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'-,,0'' The.simp-1-e,sr.ay 9 put it iq ikg this: calie is a girl who hasa rirdktoo.m-uc,h$al,9.hormone.._We._w.anfo'coqrgctthati,Neither Milton nor Tessiesaid a word. They werenlt follo*,rngeverything he doctor was sayingbut, aspeopledo with d.octors, irm-were attentive to his manner) ryrng to seehow serious hings u.erc,,Luce seemedoptimistic, confident, and Tessieand Milton b.g* wbe filled with hope.'llhacs the biology. Ics avery rare geneticcond.ition,by the rvmThe only other populations wherewe know of this mutation expre$-ing itself are in the Dominican Republic, papua New Guinea, dsoutheasternTurkey.Not that far from the villageyour parenrscafilsfrom. About three h'ndred miles, in fact." Luce removed his silrrrglasses.Do you know of any family member who may havehadasimilar genital appearanceo your daughtet'sf',"Not that we know o{,, saidMilton."When did your parents mmigratel','T.{ineteen wenty-two.,'"Do you haveanyrelativesstill living in Turkeyf,', 'T.{ot anyrnore."Luce looked disappointed. He had one arm of his glassesn hismouth, and was chewing on it. possibly he was imagining what irwould be like to discovera whole new population of carriersof thrS-alpha-reductase utation, F{ehad to conrent himself with discov--'::i*s,me'I H" put his glassesback on. ,1lhe trearment Id recommend for

: your daughter s twofold. First, hormone injecrions.second, cos-i metic surgery.The hormone rreatmenrswill initiate breastdevelop

-,'* [ ment and enhanceher fema]esecondarysex characteristics. hert ! surgerywill makecallie look exacdy ike the girl she eelsherself oi be. In fact, shewill be that girl. Her outside and insidewi-ll conforrn.\ fn..yn to9\ utcea normal girl. Nobody will be able o te[ a thing.\And then Calliecango on and enjoyher ife.,,*- Milton's brow was still furrowed with concenffationbut from hiseyes herewas ight appearing, aysof relief He turned toward ressieand patredher leg.But in a timid, breaking voice Tessieasked, will shebe able tohavechildrenl"

Luce pausedonly a second. I'm afraid.not, Mrs. stephanides.Calliewill nevermensrruatei,

"Butshe'sbeenmenstruatingforafewmonthsnowi'Tessieob-;iected...I'm afraid that's impossible. Possibly there was some bleedingfrom anothersource."

Tessidseyes illed with tears.She ooked away'..I just got a postcard rom a flormerpatientl'Luce saidconsol-;ngty. SftJad a condition similar to your daughtefs' She'sma*iedtt":*. Sfr. and her husbandadoptedt'wo kids and they're as happy ascanbe. Sheplays n the ClevelandOrchestra'Bassoonl'There was a silence,until Milton asked, Is that it, Doctorl Youdo this one surgeryandwe can akeher homel"..Wemayr'uv.todoadditionalsurgeryatalaterdate'Buttheim-mediateanswer o your question is yes'After the procedure,shecango home,"

"I{ow long will shebe in the hospitalf""Otrly overnight." ,*sw*It was,rot " difii.olt decision,especiallyasLuce had framed it. A

singlesurgeryandsome njectionswould endthe nightmareandgive

-/p"t ttl back their daughter, their Callicpe,intact' The sameen-

ti..rrr.nt that had ed my grandparentso do the unthinkable now of-fered tself to Milton andTessie.No one -"***g1)::*ffit"t"*.ever now. ,, "I ,, ,f , .,\, :."Arr"rr-(,S4rile my parentswere being given a crashcourse n gonadogenesis'I-still "in.i"Uy Calliope was doing somehomework myself' In theReading Room of the New York Public Library I was looking up,om.th!,'g in the dictionary. Dr. Luce wascorrect n thinking that hisconversationswith colleaguesand medical students were over myhead. didn t know what "5-alpha-reductase"meant,or "gynecomas-tial' or "inguinal canal."But Luce had underestimatedmy abilities,too. IIe didnlt take nto consideration he rigorous curriculum at myprep school. He didn't allow for my excellent researchand study,mL. Uot. of all, he didn't factor in the power of my Latin teachers'Miss Barrie and Miss silber. so noq asmy wallabeesmade squish-ing soundsbetween he readingtables,asl few men looked up fromtheir books to seewhat was coming and then looked down (theworld was.no longer firll of eyes), heardMiss Barrie'svoice in myear. Infants, define this word for me: bypospadias'se your GreekorLatin roots.t'

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volvulus rearing ts dragon'shead rom an cy lake. Frereyeswere fill-ing now, making the print swim, and she turned awayand hurrier*out of the ibrary.But the syxonympursuedher.All the way out the door anddorl,rathe stepsbetween hi stone lions, websteds Dictionary kept calringafter her, Mon*er, Monster! The bright banners hanging from tlrstympanum proclaimed the word. The definition inserred itself immbillboards and the adson passingbuses.on Fifth Avenuea cab wasplling up. Her father umped out, smiling andwaving. When Ca[irsawhim, her heart ifted. The voice of Webster,s toppedspeakingxher head. Her father wouldn't be smiling like that unless he nern*from the doctor had been good. callie laughed and sprinted dou,nthe library steps,almost tripping. rrer emotions soared or the time irtook to reach he street,maybe ive or eight seconds.But coming;closerto Milton, she earnedsomething about medicarreports.Themore peoplesmile, the worse the news.Milton grinned at her, per-spiring in pinstripes,and onceagain he tragedycuff link slinted iothesun. "f l;.e* r ci f or JcJ"'I+.i.r.i g,rrn:r"aglift*u*tw hi_a J*fi,:,-t. sqt_r"f_T!:f 4.y. $sr parents""frnbri.-she"ivas" - ry1g5r-ster.nd yet herewas Milton, opening the car door for her; here was Tessie,nside,smiling ascallie climbed in. The cab took them to a restaurantandsoon the threeof them were ooking over menusand ordering food,Milton waited until the &inl$ were served.Then, somewhat or-mally, he began. Your mother and I had a ittle chatwith the doctorthis morning, asyou areaware.The good news s that you,ll be backat home this week. You won't miss much school. Now for the badnews.Are you ready or the bad news,Calf,'Milton's eyesweresaying hat the bad newswasnot all that bad."The bad news s you have o havea ittle operation. Very minor.

'operatiort' isnit really the right word. I think the doctor called t a'procedure.' They have to knock you out and you have to stayovernight in the hospital.That's t. There'll be somepain but they cangive you painkillers for it."With that, Milton resred.Tessie eachedout and patted Callie,shand. "It'll be okay,honeyj'she said n a thickenedvoice. ler eyeswerewatery, ed."Slhat kind of operationf" Callie askedher father."Iust a litde cosmeticprocedure.Like getting a mole removed..

He reachedout and playfully caughtcallie's nosebetvreenhis knuck-les. Or gening your nose ixed."Callie pulled her headaway,angry."Don't do that!""Sorryi'said Milton. He cleared is throat, blinking'"What'swrongwithmel"-Ccilli,o..paaqkEd*fl dgw*hq,f-J,ojfifu

broke.Tearswererunning down her cheeks.Tfhacs wrong with me,Dhddv!, , -_: i^rr* , . .c . ; r _r, .""liir;".#ft*H"nd:*ft*,ff.1ffih#ffh*;;# ror imto say he word, to quote S/ebste1s,but he didnt' He only looked ather acrosshe table,his head ow, his eyesdark,warm, sad,and fi:ll oflove. Therewasso much love in Miltorfs eyes hat it was mpossibleto look for truth.

"ICs a hormonal thing, what you've got]'he said' "I was alwaysunder the impressionthat men had malehormonesand women hadfemalehormones.But everybodyhasboth, apparendyi'

Still Calliewaited."What you've got, see,s you've got a little too much of the malehormones'and not quite enough of the femalehormones' So what

the doctor wants to do is give you a shot everynow and then to geteverythingworking right'"He didn't say he word' I didn't makehim."It's a fu;g;gggl thin-gl'Milton repeated. In the grand schemeof,h-S,ffipHHq4m$*

Luce believed hat a patient of my agewascapableof understandingthe essentials. nd so, that afternoon, he did not mincewords' In hismellow, pleasing,educatedvoice, ooking direcdy into my eyes'.{*tss.gsqbredrhar1*wassirlwbg1.-sl*.o:T;5T:tJ14t$*.4-s'fif-gSSlSSb."He drew the same harts oi-fre ashe had tor my Par--tr;. Wh*l pressedhim on the detailsof my surgery,he s1{ o{Vthis: "We're goiog to do anoperation to finish your genitalia'They'renot quite finished yet andwe want to finish them'"

H. o"rr., mentioned anything about hypospadias,and I began ohope that the word didn't apply ro me. M*yb" I had taken t out of.orra"*a.Dr. Luce may havebeen referring to another patient. web-stet'shad said hat hypospadiaswasan abnormaiity of the penis.ButDr. Luce was telling me that I had a clitoris- I understood that boththese hings grew oot of the same etal gonad, but that didn't matter'

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: ;I If I had a clitoris-and a specialistwas telling me that I did-""xi;'tri,,_gp,gstbe but agirllThe adolescentego is a hazy thing, amorphous, cloudlike. ih

wasn"tdifficult to pour my identity nto differentvessels.n a sensewas able to take whatever form was demandedof me. I only lvarsr*to know the dimensions. uce wasproviding them. My parents up-ported him. The prospectof having everythingsolvedwaswildh-s-tractive to me, too, and while I lay on the chaise didn't ask mr*'rkwhere my feelings or the Object fit in. I only wanted it ali to be rv'm.I wanted o go home and forget it had everhappened.So I liste*mto Luce quiedy and madeno objections.He explained he estrogennjectionswould induce my breas* r"'grow "You won't be Raquel Welch, but you won't be T*iggy eitfwrr'My facial hair would diminish. My voice would rise from tenor mlalto. But when I asked f I would finally get my periocl,Dr. Llce u';*frank. "No. You won't. Ever.You won't be able o havea babyvotx-self,Callie. If you want to have a family, youill have o adopt."I received his news calmly.Having children wasn't somethinEthought much about at fourteen.

There was a knock on the door, and the receptioniststuck h*rhead n. "Sorry Dr. Luce. But could I bother you a minutel""That dependson Calliel'He smiled at me. "You mind takins,;litde breakl I'll be right backl'"I don't mindl'"Sit there a fer,vminutes and see f any other questionsoccur rryou."He left the room.While he was gone, didn't think of anyother questions. sat nmy chair,not thinking anything at all. My mind was curiously blank.It was he blankness f obedience.With the unerring nstinct of chil-

dren, had surmisedwhat my parentswanted rom me. They wantedme to stay he'r,vay was.And this waswhat Dr. Luce now promised.I was brought out of my absrracted tateby a salmon-coloredcloud passing ow in the sky. got up and went to the window tnlook out at the river. pressedmy cheekagainst he glass o seeas arsouth as possible,where the slyscrapers ose. I told myself that Iwould live in New York when I grew up. "This is the city for melI said. had begun o cry again. tried to stop.Dabbing at my eyes,I wandered around the office and finally found myself n front of one

of the Mughal minianrres' In the small' ebonyframe' two tiny figuresweremakingou"'ut'p'lt" il;;"; ilnfea uvtheiractiviry'heirfacesookedpeacefrrl';;;;"Ptttlioy sfroleaneithersffainnorec-stasy. ut of courser.^r"*, #.rerr't the ocalpoint' rtrl s;o3;tv ofthe overs'bodies' h" ;;;t"frtl ca[ig11phy f their limbs edtheeyestraishto heact"ria' e*n'r'"'Gy:f#lT*[J"it-5;-p"*h:r,'"::g:":ilffi:illlii.lill';oH; ;'*,oseeow:'$:;;3#'#:13lfi: ffi;i**:t: :'fffi -,tooooti'm."'g"'ll-;f' * **,*lfffffffl. :ffiT#."'rv-"""d1;"li:"?li:S;:tlil.1*; l ;."t J.,r'rn'r'I swungarouno',". oi.n rfi.re' IIe had eft it whenhehurriedoff'PRELIMINARY STUDY:GENETICXY (MALE) MISED ASFEMALB

The fol lol i ' ing i l lustrat ive case ind'icates thattbere is no preordained correspondence betl -reen

ge -netic an d geni tal structure; or bet""teen nascul ineor f erninine tet 'avior an d chromosor0al status'

SUBJICT: Cal l ioPe StePbanidesINfERVIIWER: ?eter luce; M'X'

IETR0DUCTORY AfAt th e patient is fourteenyears

o1d' Sb'e o" "-' i ""U as a female al l be r l i fe' At

birthl soloatic appearance l 'va-sof a penis sosmal l

as to "nn""t-*o i- u a cri toris 'Ib'e subject 's XY

karyotype "u"" oo t discoYeredunti l puberty l 'r 'rhen

sb'e began'o"-i t" 'ue'

l the girl 's parents at f i rstrefuse'l to bel ieve tb e doctor wb o clel ivered

tb ener,-, /s"o u "ro"in*ut ' try "uauu 1: "

trvo otb'er opinionsbef,ore ""t 'o*"i l - in"" c"oa"t

ld'enti tv cl inic an dfierrvYork EosPita1 Cl inic '-guring exJnination' undescencled' testes coul

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' / - 'ras uffering fron 5-a1phe-red.uctase defic iencysynd.rone. An exploratory laparotony l i ,as no t per_r.or19+r.."; A fani ly photograph (see case fj . le) shorvs h.erI et ag e twelve. Sh e appears to be a happy, heal tby. girl lv i th no vis ible signs of torcboyishnss1 de -I spi . te..her XI karyotype.* l t tR5b IM?RnssIoN: th e subject 's faciat expression,

though sonewhat stern at t i raes, is oyeral l l leas-an t an d receptive, wi th frequent sni l ing. Ih e sub_ject often casts he r eyes d.olvrlvard n a nodest orco y nanner. Sh e is feminine in he r movenents an dgestures, an d th e sl ight gracelessness of he r lvalkis in kee3ing lv i th females of he r generetion.lhough du e to he r height sone people ma y find. tb esu b ect 's gend.er at f i rst glence sonel ., /h&t nd.eter_nlnate, any prolonged. observatlon !voul_d, esul t ina decis ion that sh e I,uas nd.eed. a girl . Ee r voicelin fact l ha s a soft, breathy qual i ty. . f lbe inc11!e.she r head. to l isten l-,r.hep not.he.r person speqks end.abes -not-' [ 'old. rorth or ess.ert. ]eI .98.]_4-ion.s..n abul ly lqg.rn&nrer characterist j_c of mates. Sh e often#ak-g: hunorous ren"elli_s-r_..I 'AMIl i : Th e girl 's parents ar e fairly typieal Mid-lvestelners of tb.e World l far II generation. Ih efather id.enti f ies hircsel f as a Republ ican. fh emother is a friendly, intel l igentl an d carin per_sonr lerhaps sl ightly prone to d.epression or neu_rosis. Sh e acced.es to th e subservient lv i fely roletypical of lvomen of he r generation. Ib e fatheronly caroe to th e Cl inic t lv ice, ci t ing businessobl igations; bu t from those tl .ro rneetings it isapparent that he is a d.ominating presence, &"sel f-mad.e" ma n &nd. former naval off icer. In ad.dt i -

t ionl th e subject ha s been raised ln th e Greek 0r _thodox tradi t ion, vri th it s strongly sex_defined.roles. In general th e parents seem &ssimi lat ionistand. very ttal l -.A.erica,n" in their outlook, bu t th epresence of this deeper ethnj-c id.enti ty should no tbe overlooked,.SXXUAII r' i l {CIION: fh e subject reports engaging inchi l t lhood. senual_ play v,ri th other chi ldrenl inevery case of lvhich sh e acted as th e femininepartner, usual ly pul l ing up he r d.ress an d lett inga bo y sj .mulate coi t j .on atop her. Sh e experienced.

pleasur&ble erotosexual sensatj 'ons by posi t ion-in g hersel f by tb.e lvater jets of a nej 'ghbor'ss,,,r inning pool . Sb e nasturbated frequently fron ayoung age.

Th e subject ha s ha d no serious boyfriend'st bu tthis na y be due to her attentl ing an al l -gi rlsschool or from a feel ing of shame about he r body'The subject is aware of th e abnorroal appearance ofhe r geni tal ia ani l b'as gone to great lengths in th elocker room and' other communal dressing areas toavoid being seen nakect. f fevertb'elesst sbe reportshaving ha d sexual j -ntercoursel on e tlme onlyt "rl i tb'th e brother of he r best friendl an experience sh efouni l painfut but lvhich rivas successful fron th epoint of v iew of teenage romantic explorat ion'I t{tXRTIgW: fh e subject spoke in rapic l burststc learly an d art iculately bu t l 'v i th th e occasionalbreathlessness associated. lv i th anxiety ' Speechpatterning a.naicheracterist ics appeareci to be fem-inine in terms of oscj-l lat ion of pi tch and ti iTecteye contaet. Sb e exlresses sexual interest innele q.., ,exglusive Y. 'd,r_!W61

'r " '6orclustoN: :I n speechl nennerisnst 8nd dresst th e'' i 'eu,bJ.eet '"ri r ini fests a feminine gender identi ty an dro1el d.espi te a contrary cbromosomal status'rt is clear by this !ha! sp+ .qf T.s.e#iP"gj,'r,*,1hgrtban genet ic det ernqnant s 1 p-1FJ.P'3...95.9"+1.-e-I',L919":4th e establ ishnent qf gentleS .},,4p-11+.!VtAs th e girl t s gend'er identi ty l i 'as f i rmly estab-

lished as female at the ti rne he r cond'i ' t ion l i 'esdiscoveredl a decis ion to impleraent feniniaing sur-gery along ',v i th correspontl ing bornonal treatnentsseems colrect. To leave th e geni tels as they er etoclay lvould expose he r to al l nanner of buni l ia-t ion. Tbough it is Sossible tbat th e surgery ne yresul t in part ial or totel loss of erotosexualsensationl sexual pleasure is only one factor in ahappy 1i fe. 3h e abi l i ty to rnarry and' pass as enormal wom&n n society ar e also inportant goalstboth of which rvi l1 no t be possible lv j ' thout feni-niz5.ng surgery ancl hormone treatnent ' Alsot it ishoped that nerv methods of surgery l 'r i l l nini roigethe effects of erotosexual dysfunction broughtabout bj ' surger5-es in th e past t ! 'vben f eniniz ingsurgery rras in it s infency.

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That wening, when my morller and I got back to the hotel, I{*rrn;had a surprise.Tickets to a Broadway"musicar. acted.excited rse.later, after dinner, crawled into my parents,bed, claiming I w,as rm,tired to go."Too tiredl" Milton said. .S4ratdo you meanyou,re oo tireCi:'_Jhat'sokay,honey,,'said essie.you don't have o gol,"Supposedo be a good shoq Cal.,,'"Is EthelMerman n itf" I asked.. "No, smart-ass]'Miltonsaid,smiling. "Ether Merman s not in mShe'snot on Broadway ight now. SoL,re seeingsomething ri*n

larol Channing. She,spretry good, too. \4lhy -aorf, yor-."**,along|""No thanksj'I said.*Okay, rhen.you're missingouti'Jnll starteA o go. "Bye, hbneyi my morher said.|;i{ae1rlf t Jumpedout of bed and ,an to Tessie,hugging her.'lWrat's this forf,'she asked.My eyesbrimmed with tears.Tessieook them to betearsof relistat everything wed been through. In the narrow entryway can,edfrom a former suire,cockeyed,dlm, the two of us stood fr"ggid".dcrying.

. Ie.r they were gone, I got my suitcase rom the closet.Theri.looking at the rurquoisgflowers, I exchangedt for my fathet's suit-case,a graysamsonite I reft my skirts andmy Fair Isresweatern *ledresse.r rawers. packedonly the darkergarments,ablue crewneckths alligator shirts, and my corduroys. he brassiere aband,oned-too. For the time being, I held on io ,rry socksand panties, and I:".::.d rn my toiletry case ndre. I/hen I was inished,L."rit.d ;*Yil:":t garment bag for the cashhed hidden there. The wad wasfairly largeandcame o nearly threehundred dollars.It wasn'rail Dr. Lucet fault. I had lied to him about many things.His decisionwasbasedon farse ata.But he had been arsen turn., ," "-O-tr."".:.pbcef stationery I left anote for my parenrs.

DearMom andDad,. I know you,re o"ly tryrrrg to do whaCsbest for me, but Idont think anyoneknows for surewhaCsbest. tou. yo,-r Jdon't want to be a problem, so I've decided to go away. I

know you-ll sayfm not a problem, but I know I am' If youwant to know why I'm doing this, you'shoq*gk ?t l"*:who is a big liar! i am not a git$fiim a bovl*That'swhat Ifound out today. So l'm going wneig-nFa?ie'knows me'Everyone n GrossePointe will talkwhen they find out'Strry I took your money, Dad, but I promise to pay youbacksomedaY, ith interest'

Please ort't worry aboutme' I will beALL RIGHT !Despite ts content, I signed his dlclarltiol to my Parents: Callie'"i.*urthelasttime]-w..{.9Y"-e{:bgt-*-e$htg.L

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