Books selected and reviewed by James Park,
existential philosopher and sexologist.
The sections in black are intended to be objective reports of the contents of these books.
The sections in red are the evaluative opinions of this reviewer.
These books are organized by quality, beginning with the best.

1.  John Money  
Sex Errors of the Body and Related Syndromes:
A Guide to Counseling Children, Adolescents, and Their Families

(Baltimore, MD: Paul H. Brooks Publishing Company, 1994—2nd edition)       132 pages
(ISBN: 1-55766-150-2; hardcover)
(Library of Congress call number: RC881.5.M66 1994)
(Medical call number: WJ712M742s 1994)

    John Money—foremost sexologist of the 20th century—
presents in a small book of only 130 pages
all the basic information about sexual birth defects
and how they have been dealt with.  

    This book can be understood by every parent of an intersex baby
and by all who deal with persons
having some chromosome or hormone defects
that lead to a body somewhere between female and male.  

    Money deal with the following anomalies:
gonads, fetal hormones, internal sex organs,
external sex organs, & pubertal hormones.

    He also discusses:
Sexual orientations for persons born intersex.
Assignment problems:  Is it a boy or a girl?
Explaining the problems to children at levels appropriate for their ages.
The emergence and development of sexual responses
—both usual and unusual.  

    All-in-all, this is a good place to begin reading
about the various intersex conditions.  
This book presents in a very brief form
themes that are explored more comprehensively
in other books by John Money. 

2.  John Money 
Biographies of Gender and Hermaphroditism
in Paired Comparisons:
Clinical Supplement to the Handbook of Sexology

(Amsterdam, Netherlands: Elsevier, 1991)                    375 pages

     Detailed case studies of 22 intersex individuals,
most followed from infancy thru adulthood.  Main themes:
(1) sex assignment confusions, problems, mistakes, & later corrections;
(2) hormonal problems before birth and at puberty
—and their correction when possible;
(3) surgical correction of make the body more male or more female;
(4) family histories of coping with sexual birth defects;
(5) male/female self-designation struggles for all intersex individuals;
(6) sexual histories, romantic histories, marriage, adoption of children,
adjustment, & mal-adjustment.

     This book should be read by all intersex individuals,
their families, & all professionals who deal with them.

3.  John Colapinto 
As Nature Made Him:
The Boy Who Was Raised as a Girl

(New York: HarperCollins, 2000)       279 pages
(ISBN: 0-06-019211-9; hardcover)
(Library of Congress call number: RC560.G45C65 2000)

     This book is journalism rather than science.
But it has introduced thousands of people to sexology
who would never have taken the opportunity to read a more technical book.

     Colapinto tells the story of David Reimer,
who lost his penis in a circumcision accident at age 8 months.
After his parents saw a television program featuring sexologist John Money,
they decided explore the possibility of raising their son as a girl.
In consultation with John Money
and other psychological and medical professionals,
they decided to raise Bruce (David's original name)
as a girl (Brenda) beginning at age 19 months.
The infant's testicles were removed at age 22 months.
In retrospect, this might have been too late to change the sex of a child.
Male/female self-designation ("I am a boy." or "I am a girl.")
is probably set—imprinted—by age 18 months,
by the time a child begins to speak.

     David Reimer's story is a psychological experiment that failed.
After some troublesome years as a girl, at age 14 years,
when David learned that he was born a boy
(just like his identical twin brother),
he decided to begin living as a male once again.
And as of the publication of this book,
he has lived more than half of his life as a male again.
He married a woman who already had three children,
thereby becoming an instant father.

     Hormone treatments and a new constructed penis
have helped him to cross the sex-line for a second time.
Psychologically he seems well adjusted to being a male,
even tho he spent his childhood (ages 2-14) as a girl.

     As Nature Made Him is based mainly on interviews with David,
when he was an adult male in his early thirties,
and as many other people as John Colapinto could find
three decades after the story began.
When depending on recollections years after the events,
it now appears obvious that it was never a good decision
to try to raise David as a girl.
But David might have remembered mainly the facts
that supported his decision to live as a male again.
(In reading the life-stories of many sex-changed people,
we often note that the childhood recollections
almost always support the later decision to change sex.)
Here the adult David Reimer might want to remember
that he was always a boy,
even tho everyone around him tried to raise him as a girl.

     However, we do have some good records from her childhood
that show that Brenda always resisted having a vagina constructed.
She believed that she was a girl, but she did not want any more surgery.
Her sexual attractions (such as they were) were toward 'other' girls.

     To this reviewer's knowledge,
John Money never responded to this book,
which is highly critical of his role in advising the Reimer parents
to raise their damaged boy as a girl.
John Money is familiar with other cases of failed sex-changes,
in which the individual later decides to go back to the original sex.

     In this case, there are three possible explanations for the failure:

     (1) Perhaps 19 months was too late to try to switch the sex of a child.
If the child has already begun to speak
and has heard itself referred to as either a "he" or a "she",
the imprinting of male/female self-designation might already have taken place.
David Reimer might have had some unarticulated awareness of being a boy
from his early life before he was switched to being a girl at age 19 months.

     (2) Even more important, his parents and other adult relatives
were already very accustomed to thinking of Bruce as a boy.
Even tho they were all told to treat the new Brenda as a girl,
they knew the truth of his birth as a normal boy
and the circumcision accident that destroyed his penis,
and they might have communicated this family secret unconsciously.
David's father reports that he knew the experiment was a failure
when Brenda was 7 or 8 years old.

     (3) Even without testicles to supply testosterone (the male hormone),
Brenda developed in ways that were remarkably like
her identical twin brother, Brian.
So Brenda's body may have compensated,
still producing a boy, because all his cells said XY,
rather than XX, which is the genotype for a normal girl.
If this was the case, his body was pulling one way,
even tho his socialization was pulling in the other direction.

     When David learned the secret of his birth, he was relieved
—and immediately set out plans for becoming a boy again.
He was given all the necessary hormonal and surgical treatments,
which have helped him to be nearly a normal male as of the year 2000.

     All in all, this is a very interesting case study.
But even the author admits at the end
that one case is not a sufficient basis for drawing scientific conclusions,
John Colapinto was able to convince David Reimer to go public
at least in part because his case was being misused
to show the ease with which children could be raised as either sex.

     Now that one person has been willing to tell the whole story,
others will doubtless come forward with other case histories,
some confirming that nurture cannot overcome nature
and some showing that people can successfully switch
from one sex to the other.
It will be an interesting time for sexology.

    Postscript 2004:  David Reimer ultimately killed himself in 2004,
two years after the suicide of his twin brother.
We might never know whether his sex-change problems
were a factor in his decision to end his life at age 38.

4.  Suzanne J. Kessler
Lessons from the Intersexed

(New Brunswick, NJ: Rutgers University Press, 1998)       193 pages
(ISBN: 0-8135-2529-2; hardcover)
(ISBN: 0-8135-2530-6; paperback)
(Library of Congress call number: RC883.K47 1998)

     Intersex people were physically ambiguous at birth with respect to their sex:
They were born neither clearly male nor clearly female.
And since it became possible in the 20th century,
they were usually given medical treatments
to make them more definitely one sex or the other.

    But the author of this book takes a different stand:
Kessler believes that doctors should not interfere with what nature has created.
She believes that 'gender' is a social construct.

    Her consistent use of the word "gender" to refer to the sex of an individual
—whether that person is a male or a female—
continues the confusion so common in our everyday thinking about sex and gender.
When we discuss the gender-personality of an individual person,
whether that person has 'masculine' or 'feminine' character traits,
we are clearly dealing with learned emotional responses.
Likewise, when we refer to the sex-role of an individual,
we a discussing external behavior expected in any society
because the individual is either a male or a female.
Both gender-personalities and sex-roles are fluid and flexible.
These are cultural constructs—the results of experiences since birth.
But the biological sex of any animal organism is not a social construct.
Most animals are clearly male or female.
Only a few have any ambiguity with respect to their biological sex.
These are the intersex individuals.

    For a comprehensive discussion of such confusions,
see the present reviewer's book:
Variations of Sex & Gender:
Six Phenomena Frequently Confused:
http://www.tc.umn.edu/~parkx032/VSG.html

    As this reviewer sees it,  Lessons from the Intersexed makes more sense
if we readers substitute the word "sex" whenever the author uses the word "gender".
The author's use of the word "gender" is part of her over-all political purpose
of claiming that one's sex is as flexible as one's gender-personality or one's sex-roles.

    This book is written from the perspective of the organized groups of intersexuals.
Most babies born with some sexual ambiguity
are now diagnosed and treated from birth
so that they can be as close as possible to whichever sex they most resemble.
The parents of these intersex babies make a decision based on science.
And their children are raised as either boys or girls.
They grow up wanting to be as 'normal' as possible.
Because they want to fade into the general population as regular men or women,
they have no use for the political movement of intersexuals.
Such individuals do not figure in this book.

    Before medical treatments for sexual birth defects was possible
or when the facts were not recognized early enough,
some people grew into adulthood as intersex individuals.
Each found his or her own way to cope with his or her body as given.
And sometimes they joined social and political groups
with others who have some variation of biological sex.

    Some of the interviews for this book took place in 1985.
So they reflect the experiences of the interviewees some years before that time.
Kessler describes a rather rudimentary method for treating intersex babies:
Sex was assigned on the basis of the external genitals alone:
If it is large enough and can be enlarged, it is called a penis.
And the baby is a boy.
If it is small and can be reduced, it is called a clitoris.
And the baby is a girl.
The family doctor of decades ago had no way to discover
whether the baby was XX (female) or XY (male),
or some other patterns of genes that created an intersex baby.

    But modern science has much better tools now:
instead of depending on the appearance of the external genitals alone,
we can now decide the sex of the baby on the basis of sex-chromosomes.
A simple blood-test can disclose the exact chromosomal make-up of the new child.

    Once the biological sex of the child is determined and announced,
the socialization processes begin.
All the relatives treat the new baby as either a boy or a girl.
If there was some ambiguity of biological sex present from birth,
the doctor might have given a simple, one-sentence explanation.
But when individuals born intersex become teen-agers,
they usually want more explanation of their differences from their peers.
They might consult the scientific literature about their birth defects.

    But if they join groups for intersexuals,
they will usually have developed their own mythologies,
which explain what they are and how they should live.

    In some state laws in the United States that deal with sex-change operations,
the sex of an individual is defined by reproductive capacity:
When a born-male is changed into a female,
he must lose the capacity to father children.
Likewise, when a born-female is changed into a male,
she must lose the capacity the bear children.

    Intersex individuals who have grown into adulthood
with little or no physical modifications
might also adopt the same convention:
Their male/female self-designation might depend on their reproductive capacities.
Are they closer to normal biological males or normal biological females?
When unusual imprinted sexual fantasies and homosexual variations are added,
the situation becomes even more complex.
See Variations of Sex & Gender: Six Phenomena Frequently Confused.

    Kessler is concerned about changing the size and appearance of the external genitals.
She takes the position that doctors should do nothing.
Herein she goes against most modern medical advice.
She has talked mainly with intersex individuals who had problems later
because of decisions that were made when they were babies.
So she concludes that doctors should do nothing.

    If her research had included people who were very satisfied
with their sex as assigned (and perhaps surgically corrected)
when they were still infants,
she would not be so completely against operations to correct birth defects.
If she interviewed only intersex individuals
who believe they were damaged or mutilated as infants or children,
how could she come to any other conclusions than
that operating on intersex babies should be banned?

    However, we do have lots of experience with the 'do nothing' option:
Thru-out most of human history (and pre-history),
it was simply not possible to do anything about birth defects.
People just learned to live with whatever abnormalities they had from birth.
In other words, the 'default' decision for most of the human race was do nothing.

    Until the middle 20th century, there was no way to investigate
the causes and prognosis of any abnormality.
But now doctors can carefully compare each variation
with what is known about that variation in other individuals.

    A good scientific research project would be a follow-up survey
of all children who received some medical treatment
because of various sexual birth defects.
What percentage had each identified kind of defect?
What percentage of each class was pleased with the results as adults?
What percentage of each class was displeased with the results
—and in what regards?
There are now probably thousands of adults in the US
who were treated for birth defects related to sex.

    Adults have a right to make their own decisions about sex.
But parents must decide for their infant children.
And they will usually depend on medical advice.
So far, there are few medical experts who support the do-nothing option.
But will further research support this option?

    Readers of this book will notice a strong author-bias against doctors.
She worries that doctors will not be concerned enough
about the sexual enjoyment of people who have had genital surgery,
which would be especially relevant when 'reducing' a clitoris.
The author seems to want to blame doctors
for everything bad reported by intersexuals.
She has read the medical literature,
but she basically uses it to discredit doctors.

    The author mostly ignores the underlying
genetic and hormonal causes of the birth abnormalities.
About 70 different variations from normal biological males or females
have now been identified.
These are really mistakes of nature,
not distortions caused by doctors.
Doctors seek to correct these mistakes of nature,
not force all people to be conventional men or women.

    Is the author worried that medical science
might once again be turned toward 'curing' homosexuality?

    The people interviewed for Lessons from the Intersexed
mostly see themselves as victims and part of the sex-and-gender minority.
But most intersex babies were 'corrected' soon after birth.
And they went on to live unremarkable lives as men or women.
Some do not even know they were abnormal in any way.
And most have learned to live with whatever physical differences they have.
After all, exact genital appearance is not a matter of public concern.

    Scientific follow-up for such individuals would not be easy.
How would a researcher find them?
Those who know about their birth defects
usually do not think of themselves as socially or sexually different.
And they might not want to be reminded of their birth defects.

    Nevertheless this book was needed.
It does validly point out many problems in handling intersex individuals.
This reviewer agrees that some of the surgeries were not needed.
They were done mainly because of lack of tolerance of sexual ambiguity.
In some cases, surgery was done because it could be done.

    Since most children do not see many genitals during their lives,
they do not have a lot of data for making comparisons.
Their own variations from some norm might not be important.
But it is psychologically and socially important
for each child to know which sex he or she is.
This might be different in a hypothetical culture that ignores sexual differences,
but in most cultures, everyone must be known as either male or female.

    Some surgeries can be delayed
until the child is old enough to participate in the decisions.
For example, why construct a vagina that will never be used?

    Kessler points out that some female-to-male transsexuals
do not need a penis for sex.
They want to continue having sex with women
while believing that they are men.
Surgeons are content with good-looking results.
But the parents and the patients have to cope with lots of other problems
created when the child is not normally a male or a female.

    This book does not deal with the reproductive capacities of intersex individuals.
This seems a serious omission since having children
is one of the most important meanings-of-life for some people.
Some intersex persons are surely more concerned about parenthood
than about the external appearance of their genitals.

    A more complete (and accurate) title for this book might have been:
Lessons from Intersexed Individuals Who Disagree
with the Treatment Decisions Taken for Them When They Were Children.

Created April 22, 2001; revised 5-30-2004; 4-29-2008; 5-8-2008; 12-10-2008; 1-9-2009; 1-22-2009; 4-23-2009

    Please send additional suggestions
for books to include on this intersex bibliography to:
James Park: e-mail: PARKx032@TC.UMN.EDU

    This bibliography is related to several others in sexology.
Here is the complete list:

Sexology                                      B-SEXOLO

Sex-Script Hypothesis                 B-SEX-SC

Variations of Sex and Gender      B-V-SG

1. Intersex                                     B-CRIT

2. Transsexualism                        B-TS

Transsexual Autobiographies      B-TS-AB

3. Sex-Roles                                B-ROLE

4. Gender-Personality                 B-GEND

5. Sexual Orientation                   B-ORNT

6. Cross-Dressing                       B-TV