Joe Holliday and medical gender assignment

Picture of a 10-year-old white girl (with a distinctly boyish face) with freckles, long dark hair and a black blouse with white dots.Back in the late 1990s I remember watching a documentary about a young girl then named Joella Holliday, whose mother had been fighting to get a birth certificate issued that said she was female. She had been hastily named Joel David as a newborn when doctors could not identify a sex because several of her abdominal organs were malformed or absent and it was feared that she would not survive very long, but doctors believed she should have been assigned female as she had no penis at all. It took nearly ten years and a public legal battle to get the certificate issued, but the publicity caused her to be bullied at school and to ultimately be withdrawn. I saw a couple of other interviews with Joella over the years and a literary agent’s website carried details of a forthcoming book, but this year the book was published, and Joella is now Joel (or Joe) again, and has reverted to living as a man. He and his ghost writer have done interviews and published articles calling for an end to the medical reassignment of gender to intersexed babies, claiming that studies have found that many of those with genders reassigned (usually female) for medical reasons or because they’re “not quite male” have rejected their assigned gender as adults, and attributed the depression he had suffered in his early 20s, prior to having a routine chromosome test which revealed he had XY (male) chromosomes, to being raised in the wrong sex.

This isn’t the only well-known case of someone being reassigned female as an infant and rejecting this imposition as an adult. The best-known case is that of David Reimer, an identical twin boy whose penis was injured during circumcision at seven months and, on the opinion of John Money, was reassigned female at 22 months. Money went on to publish papers about his so-called “John/Joan case” and claim that it had been a success. In fact, Reimer had rejected his reassignment from the outset, fighting when put in girls’ clothes, and despite being brought up to all appearances as a girl, was never happy with it. When an exasperated Money asked Reimer as a teenager, “don’t you want to be a girl?”, he responded “no!”; Reimer then stopped seeing Money and had operations and hormone treatments to reverse the feminisation process. He later married, but killed himself in 2004, two days after his wife told him she wanted to separate.

In Joel/Joella Holliday’s case, his rejection of his reassigned gender took more than 20 years. The obvious difference is that he was only a year old rather than nearly two, by which time David (then Bruce) Reimer had had a chance to develop a male identity. There was no twin brother and none of the enforced sex ‘play’ that Money put Reimer and his twin brother through. His case was never intended to test a theory about gender; it was accepted that raising him as a girl was best for him as, whatever his chromosomes, he did not have the equipment to be male and that, quite apart from making finding a partner next to impossible, he would face almost certain persecution at school as a teenager. But there are other parallels. In all his media appearances as Joella, he was portrayed as an active but girly girl, in one documentary that was screened in 1998 hanging out with girl friends and going to the hairdresser’s as a social occasion. In fact, Joella had no real friends at school; the girl ‘friend’ was not a friend and just wanted to be on TV, and Joella’s real interests were more typical of boys, like football. More recently, it was claimed in newspaper interviews that Joella wanted to marry and adopt children; in fact, as he has recorded in his book, he was never attracted to men or boys when living as a female.

The media apperances happened because her mother had been trying to get a birth certificate for Joella issued that gave her sex as female. Joella had been registered as male not because of any medical evidence either way, but because only a boy’s name had been thought of and it was not believed he would survive very long. His chromosomes would not have been a fundamental concern because XY chromosomes produced a male body in the absence of any impediment — such impediments include Androgen Insensitivity Syndrome and Swyer Syndrome among other things, and Joe Holliday’s condition, with the lack of a penis, might have been considered a similar impediment. There are thousands of people with XY chromosomes and a body which is externally, and to a lesser extent internally, female. (In the case of AIS, there are no internal female organs; in the case of Swyer, the ovaries are missing.) So, the fact that his chromosomes were XY does not mean he “was really male” or “should have been male”. He had no biological sex, in reality. His assignation as female could only have been for social purposes.

Picture of a young white man with short, brown hair, wearing a white open neck shirt and a grey waistcoat.Joe’s decision to take male hormone treatments and live as a man as an adult is his right. But I am not sure if it would have been ethical for doctors to impose a male gender on a child they knew had neither a penis nor the necessary ‘plumbing’ to make an artificial one work. It would of a certainty have caused alienation and bullying for him as a teenager, unless his parents had home-schooled him (as they did, for the same reason; but doctors could not assume they would have been able or willing to do that). And there would have been the disappointment of seeing male friends get girlfriends and, later, wives and children, while he might well have experienced none of it. If he knew the story of his medical condition, he might have ended up questioning whether he should have been male at all. I do not believe it can be said for certain that his later identity problems and depression stemmed from having been ‘wrongly’ raised a girl; if a female birth certificate had been quietly issued at a year old, and there had been no legal battle, no publicity and none of the bullying that led to her withdrawal from school, and if she had had surgery to make her continent and give her genitalia, she might have developed more of a female identity and not developed the depression she did in her teens.

American research shows that many genetic males with cloacal exstrophy that are assigned female at birth (9 out of 14 in a sample of 16; the other two were assigned male as their parents resisted assigning them female) choose a male identity later in life, often in childhood; all the children in this study had what were judged to be male-typical interests and were more likely to have male than female friends, and even one of those who retained a female identity at the end of the study indicated that she might like to be a boy. It’s worth noting that none of the people in this study were older than 20 at the time it concluded, and none of the five still living as female knew of their status at birth; Joe Holliday was in his mid-20s when he decided to live as a man. It is, of course, a small sample of people of different ages; it concludes that “clinical interventions … should be reconsidered in the light of these findings” (a larger study, in 2001, still held that “gender assignment should depend on the likelihood for reconstructing an adequate phallus”). It could be that assigning such children as female, while ensuring that there are no legal or bureaucratic impediments if they later decide to live as boys or men, is the most ethical solution until such time as it is possible to facilitate male sexual function in such individuals. It would be every bit as cruel to impose a male upbringing, and the life expectations that brings, on a child one knows will never be able to perform as a male.

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