expert on exstrophy complexes, and colleagues challenged this standard treatment by studying 16 genetic males from 5 to 16 years of age, 14 of whom underwent surgical conversion to female sex. They found that more than half of them identified themselves as male; six individuals were so unhappy with their female sex of rearing as to pursue gender reassignment back to male. All 16 had interests and attitudes that were considered typical of males.

This leads to once again to fortify the idea that gender identity is primarily rooted in the brain and that performing genital reassignment on non dysphoric individuals will not change their internal sense of who they are.

Cloacal exstrophy


  1. Ehi this is interesting. I hope one day you will post the proof of gender identity in the brain :)

  2. I have no qualification to say what can or should be attempted to be done with such a defect as this. But what I do know, it is primate and barbaric - just because the penis is absent - to carry out surgery that will have everlasting consequences, biologically as well as socially on someone for the rest of their lives!
    What astonished me even more was the fact that we are only talking about a procedure that was used a decade ago! I have been in the medical scientific community for most of my professorial working life. There has been made so many advances in cosmetic and re-construction surgery in the last years, but when I hear something like this, I am personally ashamed that there are still centres of barbarisms among us.

    1. What are you talking about? We have advanced in such cosmetic surgeries and this is bad or good? I did not get you

    2. Mario, I think you were missing my point. I was not discussing the theme brain sex, interesting as it is and the main point of Joanna’s post. I was referring to the surgical procedure that was used. Of course we have advances in surgery and that is why I was getting worked up. I was saying with all these positive advances available that alternative procedures could have been possible, instead of just cleaning up the mess by putting everything inside and calling the boy a girl! That is the barbarism I was talking about.

  3. Yes I was surprised by it too but it did happen. John Money who originally proposed the idea to David Reimer's parents to reassign his gender was a believer that gender was more about socialization

    1. I can understand what happened, Joanna, I just thought we were further along the line on this front. John Money was in my mind not qualified to propose something like this in the “name” of socialization in the first place. It showed he did not at the time “know” what socialization meant in all its complexity. I just hope he has learnt something in the meantime.

  4. Sorry Joanna (and Mario)..
    The fate of those children got me riled up there. If I put my so called indifferent research cap on for a moment and look at this from an experimental point of view (I might add in no way would an Ethic Committee allow such an experiment), then with the Hopkins follow-up there are some significant results to be seen. As you said Joanna, there is evidence here that the brain has a dominating role in our sexual/social alignment and preferences. One must also say, that the brain is not solely a controlling instrument, it is influenced from within and from outside the body at many different levels through sensory, hormonal and tactile sources. Our sexuality and how we portray ourselves within our social surroundings is multifaceted and complex. And this will stay a complex subject. I will be, as with Mario, be interested in where this will go.

    1. I thank you for it. Let me ask you some questions, since you 're working in hospital (if I understand well)
      Every couple thousand of birth, there is an "atypical" one. They're intersexual, right, as the above one?
      Until some years ago, they were operate for getting the best result for genitalia (according to the physicians).
      Then, some years later, (always?) they could regret the surgery (unconsciously) and their genitalia and their role... then... they can commite suicide.
      First question: do they commite suicide because they are without their favourite genitalia or because they live as person of the opposite sex? If they try to accept their genitalia but live as person of opposite sex, do they commite suicide anyway?

      Second question: let's imagine I am an intersexual who has not been operate at birth. Am I sad because I have not the correct genitalia or I am content about it?
      Because, according to the brain sex theory, I should have the brain sex of a female or male, and SO hate my genitalia, whatever is my role! Otherwise, we cannot say that the right genitalia is written somewhere in the brain... am I right?
      My apologize for being too long, but there is some contradiction in this brain sex theory.

    2. Mario
      First I don’t see myself as qualified to answer your questions in detail but I will touch each point you have brought up in some way.
      Cloacal exstrophy: this is not a sex defect, although the sexual organs as with boys are hardly recognisable and as a consequence non-functional. Girls have it slightly better as their “plumbing” is mostly internal. The defect has to do with the abdominal organs - bladder and intestines - becoming exposed to the outside (as can be partly seen in the above picture). It often causes the splitting of both the male penis and female clitoris, and the anus is occasionally sealed off as well. As said, not very present for a child of either sex, and we should be thankful that it is rare.
      Intersexuality: (I’m in no way an expert, some researching in the net on your part please), here in short form: Intersex infants and children have the characteristics of both sexes. The male or female sex organs can be more or less predominant depending on the individual. There may be sex reassignment to give the child a socially acceptable sex, this procedure has always been controversial even more so today. Here we must back up some what and differentiate between cloacal exstrophy and intersex. In the case of the defect, surgery is imperative. As discussed above, I was only not in agreement with the procedure that was used. With intersex, surgery is not necessary! Only so called social pressures dictates that “something has to be done”. There are intersex adults in our society that cope with being not one or the other sex, but having their own third sex! They have at least the chance to make their own decision on which of the 3 sexes they feel at home in and not have had the decision made for them at birth. There is of course social pressure, but they ultimately can decide how the knife is to be used and if they want to go down that road at all.
      Suicide: There are over 1 million suicides worldwide per year, 16 for every 100.000 with an increase of 60% in the past 45 years (source: Not every one of them has been frustrated with their sex! Causes for suicide are as complex as the humans who use it. What I’m trying to say is that not all people who “know” (I use the word consciously here instead of “believe”) they are living for whatever reason (social and/or surgical) in the “wrong” body are suicidal. Please don’t see “I’m in the wrong body = suicide” that is too black or white, as I said its complex.
      Brain Sex: Your remark that one is either male or female in the brain is, in my “brain”, not correct. There are people who are predominately male or female and are happy with their lot. There are people who feel they are at the wrong end of the spectrum and need to “trans”fer to the other end to be happy. Some people are happy to go along the road and maybe like to stop of on the way for a few years before traveling on. I for example feel I am traveling towards the center at this moment in time and find a balance I’ll be happy with. I will revise my situation over time and decide in what and which direction I will journey when I come to it, if ever.
      Mario, I could go on, it is a big subject. I hope I have cleared up some points and of course open new ones! But that’s the nature of the game.

      And Joanna, sorry to have taken up so much space in your post!

  5. unfortunately we do not fully yet understand how much of gender is innate and how much is socialization. But clearly there is much about us that is defined at birth which is hard wired and cannot be undone through surgical means. Thanks to both of you for your input....

  6. You are right Joanna, but must we apologise to the world for being who we are? All this discussion is necessary I know it’s a quest and humans like quests. But isn’t it ultimately to find an excuse to our social surroundings for being here?
    (Hey people! look, this is why I am how I am and here is the scientific evidence to support it, so now you can stop your bickering!).
    I am looking inward as well as outward to find out who I am, I’m not primary concerned on how much brain vs. social influences make up “me”. I just want to a certain degree be accepted as part of the social masses but also retain that part of me, as with us all, that makes “me” “us” unique. That is the basic right of every individual on this planet who pays social taxes...
    Upps! sorry, I was on a roll there..
    I'll shut up now. :-)


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