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experiment that had decided her gender. She had refused to have further surgery to construct more complete genitalia. She felt alien and violent and distraught, and at last, when she was fourteen, her father confessed all that had been done. Soon Brenda set out to become a man, to become what biology had made her. She underwent a double mastectomy. She had a penis and testicles created from grafts and plastic. She injected testosterone to give herself a man’s muscles. She named herself David. And eventually David killed himself.
    Berlin talked about this failure, and another—with pedophiles. “Money was the first person to use medicines to lower testosterone. His theory back then, and I hope I’m doing justice to it, was that you give people a vacation from their sexuality and that gives psychotherapy time to work. Myself and some other researchers, with his permission, we took a look at the outcomes. And what we found was that as long as the people were still taking the medicine they were not reoffending, but a very high percentage who had the psychotherapy—once they stopped the medicine they did reoffend. We now don’t look at the medication as a treatment while you’re waiting for psychotherapy to work; it’s more like insulin for diabetes. This is what you need over the long haul to keep you in control of yourself.”
    Thinking about the sources of particular desires—Michael Ross’s for the sadistic; Jacob’s for feet; the most prosaic erotic preferences of the most prosaic heterosexual—Berlin acknowledged the potential role of childhood experience but couldn’t much credit it. The connections seemed loose and unlikely ever to be conclusively demonstrated. He believed that the sources would eventually be found, primarily, in the realm of biology, that they would prove to be “programmed in,” as technology advanced to better illuminate the brain. He lamented the loss of free will that his prophesy seemed to imply, worried that such biological determinism supplanted the idea of mind as opposed to brain, feared an Orwellian world where neurological understanding would be precise enough so that the sexual regions of the brain could be manipulated to eliminate variations of desire or so that sexual anomalies could be detected in the womb and fetuses could be aborted accordingly—but the truth of biology’s inborn power seemed inescapable.
    To Berlin, the only solution with someone like Jacob was to fight biology on its own terms, no matter how crude the weapon—to prescribe an anti-androgen and hope that, with lust obliterated, Jacob would find within himself at least a faint version of conventional longings. This had happened not only with the sadist who’d handed Berlin his club but, more recently, with another patient. Berlin’s gynecologist voyeur, who’d lost his practice and barely avoided prosecution before coming to Berlin for help, told me that on Lupron sheer lust was completely killed but that other yearnings—for pleasing a partner, for conforming to the society’s notion that a married couple should be having sex—continued to motivate. “The skin on skin,” he added. “The feelings of being close to someone. And the orgasm still feels good. Though you’re not fired up by the primitive side of your brain. So sex can seem a very messy thing, like more trouble than it’s worth, like why bother.” He mentioned that he used Viagra, which Berlin prescribed for some of his patients on anti-androgens, patients who’d gotten control of relatively harmless paraphilias, so that, devoid of the urgency of lust, they might be able to become erect and carry out their more tender longings. He mentioned, too, that his penis had shrunken slightly since he’d started taking Lupron. Then he laughed: “I wonder what would happen if all men went on it for six months. Think about the advertising industry. All those commercials aimed at the primitive sexual urge. They’d have to find a new way to