Rethinking Gender: What Makes Us Male or Female?

Growing up in Corinth, Miss., J. T. Hayes had A legacy to attend to. His dad was a well-known race-car driver and Hayes spent much of his childhood tinkering in the family's greasy garage, learning how to design and build cars. By the age of 10, he had started racing in his own right. Eventually Hayes won more than 500 regional and national championships in go-kart, midget and sprint racing, even making it to the NASCAR Winston Cup in the early '90s. But behind the trophies and the swagger of the racing circuit, Hayes was harboring a painful secret: he had always believed he was a woman. He had feminine features and a slight frame—at 5 feet 6 and 118 pounds he was downright dainty—and had always felt, psychologically, like a girl. Only his anatomy got in the way. Since childhood he'd wrestled with what to do about it. He'd slip on "girl clothes" he hid under the mattress and try his hand with makeup. But he knew he'd find little support in his conservative hometown.

In 1991, Hayes had a moment of truth. He was driving a sprint car on a dirt track in Little Rock when the car flipped end over end. "I was trapped upside down, engine throttle stuck, fuel running all over the racetrack and me," Hayes recalls. "The accident didn't scare me, but the thought that I hadn't lived life to its full potential just ran chill bumps up and down my body." That night he vowed to complete the transition to womanhood. Hayes kept racing while he sought therapy and started hormone treatments, hiding his growing breasts under an Ace bandage and baggy T shirts.

Finally, in 1994, at 30, Hayes raced on a Saturday night in Memphis, then drove to Colorado the next day for sex-reassignment surgery, selling his prized race car to pay the tab. Hayes chose the name Terri O'Connell and began a new life as a woman who figured her racing days were over. But she had no idea what else to do. Eventually, O'Connell got a job at the mall selling women's handbags for $8 an hour. O'Connell still hopes to race again, but she knows the odds are long: "Transgendered and professional motor sports just don't go together."

To most of us, gender comes as naturally as breathing. We have no quarrel with the "M" or the "F" on our birth certificates. And, crash diets aside, we've made peace with how we want the world to see us—pants or skirt, boa or blazer, spiky heels or sneakers. But to those who consider themselves transgender, there's a disconnect between the sex they were assigned at birth and the way they see or express themselves. Though their numbers are relatively few—the most generous estimate from the National Center for Transgender Equality is between 750,000 and 3 million Americans (fewer than 1 percent)—many of them are taking their intimate struggles public for the first time. In April, L.A. Times sportswriter Mike Penner announced in his column that when he returned from vacation, he would do so as a woman, Christine Daniels. Nine states plus Washington, D.C., have enacted antidiscrimination laws that protect transgender people—and an additional three states have legislation pending, according to the Human Rights Campaign. And this month the U.S. House of Representatives passed a hate-crimes prevention bill that included "gender identity." Today's transgender Americans go far beyond the old stereotypes (think "Rocky Horror Picture Show"). They are soccer moms, ministers, teachers, politicians, even young children. Their push for tolerance and acceptance is reshaping businesses, sports, schools and families. It's also raising new questions about just what makes us male or female.

What is gender anyway? It is certainly more than the physical details of what's between our legs. History and science suggest that gender is more subtle and more complicated than anatomy. (It's separate from sexual orientation, too, which determines which sex we're attracted to.) Gender helps us organize the world into two boxes, his and hers, and gives us a way of quickly sizing up every person we see on the street. "Gender is a way of making the world secure," says feminist scholar Judith Butler, a rhetoric professor at University of California, Berkeley. Though some scholars like Butler consider gender largely a social construct, others increasingly see it as a complex interplay of biology, genes, hormones and culture.

Genesis set up the initial dichotomy: "Male and female he created them." And historically, the differences between men and women in this country were thought to be distinct. Men, fueled by testosterone, were the providers, the fighters, the strong and silent types who brought home dinner. Women, hopped up on estrogen (not to mention the mothering hormone oxytocin), were the nurturers, the communicators, the soft, emotional ones who got that dinner on the table. But as society changed, the stereotypes faded. Now even discussing gender differences can be fraught. (Just ask former Harvard president Larry Summers, who unleashed a wave of criticism when he suggested, in 2005, that women might have less natural aptitude for math and science.) Still, even the most diehard feminist would likely agree that, even apart from genitalia, we are not exactly alike. In many cases, our habits, our posture, and even cultural identifiers like the way we dress set us apart.

Now, as transgender people become more visible and challenge the old boundaries, they've given voice to another debate—whether gender comes in just two flavors. "The old categories that everybody's either biologically male or female, that there are two distinct categories and there's no overlap, that's beginning to break down," says Michael Kimmel, a sociology professor at SUNY-Stony Brook. "All of those old categories seem to be more fluid." Just the terminology can get confusing. "Transsexual" is an older term that usually refers to someone who wants to use hormones or surgery to change their sex. "Transvestites," now more politely called "cross-dressers," occasionally wear clothes of the opposite sex. "Transgender" is an umbrella term that includes anyone whose gender identity or expression differs from the sex of their birth—whether they have surgery or not.

Gender identity first becomes an issue in early childhood, as any parent who's watched a toddler lunge for a truck or a doll can tell you. That's also when some kids may become aware that their bodies and brains don't quite match up. Jona Rose, a 6-year-old kindergartner in northern California, seems like a girl in nearly every way—she wears dresses, loves pink and purple, and bestowed female names on all her stuffed animals. But Jona, who was born Jonah, also has a penis. When she was 4, her mom, Pam, offered to buy Jona a dress, and she was so excited she nearly hyperventilated. She began wearing dresses every day to preschool and no one seemed to mind. It wasn't easy at first. "We wrung our hands about this every night," says her dad, Joel. But finally he and Pam decided to let their son live as a girl. They chose a private kindergarten where Jona wouldn't have to hide the fact that he was born a boy, but could comfortably dress like a girl and even use the girls' bathroom. "She has been pretty adamant from the get-go: 'I am a girl'," says Joel.

Male or female, we all start life looking pretty much the same. Genes determine whether a particular human embryo will develop as male or female. But each individual embryo is equipped to be either one—each possesses the Mullerian ducts that become the female reproductive system as well as the Wolffian ducts that become the male one. Around eight weeks of development, through a complex genetic relay race, the X and the male's Y chromosomes kick into gear, directing the structures to become testes or ovaries. (In most cases, the unneeded extra structures simply break down.) The ovaries and the testes are soon pumping out estrogen and testosterone, bathing the developing fetus in hormones. Meanwhile, the brain begins to form, complete with receptors—wired differently in men and women—that will later determine how both estrogen and testosterone are used in the body.

After birth, the changes keep coming. In many species, male newborns experience a hormone surge that may "organize" sexual and behavioral traits, says Nirao Shah, a neuroscientist at UCSF. In rats, testosterone given in the first week of life can cause female babies to behave more like males once they reach adulthood. "These changes are thought to be irreversible," says Shah. Between 1 and 5 months, male human babies also experience a hormone surge. It's still unclear exactly what effect that surge has on the human brain, but it happens just when parents are oohing and aahing over their new arrivals.

Here's where culture comes in. Studies have shown that parents treat boys and girls very differently—breast-feeding boys longer but talking more to girls. That's going on while the baby's brain is engaged in a massive growth spurt. "The brain doubles in size in the first five years after birth, and the connectivity between the cells goes up hundreds of orders of magnitude," says Anne Fausto-Sterling, a biologist and feminist at Brown University who is currently investigating whether subtle differences in parental behavior could influence gender identity in very young children. "The brain is interacting with culture from day one."

So what's different in transgender people? Scientists don't know for certain. Though their hormone levels seem to be the same as non-trans levels, some scientists speculate that their brains react differently to the hormones, just as men's differ from women's. But that could take decades of further research to prove. One 1997 study tantalizingly suggested structural differences between male, female and transsexual brains, but it has yet to be successfully replicated. Some transgender people blame the environment, citing studies that show pollutants have disrupted reproduction in frogs and other animals. But those links are so far not proved in humans. For now, transgender issues are classified as "Gender Identity Disorder" in the psychiatric manual DSM-IV. That's controversial, too—gay-rights activists spent years campaigning to have homosexuality removed from the manual.


Gender fluidity hasn't always seemed shocking. Cross-dressing was common in ancient Greece and Rome, as well as among Native Americans and many other indigenous societies, according to Deborah Rudacille, author of "The Riddle of Gender." Court records from the Jamestown settlement in 1629 describe the case of Thomas Hall, who claimed to be both a man and a woman. Of course, what's considered masculine or feminine has long been a moving target. Our Founding Fathers wouldn't be surprised to see men today with long hair or earrings, but they might be puzzled by women in pants.

Transgender opponents have often turned to the Bible for support. Deut. 22:5 says: "The woman shall not wear that which pertaineth unto a man, neither shall a man put on a woman's garment: for all that do so are abomination unto the Lord thy God." When word leaked in February that Steve Stanton, the Largo, Fla., city manager for 14 years, was planning to transition to life as a woman, the community erupted. At a public meeting over whether Stanton should be fired, one of many critics, Ron Sanders, pastor of the Lighthouse Baptist Church, insisted that Jesus would "want him terminated." (Stanton did lose his job and this week will appear as Susan Stanton on Capitol Hill to lobby for antidiscrimination laws.) Equating gender change with homosexuality, Sanders says that "it's an abomination, which means that it's utterly disgusting."

Not all people of faith would agree. Baptist minister John Nemecek, 56, was surfing the Web one weekend in 2003, when his wife was at a baby shower. Desperate for clues to his long-suppressed feelings of femininity, he stumbled across an article about gender-identity disorder on WebMD. The suggested remedy was sex-reassignment surgery—something Nemecek soon thought he had to do. Many families can be ripped apart by such drastic changes, but Nemecek's wife of 33 years stuck by him. His employer of 15 years, Spring Arbor University, a faith-based liberal-arts college in Michigan, did not. Nemecek says the school claimed that transgenderism violated its Christian principles, and when it renewed Nemecek's contract—by then she was taking hormones and using the name Julie—it barred her from dressing as a woman on campus or even wearing earrings. Her workload and pay were cut, too, she says. She filed a discrimination claim, which was later settled through mediation. (The university declined to comment on the case.) Nemecek says she has no trouble squaring her gender change and her faith. "Actively expressing the feminine in me has helped me grow closer to God," she says.

Others have had better luck transitioning. Karen Kopriva, now 49, kept her job teaching high school in Lake Forest, Ill., when she shaved her beard and made the switch from Ken. When Mark Stumpp, a vice president at Prudential Financial, returned to work as Margaret in 2002, she sent a memo to her colleagues (subject: Me) explaining the change. "We all joked about wearing panty hose and whether 'my condition' was contagious," she says. But "when the dust settled, everyone got back to work." Companies like IBM and Kodak now cover trans-related medical care. And 125 Fortune 500 companies now protect transgender employees from job discrimination, up from three in 2000. Discrimination may not be the worst worry for transgender people: they are also at high risk of violence and hate crimes.


Perhaps no field has wrestled more with the issue of gender than sports. There have long been accusations about male athletes' trying to pass as women, or women's taking testosterone to gain a competitive edge. In the 1960s, would-be female Olympians were required to undergo gender-screening tests. Essentially, that meant baring all before a panel of doctors who could verify that an athlete had girl parts. That method was soon scrapped in favor of a genetic test. But that quickly led to confusion over a handful of genetic disorders that give typical-looking women chromosomes other than the usual XX. Finally, the International Olympic Committee ditched mandatory lab-based screening, too. "We found there is no scientifically sound lab-based technique that can differentiate between man and woman," says Arne Ljungqvist, chair of the IOC's medical commission.

The IOC recently waded into controversy again: in 2004 it issued regulations allowing transsexual athletes to compete in the Olympics if they've had sex-reassignment surgery and have taken hormones for two years. After convening a panel of experts, the IOC decided that the surgery and hormones would compensate for any hormonal or muscular advantage a male-to-female transsexual would have. (Female-to-male athletes would be allowed to take testosterone, but only at levels that wouldn't give them a boost.) So far, Ljungqvist doesn't know of any transsexual athletes who've competed. Ironically, Renee Richards, who won a lawsuit in 1977 for the right to play tennis as a woman after her own sex-reassignment surgery, questions the fairness of the IOC rule. She thinks decisions should be made on a case-by-case basis.

Richards and other pioneers reflect the huge cultural shift over a generation of gender change. Now 70, Richards rejects the term transgender along with all the fluidity it conveys. "God didn't put us on this earth to have gender diversity," she says. "I don't like the kids that are experimenting. I didn't want to be something in between. I didn't want to be trans anything. I wanted to be a man or a woman."

But more young people are embracing something we would traditionally consider in between. Because of the expense, invasiveness and mixed results (especially for women becoming men), only 1,000 to 2,000 Americans each year get sex-reassignment surgery—a number that's on the rise, says Mara Keisling of the National Center for Transgender Equality. Mykell Miller, a Northwestern University student born female who now considers himself male, hides his breasts under a special compression vest. Though he one day wants to take hormones and get a mastectomy, he can't yet afford it. But that doesn't affect his self-image. "I challenge the idea that all men were born with male bodies," he says. "I don't go out of my way to be the biggest, strongest guy."

Nowhere is the issue more pressing at the moment than a place that helped give rise to feminist movement a generation ago: Smith College in Northampton, Mass. Though Smith was one of the original Seven Sisters women's colleges, its students have now taken to calling it a "mostly women's college," in part because of a growing number of "transmen" who decide to become male after they've enrolled. In 2004, students voted to remove pronouns from the student government constitution as a gesture to transgender students who no longer identified with "she" or "her." (Smith is also one of 70 schools that have antidiscrimination policies protecting transgender students.) For now, anyone who is enrolled at Smith may graduate, but in order to be admitted in the first place, you must have been born a female. Tobias Davis, class of '03, entered Smith as a woman, but graduated as a "transman." When he first told friends over dinner, "I think I might be a boy," they were instantly behind him, saying "Great! Have you picked a name yet?" Davis passed as male for his junior year abroad in Italy even without taking hormones; he had a mastectomy last fall. Now 25, Davis works at Smith and writes plays about the transgender experience. (His work "The Naked I: Monologues From Beyond the Binary" is a trans take on "The Vagina Monologues.")

As kids at ever-younger ages grapple with issues of gender variance, doctors, psychologists and parents are weighing how to balance immediate desires and long-term ones. Like Jona Rose, many kids begin questioning gender as toddlers, identifying with the other gender's toys and clothes. Five times as many boys as girls say their gender doesn't match their biological sex, says Dr. Edgardo Menvielle, a psychiatrist who heads a gender-variance outreach program at Children's National Medical Center. (Perhaps that's because it's easier for girls to blend in as tomboys.) Many of these children eventually move on and accept their biological sex, says Menvielle, often when they're exposed to a disapproving larger world or when they're influenced by the hormone surges of puberty. Only about 15 percent continue to show signs of gender-identity problems into adulthood, says Ken Zucker, who heads the Gender Identity Service at the Centre for Addiction and Mental Health in Toronto.

In the past, doctors often advised parents to direct their kids into more gender-appropriate clothing and behavior. Zucker still tells parents of unhappy boys to try more-neutral activities—say chess club instead of football. But now the thinking is that kids should lead the way. If a child persists in wanting to be the other gender, doctors may prescribe hormone "blockers" to keep puberty at bay. (Blockers have no permanent effects.) But they're also increasingly willing to take more lasting steps: Isaak Brown (who started life as Liza) began taking male hormones at 16; at 17 he had a mastectomy.

For parents like Colleen Vincente, 44, following a child's lead seems only natural. Her second child, M. (Vincente asked to use an initial to protect the child's privacy), was born female. But as soon as she could talk, she insisted on wearing boy's clothes. Though M. had plenty of dolls, she gravitated toward "the boy things" and soon wanted to shave off all her hair. "We went along with that," says Vincente. "We figured it was a phase." One day, when she was 2½, M. overheard her parents talking about her using female pronouns. "He said, 'No—I'm a him. You need to call me him'," Vincente recalls. "We were shocked." In his California preschool, M. continued to insist he was a boy and decided to change his name. Vincente and her husband, John, consulted a therapist, who confirmed their instincts to let M. guide them. Now 9, M. lives as a boy and most people have no idea he was born otherwise. "The most important thing is to realize this is who your child is," Vincente says. That's a big step for a family, but could be an even bigger one for the rest of the world.