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bite or other accident, or even abuse. Again, the idea that gender identity and gender-related behavior was overwhelmingly due to social rearing conditions—combined with the fact that it was easier surgicallyto create something like a vagina than a penis—led to a number of these boys being labeled and raised as girls and getting hormone treatments at puberty to make them as much as possible into women. One such unlucky child, whose identical twin was typically male, was assigned to be female shortly after the accident. A vagina was surgically constructed early on, and female hormones were given in adolescence. It was hoped that these interventions, along with enveloping family and cultural influences, would make this child an infertile but otherwise normal woman.
    It didn’t. The young woman always felt uncomfortable in her role. Eventually she searched for information about her early life and learned for the first time her own physical history. What she found out came as a great relief to her. It explained a whole life of feeling like a misfit, and she made up her mind to reorient her identity. When she was a girl named Joan, others arranged for her to have surgery and hormone treatments to make her more female. Now she decided to become John and as an adult independently arranged to have the reverse surgeries and medical treatments. One of Joan/John’s doctors said in an interview later on, “He got himself a van, with a bar in it. He wanted to lasso some ladies.” Sadly, two years after his twin brother committed suicide, John was depressed and took his own life. Since his twin had a typical male anatomical history, John’s suicide cannot simply be attributed to his unusual one; obviously the causes were complicated.
    Some would say this story is a tribute to free will—Joan decides to become John (as many thousands of transsexuals have now done, one way or another) and, with a little help from her surgeons and endocrinologists, crosses a boundary that used to be thought impassable. But in this case, a determining, or at least a very influential factor—male hormones affecting Joan/John’s brain before birth—made her uneasy in her assigned role as a girl becoming a woman. The most basic human compassion allows sympathy for her wish to be a man. In another such case—fortunately, they arerare—the penis was lost at the age of two months, sex reassignment and corrective surgery was done by seven months, and the child was raised as a girl. She retained a secure female identity, although she always leaned toward boy-typical toys and games. Interviewed at age twenty-six, she disclosed that she had had an unsuccessful relationship with a man and was in a successful one with a woman; at this time she described herself as a lesbian. So biology has its influence, but it interacts with experience in complicated ways.
    What about the growing number of transsexuals—people seeking surgery and hormonal treatment to make them into the sex that they are not? Today, many thousands have had such surgery. Don’t they show evidence of pure free will, now for the first time in history able to be exercised in this way? Not really. People cannot legitimately be granted the chance to surgically and medically change their sex unless they can show that they deeply feel, and have pretty much always felt, at odds with their own bodies. That is, they have male bodies but feel that they should be women, or they have female bodies but feel they should be men. Free will? In one sense, yes. Medicine and surgery allow them to choose, doctors and counselors help them, and the laws in enlightened countries don’t stop them. But where did their will to change come from? We don’t know the biological history of their profound discomfort, their elemental desire to belong to what we call “the opposite sex.”
    Randi Ettner, a psychologist who has devoted her career to helping such people, has written, “Many young children experiment with