How to Speak Hermaphrodite
You could study the Intersex Society of North America for years and still get tripped up on the personal-pronoun platform. While some intersexuals freely accept "she" or "he," the ISNA brain trust has been hard at work coming up with alternatives. The preferred pronoun is "s/he," although it isn't practical for conversational use. For those purposes, some offer "e" or "she-he" or -- go figure -- "sie." Possessive pronouns are hairier still; Dana Montgomery, of the Middlesex Group, likes "hir." Or "herm."If Robert Jeffs walked past Morgan Holmes that Saturday, he chose to blend in with a thousand elbow-patched pediatricians looking for a nice lunch spot. As it turns out, Jeffs would probably not remember Morgan Holmes even if Morgan Holmes was her real name, and even if she hadn't aged 21 years. After 40 years of practice -- during which he helped pioneer this treatment at two different hospitals -- Jeffs can't remember every face.Nor can he comment on the specific case, he explains, during a telephone interview from Johns Hopkins, where he now practices. In general, though, he and other physicians say steering children immediately toward their apparently dominant gender -- surgically, chemically and socially -- is the best way of assuring them a relatively normal life. Children, the argument goes, only come in two genders, and the more perfectly they pass, the happier they will be.As for the surgeries, Jeffs says they are necessary even when the condition is not life-threatening -- chromosomal girls, for instance, could have full male phalluses, and delaying surgery until puberty could mean they start menstruating through them. The longer doctors wait, in other words, the more conflicted the child, and the more tortured the parents who have to explain why their daughter has a penis."Put yourself in the same suit," he says. "Say you're going out, and the babysitter's going to change the child. You say, 'Change Sadie in two hours.' What else do you say? So there's an issue there. How long do you go on in that vein, in terms of babysitters, grandparents, and, later, locker rooms?" And as for what happens 21 years later, Jeffs says he has no way of knowing. "You do something at the age that is appropriate in terms of [the baby's] well-being," he says. "The parents look with you during the follow-up and say 'Oh, that looks normal. That should work.' Now, is this going to be one that's satisfied or one that's out on the street with a placard? I don't know."I think there is a silent majority," he says. "Whether they are silent and happy or silent and unhappy I don't know."It's a matter that has only just emerged into the public domain, thanks to the small ruckus initiated by Hermaphrodites with Attitude. The day of the protest, a spokesman for the American Association of Pediatrics was still blinking with confusion as he ran off copies of a brand-new AAP statement on infants with mixed genitals, who make up about one in every 2,000 births. No one had ever asked for a statement until that day.The policy goes this way: early genital surgery to counteract sexual ambiguity is the best choice for the emotional health of the child. Until the age of 21Ú2 , a child with unclear genitalia can be successfully raised into either sex, provided surgery is performed as soon as possible and the parents raise the child unambiguously into one gender, doling out information in line with the child's maturity. For all concerned -- in order to avoid rejection by the parent, among other things -- the optimal period for surgery is between six weeks and 15 months from the child's birth.CHERYL CHASE, like Holmes, retains a flinty anger toward the doctors who gave her a complete clitorectomy at birth. At 39, she has virtually no genital sensation. A Bay Area computer consultant, Chase founded ISNA three years ago. She was the first to go public with her lobbying efforts, and the first to put her name in print, and she is known as the Joan of Arc of the movement.Begun strictly as a support group, ISNA now has 150 members and has become gradually politicized, with its chief goal a moratorium on genital surgery on children and infants, which Chase likens to the clitorectomy practiced in Africa. She is almost gleeful about taking on the doctors -- some of whom have dismissed ISNA in the press -- although direct confrontation, which she has attempted, is "not a useful way to use our time."Still, "I think a lot of intersexuals have at some time nursed homicidal feelings" toward their doctors, says Max (born Judy) Beck, 31, an ISNA member from Atlanta. "Our anger is very disturbing to the doctors. They're the only people who aren't comfortable with the emotional side of the problem."The ISNA platform, as it has developed under Chase, demands that surgery -- although not gender choice -- should be put off until the child hits puberty, so that he or she can choose whether to undergo it. Mental-health specialists should be present after diagnosis to counsel parents, informing them, among other things, that their child may not turn out to fit the gender assigned to them. And ISNA promotes full disclosure to children -- that they understand their condition, that they have access to peer groups, and that they are never made to be ashamed.What makes ISNA's stance hard to swallow, Chase says, is that it doesn't promise parents a neat solution. "Doctors are telling parents they can fix it. You can't really fix it, but there are things you can do to make it better," she says. "This isn't going to be without pain."Beyond that is what Beck calls "the theoretical Utopian second phase" of ISNA's platform: the desire to make room for sexual variance in our society. That, as a goal, hovers somewhere beyond the horizon; they envision a world in which a child would not necessarily have to have a gender. This vision -- a world where gender is no longer binary -- underlies all of ISNA's positions. Some members dream of putting I, for "Intersexual," on their drivers' licenses.ALONE AMONG the passing pediatricians, Dr. Pete Kelly, a Chattanooga urologist, walked over to talk to Holmes for a while. Although he was sympathetic to her argument, he ventures that he would be hard-pressed to find one set of parents in the state of Tennessee willing to raise a child with ambiguous genitals, much less an ambiguous gender. They want the child fixed, and fixed fast."Let me tell you, these parents are devastated," he says. "They don't know what they have. All they want is a normal baby."Of course, Kelly wouldn't have walked over in the first place if something about the protest hadn't struck a nerve. There remains, among the doctors, a fuzzy view of what happens to their patients 15 or 20 years down the line, as well as the conviction that the early operations were gratuitously damaging -- micropenises that were "recessed" to look like normal female clitorises often lost all sensation. Jeffs, from his office at Johns Hopkins University, freely admits that."Certainly there was a time when erectile tissue was simply eradicated," he says. "That hasn't been my practice for 30 years. I can understand that they have a problem. I'm not sure that if one went back, that individual problems could not have been managed better with the techniques we have now. One does the best one can."Richard Pillard, a psychiatrist at Boston University's Family Studies Laboratory, is among ISNA's handful of witnesses for the prosecution. Like a number of psychiatrists and social workers, he is encouraging physicians to admit that their cases do not end in post-op, but must be followed for a lifetime to judge their success."It's just like radiation therapy -- from time to time we've had to relook at a treatment and say the treatment we've given was ill-informed," Pillard says. "We do something because we have to do something, and then we realize it wasn't the right thing. Isn't that the way science is?"And so, today, doctors treat the cases as they come up, with the best solutions they can think of to integrate sexual anomalies into society. The truth is, not even the doctors know how thoroughly they are succeeding over the long term. By the same token, they have no evidence that anything else would work better. One doctor who responded to ISNA is David Sandberg, a psychoendocrinologist at Buffalo Children's Hospital, who wrote this for the ISNA newsletter: "I would suggest, however, that there is very little data to support either [the current approach] or ISNA's approach. We are unfortunately all flying by the seat of our pants, clinically."MEANWHILE, CERTAIN of the ralliers left the picket line for a life still lived in half-darkness. Because intersexuals -- when they are not lobbying -- tend to fall well outside the social comfort zone, feeling wronged by science and cast out by the community. At the end of ISNA's demands is this: we should no longer be treated with horror.Dana Montgomery, who uses a handful of fictional names, is 6--1 and broad-shouldered, with fully developed breasts and slightly swelling hips, smooth skin and long, straight hair. He (he prefers "she") took male hormones beginning at the age of 16, and now appears indeterminate."If I need a newspaper, I get it from a vending machine, not a store." says Montgomery, in a quiet, feminine voice. "It's really difficult for me to go out. I go out mostly at night, after dark. I'm closer to invisible at night. I try to avoid people."At 42, Montgomery house-sits in Newtonville -- his parents' house, until they left, he says, because they could no longer stand the sight of him. He has very little money, close to none, and lives an isolated life. Though he says he could give a parent better advice at raising an intersexual child than science currently offers, he says he couldn't assure them a happy child. A world in which he would have grown up happy is a distant prospect.As things are, "there's a split," says Montgomery, who founded an intersex support group called the Middlesex Group. "There are people who function pretty well. They often went into computer programming, or sales, which requires a lot of acting anyway. And there are people who can't handle it and wind up hermits and scraping by."Raven Kaldera falls into the former category; she displays the kind of serenity that comes after the end of an ordeal. Five years ago, Kaldera gave up a 16-year effort to be female. Born with congenital adrenal hyperplasia, she never underwent surgery, but an aggressive program of estrogen injections held her male puberty at bay through an early marriage and the birth of a baby daughter."Finally it was like, 'If this bird ain't flown, this bird ain't gonna fly,'Ê" says Kaldera. Since going off estrogen her libido has skyrocketed, her voice has dropped a register, and those whiskers have come back. She is no longer wholly female, and expects to pass for a male visually (if not chromosomally) within three to five years.All things being equal, it's gone well for Kaldera. At 31, she sees an alternative somewhere -- in the natural tolerance of children, in history, in mythology -- and hopes that after a while it will ripple out through society. Once, when she was 10, she found a description of a hermaphrodite in a book of Greek myths, and for a brief period she recognized herself. Then she was a woman for 16 years. But there was that moment."My first reaction was, 'Yeah, this is right,'Ê" she says. "And then the social taboos kicked in. But at first, I thought it was magical. I was becoming a mythical beast. It was like I was sprouting a horn. It was like I was becoming a unicorn."